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Over 3.2 million New Yorkers have no health coverage. The "N.Y. Health" Bill, A.3571, which I introduced in Albany, would set up a State-sponsored universal health plan for all New Yorkers -- like Medicare, but for everyone.

Eighty percent of the uninsured are in a household headed by an employed person. More and more working people have jobs that do not provide health coverage for them.

Lack of coverage means they and their children don't get the health care they need. When they do get care, their condition is worse, the care is more expensive, and the cost is a burden on their health care provider. Almost every problem in health and health care is made more serious and harder to solve because of the large and growing number of uninsured.

Those who do have health coverage have problems, too. Insurance companies and HMOs dictate health care decisions. These powerful corporations spend as little as possible on our health care, so they can hold down the premium they charge to employers and pay more dividends to their stockholders. Politicians trying to cut budgets attack Medicaid because the poor are an easy target. Hospitals and health care professionals are pressured to act more and more like arms of those corporations. The pressure from employers, insurance companies, and HMOs hits especially hard on mental health care.

We keep trying to patch the system. Managed care reforms give some hope to those who have coverage. New York's Child Health Plus program provides free or very low cost coverage to kids in low or moderate income working families that have no other coverage. We hope to use New York's tobacco settlement money to pay for a new "Family Health Plus" program to offer coverage to low-income uninsured adults. But the eligibility cut-off for these programs is very low, and they leave millions of uninsured.

As long as the system depends on the decision of employers or individual buyers, there will be unavoidable powerful downward pressure on quality and access. That downward pressure means more cutbacks, more managed care abuses, and more people with no health coverage.

We should learn from the part of our health care system that has worked best -- Medicare. Everyone contributes to the cost, and Congress has kept it a pretty good plan because all the elderly -- rich and poor, powerful and powerless -- are in the same boat.

The only way to assure quality, access and affordability of health care is a universal plan that covers all of us, with broad-based public funding.

That's what the N.Y. Health Bill would set up for New York. It would provide comprehensive health coverage -- including mental health services -- to every New York resident, with free choice of doctor and other health care providers. It would be paid for by premium payments by all employers, employees, and self-employed (similar to the way Medicare is funded), plus the funding that now pays for Medicaid, Medicare, and other programs.

The critical element is that it be truly universal. Programs that are only for the poor tend to be poor programs. But if the plan covers all of us-employer and employee, legislator and voter-then the forces that control our society's resources will see to it that it is kept working well, because it will cover them and their families.

How can we make this happen? First, we need to focus the attention of the 3.5 million uninsured New Yorkers and many more who know they could easily lose their coverage.

Next, convince hospitals, physicians, and other providers that they'll do better under a universal health plan than with the current mix of corporate coverage, Medicaid, and no coverage. In fact, a universal health plan is the only way they can survive.

Our managed care reform victories in Albany came from a coalition of consumers and providers. That coalition should come together to support universal health coverage.

We may also show some employers that the health benefit dollars they now spend could go a lot further in a universal system where all employers contribute.

This is a fight we can win and must win!