On health care, most U.S. politicians have it all wrong. When Democrats take over Congress next month, health care accessibility will be Topic No. 2, just below resolving the mess President Bush created in Iraq.

The Republican answer on health care -- so-called health savings accounts (HSAs) -- doesn't allow low-income people any possible way to save enough money for cancer treatment or other catastrophic illness. A Government Accountability Office report to Congress this January on the government's experimental rollout of those plans for federal workers showed those who elected to go the HSA route were younger and earned more money than the general population.

Democrats, still reeling from the foray by Sen. Hillary Clinton, D-N.Y., into nationalized health care when she was first lady, are smart enough to know voters oppose it. Why? Middle-class Americans who work hard to pay for health insurance know we can barely afford it for ourselves and our families. If it's offered for free or if the government subsidizes health care for low-income Americans, we know who'll bear the cost. And they feel they should not be saddled with that burden.

Instead, as they take control of Congress, Democrats are pursuing a variety of options. As long as they steer clear of repeating Hillary Clinton's health care debacle, they're acting wisely. But if they try to disguise nationalized health care using the cover of Medicaid expansion or coverage of uninsured children, they risk the voters' wrath once more.

Setting up a federal program to negotiate prescription drug costs on a national basis, however, is a smart idea. It costs taxpayers little or nothing and it produces huge savings. Polls show seniors approve overwhelmingly of the Medicare Part D drug program (those who have the smarts to sort through its myriad plan offerings). Private insurers have used the clout that plan provides them to negotiate savings making the program far less costly than expected.

My father died of multiple myeloma earlier this year. Two years ago, I interviewed a senior executive of one of the major U.S. drug manufacturers. I asked him why The Wall Street Journal had reported a 50-milligram tablet of Thalidomide cost my father roughly $29 (he was paying about $1,000 per month for his life-saving prescription) while the Brazilian health care system was purchasing 100-milligram capsules for 7 cents apiece.

His answer was twofold. First, he said, somebody has to pay for the research and since U.S. consumers are the richest in the world we get socked harder. Second, he said drug companies negotiate prices with almost every government in the world except for the U.S. It struck me as just this side of insane that our government does not mandate similar negotiations.

There are two reasons why most politicians get it wrong on health care. First, health care is not a birthright; it's a service much like groceries, rent, electricity and water -- none of which we can live without.

The best way to give all Americans access to health care is to educate them. So education is the solution to universal health care access, not government subsidized health care. The second point is that even many low-income uninsured Americans could afford catastrophic insurance for themselves and their families. According to the Web site simplecare.com: "In 2004, minimum health insurance for a family cost around $9,000/year. Catastrophic health insurance cost(s) around $3,000/year."

It'd be tough, but affordable.

Census data for 2005 show there were about 45 million Americans lacking health coverage. Only 15 million of them live in households with annual incomes of $25,000 or less. If the government were to spend $3,000 on catastrophic care for those families, that right there would solve the true health care crisis in the U.S., and economically so.

Another 15 million Americans without health insurance live in households earning $50,000 or more annually. We must reach a national consensus that families earning $25,000 or more can spend $3,000 on catastrophic health insurance. If they don't choose to buy it for themselves, middle-class taxpayers should not be forced to buy it for them.

I know a single 40-something man earning more than $30,000 who recently had a heart attack but didn't have health insurance. He could have afforded it. He chose not to buy it. Such irresponsibility should not be subsidized by others. When politicians come to understand that, they will "get it" on health care.

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