Probably within the next five years or so we will adopt some form of universal health care in this country. This is because the so-called free market approach isn't working.

One reason, naturally, is that our system is a hybrid variety of free market at best. There is government-paid health care for the government-defined poor (Medicaid) and government-paid health care for the elderly (Medicare).For a variety of reasons health-care costs have risen so high that almost anyone but a millionaire can become medically "indigent" if they have the misfortune to have certain critical medical problems. A colleague of mine recently had an $11,000 appendectomy with no complications - an operation that used to cost $125.

The people most at risk today are the lower middle class who don't have the good fortune to work for large corporations that can afford to subsidize their health insurance. They can be wiped out financially by a gallstone. Even large corporations, however, are being squeezed by astronomical health-care costs. Those who are ideologically opposed to what they like to call socialized medicine will find fewer and fewer allies in the corporate executive suites.

It seems clear to me we ought not to waste a lot of time trying to play pin the blame on somebody and just set about fixing the problem. The goal should be a reasonable level of health care available to every citizen at a reasonable cost.

In looking for ways to reach this goal, there are some mental roadblocks we ought to clear away. One is the panacea approach. There just is no perfect solution to this problem.

The other is the free market approach. There is no way in our society at this time in our history that a true free market can be attained since that would involve Congress abolishing both Medicaid and Medicare. If you think that is going to happen, please don't waste my time. Go find some other like-minded souls who enjoy sitting in a room debating the kind of government needed for the first Martian colony.

No matter what system we devise it will have limitations. Health care will be rationed. The free market, if it existed, would ration it on the basis of ability to pay. Every government-subsidized system in the world today also rations health care based on different criteria. Every government-subsidized system in the world today, including Canada's, which is a favorite among a lot of people, is being squeezed by rising costs.

In our own country, private health insurance companies are being squeezed and are themselves rationing their policies by one device or another.

One approach we might consider would be a government-paid system of basic health care for all citizens, paid for by a health-care tax; and reserve, for private insurance, catastrophic-type health care. For example, relatively few enough people will ever need a kidney transplant, so transplant insurance ought to be financially feasible at a fairly low cost - low enough to attract people who wish to pay for peace of mind.

All of us might as well begin to think about this because the present hodge-podge system is fast approaching the line of political and social intolerance. Hardly any class of people is happy with it and if it is allowed to just drift on with patches here and there, it will collapse.

Let's try to fix this problem with a minimum of hysteria, demagoguery and ideological claptrap. In the meantime, try to stay healthy.