-- Will the system care for us when we are sick and help prevent illness when we are well?

-- Will we have access to medical care without risking financial ruin?

-- Will we be able to find a doctor easily without encountering excessive red tape?

-- Will health spending be managed wisely?

Health care reformers owe us a system that addresses these questions. But what is emerging in the debate is the idea that a government-sponsored single-payer system is antithetical to "American values." Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, declared it to be so when he said that a public-private hybrid system is essential because it is a uniquely American solution.

The claim that American values dictate health care reform anchored in the private insurance industry is an excuse that has remained unexamined. In an article in the July 30 issue of the New England Journal of Medicine, Dr. Allan S. Brett of the University of South Carolina dissects this premise and argues that it is used as a trump card to stop discussion of a government-sponsored single-payer system in its tracks. Americans have been misled, he adds, by the rhetoric about choice. Unlike a single-payer option, a system with multiple insurers would continue to restrict one dimension of choice - selection of physicians - and perpetuate wasteful spending on administrative overhead. His views should be required reading by everyone interested in the subject.

Despite Baucus' assertion, there is no such thing as American values regarding health care. Ethnically, culturally, politically and socioeconomically, we are increasingly diverse, and it is ridiculous to suggest that we all hold similar ideas that translate into a preference for private insurance.

But freedom of choice is indeed the relevant issue. For most of us, it implies choice of doctor, hospital or clinic. For such a choice, a single-payer system beats the competition hands-down, while incremental reforms to preserve the private insurance industry would perpetuate the restricted choice of health providers Americans already encounter. Private plans typically limit access to certain doctors and treatments. A single-payer system would eliminate those restrictions.

I believe that health care reformers, including the president, owe us a system that best addresses what we need. In surveys during the past decade, more than 60 percent of respondents have favored government-guaranteed health care for all. It would be a far better system because administrative costs would be consistently lower than in private-based systems, where more of the budget, from 10 to 40 percent, goes to pay for administration.

Baucus seems to have abandoned the idea of a public plan that would provide an alternative to the rapacious private insurers and is pursuing a hybrid public-private solution that would be "uniquely American," all right, but would preserve the status quo solution that led to our unwieldy, costly and broken system we have today. Real reform seems to be dead for now and for many years to come because our leaders have squandered the opportunity to come up with the right plan when the time was ripe. This includes President Obama, who delegated the job to Congress, which put the legislation in the hands of lobbyists.

Spyros Andreopoulos is director emeritus of communication and public affairs at the Stanford Medical Center. Contact us at forum@sfchronicle.com.

This article appeared on page E - 3 of the San Francisco Chronicle