Anyone who thinks forcing people to buy insurance as “universal health care” ought to talk to Susan Siens of Unity.

Six years ago, Siens was in a bad accident when another driver plowed his truck into hers. After surgery, $24,000 in hospital bills and ongoing medical problems, she still has substantial health insecurity.

“My husband is now a registered nurse, works for a hospital, and we have health insurance … kinda,” she says. “We now pay $2,000 a year for the privilege of having ‘health insurance’ with a huge deductible and a maximum charge of $8,000 in out-of-pocket expenses. I am scheduled to see a surgeon in March, but the costs of treatment will add to the debt we incurred for my husband’s schooling and living expenses.”

Siens was one of more than 700 who responded in the past few weeks to a California Nurses Association-National Nurses Organizing Committee ad describing the disparity of care available to Vice President Dick Cheney and members of Congress and the rest of us.

Her story should remind us that simply adding more Americans into a flawed insurance system will not solve our national health care crisis. Especially when you let insurers continue to charge as much as they want, and do nothing to stop their callous, all too routine practice of denying medical treatment or blocking access to specialists or diagnostic tests because they don’t want to spend the money.

Mandating people to buy insurance is at the center of the debate on health care between Sens. Hillary Clinton and Barack Obama – she’s for it, he’s against it – and it’s at the heart of the Massachusetts law now foundering on a sea of red ink and broken promises.

“Having” insurance is not the same as being able to use it. You’re only being mandated to purchase the premiums; they’re not mandating the insurance companies to make sure you get the care you need.

Obama has a point that the cost of insurance makes it a bad bargain for many Americans. Insurance policies now average over $12,000 per family just for the premiums, not including skyrocketing deductibles, co-pays and other costs that have made medical bills the leading cause of personal bankruptcy.

Last year, Consumer Reports identified four in 10 Americans as “underinsured.” Among those, more than half postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Additionally, over a third postponed home or car maintenance repairs due to medical bills.

Add to those numbers the onset of a recession and it’s not hard to imagine an individual mandate exacerbating financial insecurity and encouraging many families to self ration care because they can’t afford the rising co-pays and deductibles while still having to pay the premiums.

The individual mandate cheerleaders claim that if you don’t put everyone in the insurance pool, only the sick will buy health care and insurance companies will raise costs. Have any of them noticed that insurance premiums have gone up 87 percent nationally the past decade without a national individual mandate?

But individual mandates are popular with the insurance industry and those close to it. Insurers reap millions of new customers with minimal requirement to change their behavior. It further entrenches a broken system, expanding the reach of an industry that treats every dollar spent on care as a “medical loss ratio.”

It distorts the role of government, which should be to protect people, not act as an insurance agent.

It transfers the health risk and financial burden from the health care industry to individuals and families; just a crushing burden on individuals to make it on their own.

There’s only one way to achieve genuine universal health care, the approach taken by every other industrialized country with a national health care or single payer system. In the U.S. we have that opportunity with H.R. 676, a single-payer reform that would establish an expanded and improved form of Medicare for all.

Surely, families like Siens’ deserve guaranteed health care, not just more insurance.

Deborah Burger, RN, is a member of the Council of Presidents of the National Nurses Organizing Committee-California Nurses Association. Maureen Caristi, RN, is president of the Maine State Nurses Association and an NNOC-CNA board member.