A wise Mainer said the other day: “America has the best health care system in the world -with two exceptions: It’s uneconomical and it’s unethical.”

Uneconomical because it is far too costly. Unethical because it doesn’t cover 45 million of its citizens.

Per capita U.S. health spending in the year 2000 was $4,631 – 44 percent higher than Switzerland, the second highest, according to the Organization for Economic Cooperation and Development. Canada’s figure was only $2,333. America’s health costs are an insupportable and fast mounting burden on employers and employees alike, as well as state governments.

Worse, we are not getting our money’s worth. The United States does not make the top 20 in any of the World Health Organization’s lists of countries with the highest life expectancies, the lowest infant mortality rates, and the lowest childhood mortality rates. Cuba’s statistics are better, and its per capita health cost is only $229.

What to do about this crisis? A broadly based group, the National Coalition on Health Care, has come out with a report calling for comprehensive reform. It presented four scenarios, any one of which it says would save from $320 billion to $1.1 trillion in the first 10 years while extending health care to every American within two or three years and improving quality at the same time.

The coalition is no wild-eyed group of visionaries. It comprises 90 organizations with 150 members or employees, including the AARP and the AFL-CIO, Blue Shield of California, AT&T and Verizon.

Kenneth Thorpe, the former top economist at the Department of Health and Human Services, crunched the numbers for the four suggested new systems. One would be an expansion of the present employer-financed system. A second would expand Medicare and Medicaid. A third would rely on various insurance plans. The fourth would be a universal single-payer plan something like the Canadian and British health plans.

Mr. Thorpe denied trying to make a case for the fourth scheme, but his calculations showed that it would bring the greatest savings, since it would mean closing down the present huge administrative system of billing and approving or rejecting medical procedures and hospital admittances.

He suggested that it could be financed by a 10 percent payroll tax to be paid half by employers and half by employees. He said by 10 years from now it would save employers from $120 billion to nearly $200 billion a year and households from $40 to $70 billion. He said savings would be even greater if the system was publicly financed.

Sticking with the present system, he said, would mean zooming costs and a jump in uninsured to 51 million by the end of next year.

With the status quo intolerable and an outline of a rosy future, it is clearly a time for action. Congress should check on the accuracy of this new report and, if it stands up, go forward toward a comprehensive reform. One of the four plans or some combination of them could improve coverage, save money and make the currently unsustainable Medicare program more effective for the long term.

And it is high time to forget the incorrect lesson learned from the failure of Hillary Clinton’s proposal in the 1990s. It had its faults, but the main reason for its defeat was a scare campaign by the insurance industry. It did not mean that all health care reform is doomed.

So let’s go forward.