PEOPLE SAY nothing is happening in Washington on healthcare. They say the only thing that has happened is that the crisis has gotten worse. They're right.

But while Washington waits, Wall Street has acted. Too many big businesses are deciding that to compete and win in the global economy, many jobs no longer will come with healthcare.

While companies such as General Motors struggle under enormous healthcare obligations, companies such as Wal-Mart are opting out of employers' traditional healthcare responsibilities. Wal-Mart currently insures fewer than half of its employees that's 800,000 workers left outside the system, some turning to Medicaid just to get healthcare at all. It's not right, but it shouldn't be a surprise. Good corporate citizens are coping with a competitive disadvantage in the global marketplace. GM pays $1,500 in healthcare costs on every vehicle it manufactures. Toyota pays only $200.

We're stuck with a 20th-century healthcare system that just doesn't work for a 21st-century economy.

The traditional employer-based healthcare system can no longer meet all our needs. Costs are too high, and businesses overseas are operating on a whole different playing field.

Healthcare for a family of four now costs more than a minimum- wage worker earns in a year. Certainly, things have gotten worse. Under this administration's watch, the number of uninsured Americans has grown by 6 million and premiums are up a whopping 73 percent.

This affects all of us. It matters if the kid down the block isn't immunized. It matters to your tax burden when simple, treatable illnesses turn into expensive emergency room visits often the only option for those without insurance. And it matters if we care about our moral obligation to others.

We need to cut healthcare costs. And we need a healthcare system that ensures quality, affordable healthcare for every American man, woman, and child.

We need big ideas and bold solutions, not more of timid Washington tinkering around the edges. If Americans can discover cures for the most devastating illnesses, we can surely find a way to make sure that all Americans benefit from those cures.

Right now the most expensive 0.4 percent of insurance claims account for 20 percent of all healthcare costs. We need to lower costs to businesses with a new federal reinsurance plan for catastrophic care those with the most serious, and expensive, illnesses. Reinsurance is a simple concept: It's insurance for insurers; a way for health plans to manage their risks and lower your costs.

Second, no child in America should lack health insurance. Leaving 11 million American children uninsured is wrong and, from the administration that brought us "No Child Left Behind," it is breathtakingly hypocritical.

Most single moms raising two kids on $36,000 a year don't qualify for any help. My Kids First plan would change that, covering all children up to three times the poverty level.

Finally, it is untenable for 35 million adults to go without insurance. We need to use every weapon in our arsenal until everyone is covered, including making the Federal Employees Health Benefits Program affordable and accessible for everyone in America with targeted tax credits for small businesses, middle-class families, and people between jobs. Members of Congress give themselves great healthcare and give taxpayers the bill if it's good enough for senators and congressmen, it should be good enough for every American who wants to choose it.

Doctors follow the motto "First do no harm." So should Washington. We don't want to reinvent the wheel on healthcare; we need to take what's already working for those of us who are lucky and make it work for the millions of Americans being passed by. And we need to improve quality and lower costs for those with coverage today.

All of this and more could be paid for by simply repealing President Bush's cripplingly expensive tax cuts for those making more than $200,000 a year.

Americans have a choice. If Congress won't fix healthcare, then Americans will fix Congress.

It's time for Washington to act to free Americans from the fear of being one healthcare bill away from financial ruin, and leave our businesses more competitive and our kids a lot healthier. It's time for a national commitment to a healthcare system that can be a reflection of our ambitions and not an accident of our history.