Almost every week, a new survey comes out showing once more how fundamentally worried the American people are about health care — and they are right to be worried. The basic indicators are heading in the wrong direction. Costs are going up and coverage is going down.

Since President Bush was elected, the cost of the average individual insurance plan has risen from $2,652 to $4,479, and the cost of a family plan has risen from $7,056 to $12,106, during a period that the wages of working Americans have not kept pace. More and more Americans can’t afford to buy insurance, and more and more businesses can’t afford to offer it to their employees. The result is growing numbers of Americans who have no health insurance. Nearly 47 million Americans now lack any health insurance, and millions more have only inadequate coverage.

Members of Congress don’t need to worry about their coverage. Every Member can sign up for quality health insurance the day they take office. Members also have the peace of mind of knowing they can go to the Capitol physician or Walter Reed Army Medical Center or National Naval Medical Center for needed health care. But 47 million Americans we represent don’t have that luxury.

President Bush isn’t worried about the rising number of the uninsured. He feels that Americans can go to the emergency room to get care. Try telling a mother whose child is sick with an ear infection or a cough that it’s acceptable to wait for hours in a crowded emergency room instead of having a family doctor. If Members of Congress or a Cabinet secretary would take their child or grandchild to the emergency room instead of their family doctor, let them speak up.

It can’t be said that the White House has done nothing on health care. They have. They have made it worse. When presented with an effective, reasonable, bipartisan compromise to improve children’s health care, the president vetoed it. For 10 years, the Children’s Health Insurance Program has been virtually immune to partisanship. It has been supported by governors and legislators of both parties, and by families, physicians and the millions of children it has served so well. Yet this administration picked a partisan fight over a bipartisan proposal to keep our children healthy, productive and ready to learn. The American people are demanding change. They need help with the soaring cost of health care. They need action to see that good health coverage is available and affordable — not coverage riddled with holes for major services like mental health care or genetic illness, but genuine and effective coverage they can afford.

In Massachusetts, we showed the way forward. Our state brought together business leaders, patients and health care providers, Republicans and Democrats to create a principled compromise. It was based on the strong foundation of effective and improved public programs and included a novel mechanism to make insurance more accessible and affordable. Finally, it asked all sectors of the community, including businesses, to pay their share.

We should encourage responsible state reforms, but it’s essential to have a comprehensive national solution as well. This desire to encourage state efforts must not become an excuse to shift national responsibility onto overburdened states. We didn’t do that with Medicare a generation ago, and it is one of the most successful social programs ever enacted.

In 2008, the American people will have to make a judgment on the health care they want for themselves and their families. They could vote to continue current policy. If they make do, they will see the same results they have seen over the past seven years. Massive subsidies to HMOs and other insurance companies. Laws written for the drug companies and by the drug companies. Another distressing round of expanding costs and shrinking coverage. Vouchers for health care instead of real reform.

Or they could choose another path.

I have proposed an obvious answer — extending Medicare to all Americans. Its costs are low and satisfaction with it is high. Others have proposed different ways to implement the same fundamental principle — that every American should have access to affordable, quality health care.

The people will decide whether, at its core, health care is a basic right for all, or just an expensive privilege for the few. If they believe health care is a privilege, then they should choose to continue on the current path. But if they believe it’s wrong for millions of honest, law-abiding Americans to be denied basic health care, then they must choose change.

Sen. Edward Kennedy (D-Mass.) is chairman of the Health, Education, Labor and Pensions Committee.