The number of Americans without health insurance grew by nearly 1.3 million in 2005, the sixth straight year it has increased. Nearly 46.6 million people are now uninsured, the U.S. Census Bureau reported this week. If that doesn't push health care into the center ring of the 2008 election circus, it is hard to know what will.

What this means is that about 16 percent of Americans had no health coverage in 2005. From 2000 to 2005, the number of Americans without health insurance grew by nearly 7 million.

It is now inescapably clear that a structural change is under way in how Americans pay for health care: Employers want out from under the costs, and government can't afford them, either. That change will not be eased by an improving economy, it leaves increasing numbers of working people either without access to care or impoverished by its costs.

In the absence of a national plan, these changes could sink the health care system we all depend upon. That's because the cost of caring for people without insurance is covered either by tax dollars (through Medicaid, which makes payments to hospitals based on their number of uninsured patients), or by "cost-shifting." That's a long-standing practice by hospitals of charging people with insurance slightly more than what it costs to care for them; the extra money covers care to those who can't pay.

The fewer Americans without health insurance, the smaller the cost shift; conversely, the more Americans without health insurance, the greater the cost shift. Some experts estimate that the cost shift adds $900 a year to the premiums of those with health insurance. And as premiums increase, more individuals and employers can't afford them, feeding the vicious cycle. At some point — no one knows exactly where — the cost shift becomes unsustainable and hospitals can't stay in business.

Most Americans still have access to health care, and most still get health insurance through their jobs. But that's changing rapidly. In 2000, 64 percent of Americans had employer-provided health coverage; last year, only 59.5 percent did. Demographers say the drop in employer-provided coverage accounts for most of the increase in the number of uninsured.

As always, low-income, low-skill workers and their children are the hardest hit. About one child in five living in poverty has no health insurance. About one adult in four earning less than $25,000 a year has no health insurance.

It's long past the time for Congress, employers, insurance companies, workers and health care providers to come together and hammer out a viable, long-range health care strategy for all of America — those with good benefits, those with dwindling benefits and those with none at all — that spreads risk, pools resources and contains costs. The conversation should start now, while we still have a health care system to save.

— St. Louis Post-Dispatch

The deadline for Iran to suspend its nuclear program passed Thursday with the usual bluster, threats and defiance the world has come to expect from Tehran. Iranian President Mahmoud Ahmadinejad, who has been nothing if not absolutely clear on this matter, issued another blast of red-hot rhetoric, vowing that Iran would not be bullied into surrendering its right to nuclear technology.Tehran's response is clear.The country will not suspend its nuclear program. Just the opposite. It inaugurated, with great fanfare, another nuclear facility last weekend that could someday help to build bombs made of plutonium. And it started enriching a new batch of uranium just about a week ago, according to a new report from the International Atomic Energy Agency.That's not a "maybe" from Iran. That's not a cleverly veiled diplomatic response, fishing for more incentives. That is NO, in capital letters, shouted to the world.The U.N. Security Council set an Aug. 31 deadline for Iran to halt all of its nuclear activities or face economic sanctions. That deadline has passed. Iran has refused to comply.The United States is pushing for swift economic sanctions to punish Tehran. And its European allies?After years of futile bargaining with the Iranians, after years of offering up ever sweeter incentives only to be rejected by the mullahs, after years, in short, of getting diplomatic sand kicked in their faces, they hear "no" and still think it means "maybe."The Europeans are launching yet another effort to negotiate. The European Union's foreign policy chief, Javier Solana, will meet with Iran's top negotiator sometime next week, according to U.S. Ambassador to the U.N. John Bolton.Incredible. The Europeans have spent years hoping they could find just the right recipe of incentives to sweet-talk the Iranians into suspending uranium enrichment. They have failed, time after time after time. Even when the United States joined, promising direct talks with Tehran and other incentives, the response was still the same: No.In late August, with the U.N. Security Council deadline approaching, the Iranians issued a 23-page "answer" to the last set of proposals.They tried to bluff the world, touting a "new formula" to resolve the dispute. But it was more of the same. Iran won't stop enriching uranium.Tehran has delivered its answer.And the Europeans have blinked, again.