CHARLOTTESVILLE, Va. — There are more than 47 million Americans without health insurance — more than the entire population of Canada or Australia. Did you know that the vast majority of the uninsured work? But unless you make $60,000 a year an individual can't afford health insurance.

Sure those who work for the federal government or large businesses and make less than $60,000 can get health insurance — but what about the rest?

Before Congress took its summer recess, both the House and the Senate passed bills to extend the State Children's Health Insurance Program. A huge step — but they're not done yet.

The so-called debate in Washington about whether passage of SCHIP in whatever form presages a government-run health system is not germane. We must have both public and private systems. It seems reasonable to expect everyone who can to contribute to the cost of health insurance to do so.

Of course, the poorest in the land will need help to pay for all their health insurance; that's what a public program does. But above a certain level, we expect people to pay; that's what a private system does.

Exactly where the border zone is between public and private is what this debate is about; wherever SCHIP ends up, it will neither be the dragon some think nor the solution claimed by others.

It simply is a step in the right direction — likely with further initiatives that individual states mount that will build on SCHIP, either with SCHIP expansion, or with private expansion — likely both. Hopefully, at some point, we will come to our senses and realize that it's time to cover everyone in a similar way throughout the country.

One of the big barriers to us getting everyone covered — and it certainly applies to many who worry that SCHIP will rule the world — is that they don't realize how unaffordable health insurance is for the low-wage earner. So just what is affordable?

In general, most experts agree that approximately 5 percent of income is reasonable to be spending on health insurance — although some might say up to 7 percent and some as low as 2 percent for the very poor.

So, let's go with 5 percent. What does health insurance cost? The current premium for an individual seeking health insurance in the individual market is about $3,000. Do the math: for his premium to be "affordable" at 5 percent of income, the individual has to make $60,000 — or approximately 600 percent of the Federal Poverty Level. For families, the math's about the same.

In the 1960s, the United States decided that we will cover the poor for health insurance. The public program created back then, Medicaid, currently covers largely children and those over 65 to about 130 percent of the FPL. SCHIP is meant to cover children up to what was, at one time, felt to be a reasonable level — perhaps 200 percent, or about $20,000 in today's money — of the FPL.

If coverage stops at that level, just understand who is being left behind: About 2 million children would not be covered — that's roughly the population of everyone in Houston. Pretty bad! But how about all uninsured adults from 19-64 who are under 600 percent of the FPL? That's about 35 million — or about the population of the entire state of California.

Unless you're disabled, blind, have kidney disease or a parent of a child on Medicaid who works less than 50 percent time, you have no federally guaranteed health insurance.

Forget it if you are an adult with no children and no coverage no matter how poor you are.

But let's get on with it — uninsured children and adults die alarmingly faster than those with insurance. We need to get to covering the uninsured now, and so SCHIP should cover as many people as possible.

Let's at least create as good a safety net as we can — but remember, there are huge holes right now, because of the expense of health insurance. So, right now many still have to ask the question, "Do I want health insurance or do I want to eat?"

Arthur Garson Jr. is the executive vice president and provost and the former dean of the School of Medicine at the University of Virginia.