This year presidential candidates will urge the adoption of legislation to provide universal health care, meaning care for everyone. The biggest debate will be whether to create a single payer system comparable to that of Canada and Great Britain, or a system similar to prescription drug insurance, with a choice of private sector insurance companies vying for the business and providing an element of competition.

It appears that the prescription drug approach has worked better than many thought it would. It still has the glaring omission of failing to use the leverage of the government’s purchasing power to get the lowest price for drugs. If the Secretary of Health and Human Services were given the power to negotiate the purchase of all of the drugs for the various drug plans, instead of leaving the individual insurance companies to negotiate their own deals, it might save money.

The Democrats, now in the majority in Congress, have stated that they will legislate the change needed conferring the power on the Secretary of Health and Human Services, who continues say he doesn’t need it. Another approach would be exempting, for this purpose only, insurance companies from the anti-trust laws so that they could bundle their purchases using the bulk purchasing power of the entire industry the exemption would provide. At the moment, former U.S. Sen. John Edwards is in the lead among the candidates proposing a concrete plan on covering the 47 million Americans not now covered. We are spending a fortune on providing medical care, including those not covered by insurance. But the latter are not getting the kind of medical attention we would want for ourselves. We want a doctor with the same name and face in charge of our case and not have to rely on emergency aid at a hospital emergency room when a problem arises. That kind of care at the emergency room costs lots more than regular care at a doctor’s office. In 2006, the United States spent over $1.7 trillion on health, which is 16 percent of our Gross Domestic Product.

After years of discussion, how can it be that in the Western world only the United States is without legislation that provides universal medical care, prepaid by insurance required to be purchased by employers, the self-employed and by those individuals not otherwise covered by Medicare and Medicaid. Knitting the disparate groups together covering everyone is surely doable.

We hear of a few of the 50 states which have decided they can no longer wait for the federal government to preempt the field. The three states that come to mind are Vermont, Massachusetts and California.

My candidate for President in 2008 is Hillary Rodham Clinton and her position on any one issue will not cause me to change my mind, but I am surprised that she has not preempted the field on this issue, having been so out front when she was the first lady. Yes, she was burned at the time,  but the issue has, I believe, become a paramount issue for the next election. Hillary ought to become the frontrunner on this issue because of her prior involvement with it.

I do not believe that the war in Iraq, no matter what tack it takes between now and 2008, will be the only major issue that the voters will take into consideration in determining their vote. I believe that there are enough experts out there that Hillary could ask a panel to examine all of the national health plans proposed and in existence and come up with the best one, with or without amendments. Unless and until I am convinced otherwise, I support the concept of the single payer: the U.S. government.

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According to The New York Times, “the unpaid taxes, mostly on unreported earnings … the IRS estimated was about $300 billion a year.” According to the Times, the IRS estimates that of this amount the loss is “$169 billion on unreported business income, almost all of that from sole proprietors, like painters, plumbers, dry cleaners, florists, limousine drivers and restaurant owners.” These businesses tend to be cash businesses. One doesn’t have to be a rocket scientist to figure out that cash businesses are rife with criminal acts involving income tax evasion.

I have no doubt that hiring the right minds to figure out how to find the crooks would produce an enormous recovery of revenue, providing efforts were made to send those uncovered as violators to prison. When I was Mayor of New York City, we had a plan to collect unpaid taxes and it worked to some extent. We also used an amnesty program which allowed taxpayers to avoid prison time if they voluntarily came in and filed amended income tax returns paying interest, but no penalties.

The Times reported, “Based on an analysis of audited tax returns from 2001, the IRS recently estimated that the government lost $290 billion that year as a result of underreporting and underpayment of taxes.” New York has a history of intelligent people not filing annual income tax returns. If those owing money don’t file, we are deprived of revenues that could otherwise be provided and used for vital services.

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Question for all of those who want to pull our troops out of Iraq immediately. Do you think the terrorists will seek to follow us across the sea? If they do and God forbid we sustain civilian casualties comparable to those caused in Iraq by car bombs, will you publicly accept responsibility?

Former New York City Mayor Ed Koch can be heard every Friday at 6 p.m. on Bloomberg Radio.