Our health care system is deteriorating. There are now 47 million people who have no health insurance, 8 million more than when President Bush took office. Millions more are underinsured. Costs are soaring. The result is not only widespread human tragedy but major economic problems. Whats more, at a time when we are not producing the numbers of doctors, nurses, and dentists needed, 56 million Americans whether or not they have insurance lack access to the most basic primary health care services. In some parts of the country life expectancy is even declining, while some 22,000 of our citizens needlessly die every year because they lack health insurance. Meanwhile, we spend twice as much per capita on health care as any other country. As a result of the greed, waste, fraud and bureaucracy in our current system, the United States now spends $2.3 trillion a year, or 16 percent of the gross domestic product, on health care. That amounts to an unsustainable $7,600 for every man, woman, and child. What do we get for all this spending? According to the World Health Organization, the United States ranks 37 in terms of health system performance and 72 in overall population health. Moreover, a recent international survey found the U.S. is dead last in terms of patient satisfaction. In the long term, we need to have the courage to take on the insurance companies, drug companies, and other powerful and well-funded special interests which make billions of dollars off of human illness. Simply stated, we need to move toward a national health care program that guarantees health care to all as a right, not a privilege. When we do that, and end the greed and profiteering in the current system, studies show that we can provide quality care for all Americans without spending a nickel more than we currently spend. While more and more Americans and health care practitioners continue to fight for the establishment of a national health care program, there are also short-term actions Congress can take that would radically improve health care opportunities for tens of millions of Americans and make the current system far more cost effective. For a relatively small amount of money, we can provide primary health care to every American in need of it through an expansion of the successful Federally Qualified Health Center program. On a budget of only $2 billion a year, this program, which has enjoyed widespread bipartisan support, now provides primary health care, dental care, mental health counseling, and low-cost prescription drugs to 17 million people through 1,100 health center organizations in every region of the country for an average cost of $125 per patient per year. The doors of these centers are open to all, including patients with Medicaid, Medicare, private insurance, or no insurance at all, with sliding-scale fees. Today, another 800 community health centers already have been approved but have not been funded because of inadequate resources. The simple and very important truth is that, if we fund these 800 already approved centers and an additional 2,900 centers over the next five years, we could provide primary health care to every American in need of it. In other words, for a total of $8.3 billion a year, we could have 4,800 centers caring for 56 million people in every medically-underserved region of the country. This upfront investment, which constitutes less than 0.5 percent of overall U.S. spending on health care, would more than pay for itself. The centers are among the most cost efficient federal programs in existence today. On average, medical expenses at health centers are 41 percent lower than in other health care settings. Most importantly, from a financial point of view, by treating people when they should be treated, we can save billions by keeping patients away from emergency rooms and expensive hospitalizations. In fact, community health centers are estimated to cut the United States health care spending by between $10 billion and $18 billion annually through reduced emergency and specialty care. Its not often that we are presented such a win-win situation a program that meets critical needs while reducing overall health care expenditures by more than it costs. Hand in hand with expanding health centers, we also must train the next generation of primary care providers needed to staff them. Already, fewer and fewer students are going into primary care professions, and this trend is only worsening at a time when we need them most. That is why a major investment in the National Health Service Corps and other health profession education programs is necessary in order to restore the supply of primary care providers. At a time when the middle class is in rapid decline, the United States must guarantee health care for all. A major expansion of the community health care program would be an important step forward in that direction. U.S. Sen. Bernie Sanders (I-Vermont), Washington, D.C.