A HOUSE subcommittee held hearings this week to remind us that one of the many costs of a severe recession is that it leaves millions of Americans unable to pay for needed medical care. This is not, of course, the first time an economic downturn has drawn attention to the fact that the American health-care system, for all its many triumphs and its huge cost, leaves many people without access to even the most basic types of care. But the losses are especially large in this recession because unemployment has been longer in duration and because it has hit far more heavily on family breadwinners than is generally the case.

Some who have lost jobs are fortunate to have a second worker in the family with health insurance coverage. Most, however, do not. For certain of these people, Medicaid can provide last-ditch coverage for very expensive illnesses. But no state provides Medicaid coverage for an adult who doesn't have children and is neither aged nor permanently disabled. In many states, even families with children can't qualify if the father is present in the home. And even if a family meets these requirements it must "spend down" both its income and assets to subsistence levels before Medicaid will help out with medical bills.

So inadequate is the so-called safety net, that the Congressional Budget Office estimates that job loss in the current recession has left 11 million adults and children without health insurance coverage. To this number must be added 20 million other people who don't have health coverage at all--because they work for employers who don't provide it, move frequently from job to job, work part-time or are self- employed--and the many others who have only very limited coverage. In theory these people could buy private insurance, but in fact it is often beyond their means.

The most straightforward--and, in fact, least expensive--way to fill this gap would be to have government provide either insurance or direct clinical services. But one peculiarity of the American system is that it would rather incur larger costs just as long these costs don't show up in the federal budget. Forcing employers to continue coverage to laid-off workers is another choice, but that would simply add to their costs and force more layoffs. And it wouldn't help people who were never lucky enough to hold jobs with health insurance benefits.

Nonetheless, some response--however much a patch-up job--is needed. A country that can afford to spend seemingly limitless amounts of money on high-technology interventions to preserve, improve and prolong life for a relative few, can certainly afford to assure basic medical services for everyone.