On that clear, distant morning when every American has access to high-quality, affordable medical care, the nation's health care system may be the polar opposite of what it is today.

Where now, patients see doctors thanks to a moth-eaten patchwork that includes work-based coverage, government programs and charity care in emergency departments, tomorrow they may receive treatment by one, and only one, means.

It could be a Medicare-for-all system that looks like other Western nations' government-run, taxpayer-funded health plans. Could be a system of mandated self-insurance, where each person has her own health plan - purchased and maintained individually.

But if producing those reforms were akin to getting in to see your doctor, the best advice would be to get comfortable in the waiting room. Finding the perfect patch for the health-care safety net is proving as elusive as cures for many cancers.

Most health-care experts conclude, as a Boston Globe commentator recently noted, that "we are stuck with a hybrid system in which government and business share the responsibility for moving us toward universal coverage."

The important thing to remember is that stuck doesn't have to mean inert. The good news is that the national conversation on health-care reform is showing remarkable life signs.

It's even prodding some reforms in the current employer-based system. Wal-Mart has announced plans to get more of its part-timers health coverage. General Motors and its unions have a plan aimed at reducing health costs that hamstring competitiveness, a problem affecting other U.S. industries as well.

Setting a national goal of getting every retiree to enroll (deadline: May 15) in the new Medicare drug benefit would fill in yet another piece of the health-care policy puzzle.

Massachusetts is the current leader among states striving toward universal coverage. Its new directive for 2007 that, as with auto insurance, everyone should have at least catastrophic coverage is a bold experiment.

Detractors are predicting the Bay State's coverage won't be affordable, which could prompt many of its 500,000 uninsured to remain without coverage and risk paying fines and other penalties.

Guess what, though? Massachusetts' plan is already a success by one calculation. How so? Because it has raised the bar for what is possible - to take a holistic approach to health care. In a nation with 46 million citizens without health insurance, with a staggering public tab for charity care, and with runaway medical costs generally, what Massachusets is doing is a medical breakthrough of a different kind.

Want proof? Look no further than the Philadelphia-based Fortune 500 CEO now calling for a national health insurance system. GlaxoSmithKline's Jean-Pierre Garnier used a speech before other health industry executives to promote the many virtues of protecting every citizen against major medical needs.

Garnier makes a compelling case that universal coverage not only would promote better health outcomes but also produce cost savings by heading off health problems before they become dire.

The pharmaceutical giant's CEO doesn't envision a socialized medicine system, but, rather, one remaining in private hands. That's fine; it still would have the virtue of targeting tax dollars in a better way toward the overall goal.

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