Imagine if the first people infected in a smallpox attack had no health insurance and delayed seeking care for their flu-like symptoms.

The odds are high: Pick a number from one to six. Would you bet your life on a roll of the dice? Would you play Russian Roulette with one bullet in a six-chamber gun?

One in six Americans under age 65 has no health insurance. The uninsured are more likely to delay seeking medical care, go to work sick for fear of losing their jobs, seek care at overcrowded emergency rooms and clinics, and be poorly diagnosed and treated.

The longer smallpox – or another contagious disease – goes undiagnosed, the more it will spread, with the insured and uninsured infecting each other.

Health care is literally a matter of life and death. Yet, more than 41 million Americans have no health insurance of any kind, public or private. The uninsured rate was 14.6 percent in 2001 – up 13 percent since 1987. The rate is on the rise with increased health care costs, unemployment, and cutbacks in Medicaid and the State Children’s Health Insurance Program (SCHIP).

One in four people with household incomes less than $25,000 is uninsured. One in six full-time workers is uninsured, including half the full-time workers with incomes below the official poverty line.

The share of workers covered by employment health plans drops from 81 percent in the top fifth of wage earners to 68 percent in the middle fifth to 33 percent in the lowest fifth, according to the Economic Policy Institute.

As reports by the American College of Physicians, Kaiser Family Foundation and many others have shown, lack of health insurance is associated with lack of preventive care and substandard treatment inside and outside the hospital. The uninsured are at much higher risk for chronic disease and disability, and have a 25 percent greater chance of dying (adjusting for physical, economic and behavioral factors).

To make matters worse, a health crisis is often an economic crisis. “Medical bills are a factor in nearly half of all personal bankruptcy filings,” reports the National Academy of Sciences Institute of Medicine.

The United States is No. 1 in health care spending per capita, but No. 34 – tied with Malaysia – when it comes to child mortality rates under age five.

The United States is No. 1 in health care spending, but the only major industrialized nation not to provide some form of universal coverage.

We squander billions of dollars in the red tape of myriad health care eligibility regulations, forms and procedures, and second-guessing of doctors by insurance gatekeepers trained in cost cutting, not medicine. Americans go to Canada for cheaper prices on prescription drugs made by U.S. pharmaceutical companies with U.S. taxpayer subsidies.

While millions go without health care, top health company executives rake in the dough. A report by Families USA found that the highest-paid health plan executives in ten companies received average compensation of $11.7 million in 2000, not counting unexercised stock options worth tens of millions more.

The saying, “An ounce of prevention is worth a pound of cure,” couldn’t be truer when it comes to health care. Yet, we provide universal coverage for seniors through Medicare, but not for children. We have economic disincentives for timely diagnosis and treatment of diseases.

Universal health care is a humane and cost-effective solution to the growing health care crisis. Universal coverage won’t come easy, but neither did Social Security or Medicare, which now serves one in seven Americans. Many proposals for universal health care build on the foundation of “Medicare for All,” albeit an improved Medicare adequately serving seniors and younger people alike.

Health care is as essential to equal opportunity as public education and as essential to public safety as police and fire protection. If your neighbor’s house were burning, would you want 911 operators to ask for their fire insurance card number before sending – or not sending – fire trucks?

Health care ranked second behind terrorism and national security as the most critical issue for the nation in the 2002 Health Confidence Survey, released by the Employee Benefit Research Institute.

The government thinks the smallpox threat is serious enough to start inoculating military and medical personnel with a highly risky vaccine. It’s time to stop delaying universal health care, which will save lives every day while boosting our readiness for any bioterror attack.

Holly Sklar is coauthor of “Raise the Floor: Wages and Policies That Work for All Of Us” (www.raisethefloor.org). She can be reached at hsklar@aol.com