Our health-care system is so enmeshed in the economy that expenses and revenues are measured with the same intense anxiety I feel when monitoring a diseased patient's failing vital signs. With economists predicting that four million more people are likely to lose their jobs and health coverage in 2009, I shudder for the hard times ahead.

Something encouraging, however, is encased in the bad news: Our political leaders are finally connecting the dots between health care and the economy. The implications for serious health-care reform are enormous.

Previous attempts to fix our ailing health-care system failed partly because we felt no serious economic pain. We were so accustomed to health care's costly inadequacy that we convinced ourselves it was normal.

Sure, the evidence was strong that America's health care was unfair, unsafe and unreliable. But absent the pain, the only people who cared about reform were the reformers, and even they couldn't agree on what to do first. It's hard to lead a revolution when no one is following.

But with the economy collapsing and the artificial anesthesia of past good times wearing off, health care's economic pain affects everyone. Workers lose jobs and health insurance, putting whole families at risk. Uninsured or underinsured workers are less productive and more likely to miss work. Businesses suffer.

At the same time, uneven, wasteful and defective care rob the system of dollars and services. It's a cycle as vicious as a drug-resistant virus.

This is nothing new. What is new is that policymakers acknowledge the peril to the nation's stability and health.

The Congressional Budget Office, which is known for its caution, boldly reports that "the rising costs of health care and health insurance pose a serious threat to the future fiscal condition of the United States." In essence, we're all in this together.

Where I work, we see the burden falling across every economic aspect of American life:

Last year, nearly one of every five Americans had trouble paying medical bills. A quarter of cancer patients or their families reportedly use up all or most of their savings to pay for treatment.

Businesses are taking a big hit, and some show signs of buckling. The cost of covering employees has nearly doubled since 2000, contributing to the near-collapse of the Big Three automakers. Fewer than half of the smallest businesses now offer health benefits. For employees of those that do, family premiums are up 78 percent, while real wages have risen only 2 percent.

As tax revenues slump and the newly unemployed swell government health programs, more than 40 states are struggling with a combined $79 billion budget shortfall. Governors are asking the federal government for $40 billion for Medicaid alone.

Those additional unemployed workers will multiply the burden. A year from now, more than 50 million people could be without health insurance.

The political debate has focused on coverage. But health insurance for everyone is only part of the answer. Long-term recovery depends on how well we close the huge value gap between what we spend for health care and what we get. Better value means healthier results, which will lower demand and reduce spending.

We spend $2.4 trillion a year, nearly half of what the whole world spends on health care, to care for only 4.5 percent of the world's population. We spend twice as much per person on health care as any other industrialized nation.

But we deliver shockingly less. In quality, access, efficiency, infant mortality and life span, we rank last or next to last in every recent international study.

This patient is very sick. Yet, blinded by ignorance or denial, we still like to brag that American health care is the best in the world.

Unaddressed, health care's economics of insufficiency will sabotage any hope for economic recovery. President Obama is correct: The economy and health care are intertwined parts of the same emergency. We can't fix one without the other, and we need to fix both right now.

E-mail Risa Lavizzo-Mourey at oped@rwjf.org.