The health-care system has become much like an old spin-the-plates comedy act out of vaudeville. In this version, the elegantly dressed star never appears to notice that most of the plates fall, only to be caught by the frantic assistant. The incompetent star is the private and public insurance system that covers a shrinking number of Americans. The nearly exhausted assistant is Medicaid, the joint federal-state program whose costs threaten to bankrupt state governments.

Nationally, 70 percent of the 45 million Americans who lack health insurance either work full-time or are the dependents of someone who does. According to a study done by the state Department of Health and Human Services, about half of the 70,000 children enrolled in one of Medicaid's Healthy Kids insurance programs have a parent or parents who work full- or part-time for an employer that does not provide health insurance.

It costs $2,200 per year to cover each child in the Healthy Kids program. Since parents who can afford to do so pay a premium based on their income, it's not easy to say how much the state would save if the parents had employer-based coverage. But the cost to taxpayers runs into the millions -perhaps tens of millions.

The state's study found that the employer with the greatest number of workers with children on Medicaid is, as you might guess, Wal-Mart, the nation's largest employer. In New Hampshire, 487 of its 8,500 workers have children enrolled in the program.

According to the Associated Press, 22 percent of the employers with workers with children on Medicaid are in retail, one of the state's fastest growing job sectors. Health-care providers come in second at 16 percent, followed by service sector companies, 15 percent, and state and local government, 10 percent.

The availability of taxpayer-subsidized health insurance gives employers an incentive not offer it. No company has been more often accused of shifting health-care costs to taxpayers than Wal-Mart. Thanks to low wages, coverage that's more expensive than its employees can afford and long waiting periods for eligibility, this company insures fewer than half its workers. By comparison, Wal-Mart's major rival nationally, Costco - a company founded on a belief in social responsibility - insures roughly 96 percent of its employees.

For years, the drive to avoid health-care costs has led employers to hire more part-time workers, including people who work just a few hours per week short of what would qualify them as full-time. Even state and local governments have sometimes fallen to this temptation.

Most states are taking steps to rein in Medicaid costs. Nearly a dozen are trying to pass laws to force large companies to cover more of their workers, but the effectiveness of that approach is doubtful. Maryland's legislature recently passed a bill that would require very large employers - large enough that the bill affected only Wal-Mart - to spend at least 8 percent of their payroll on health care for workers. Last week, Maryland's governor vetoed the bill.

States are tightening eligibility requirements, requiring higher premiums from Medicaid recipients and taking other steps to reduce Medicaid rolls. Since it costs taxpayers far more in the long run when children do not receive adequate health care, such measures are counterproductive.

Nor, we believe, will attempts to force some but not all employers to insure their workers succeed. The competitive advantage of not providing health care is great and growing.

In the end, the health-care problem will have to be addressed not by beating up employers or encouraging a system that creates 30-hour-per-week jobs. It could be solved if businesses band together to force political leaders to put real and lasting solutions on the table for discussion.