Wall Street and the global economy may have gone off the rails, but the runaway health-care system — widely regarded back in the good ol' days a few weeks ago as the single-biggest economic threat — just keeps gaining momentum.

According to figures released today by the U.S. Census Bureau, the number of Americans without medical insurance has reached a record high. Nearly 47 million nationwide don't have coverage, including 388,000 Utahns. That's nearly 100,000 more than state agencies estimated, and 40,000 more than worst-case predictions by local advocates for the uninsured.

For government officials and health-care policy analysts, seeing an 8 percent increase over the totals the census announced eight years ago is a little like telling a homeowner with a flooded basement how deep the water is.

"It may change a sense of urgency in trying to address this problem, but it really doesn't change our focus," Rep. David Clark, R-Santa Clara and co-chairman of a special legislative task force mapping out the state's reform efforts, told the Deseret News.

"Windows of opportunity come and go," Clark said. "And right now, across this country and in this state in particular, the window is open economically and politically," he said, referring to the dual imperative of health-care costs running rampant and impending top-down health-care reforms promised as recently as Tuesday night by both candidates for U.S. president.

Unlike the larger economic turmoil and the forces trying to shape solutions, "health-care reform remains in our hands," Clark said. "Enhancing both access and quality ourselves will be a much better solution than anything that is imposed. And becoming part of that effort at this stage is as open to the single mom who can't find coverage to the business owner trying to cover employees in the face of double-digit insurance premiums."

At least 20 states nationwide have health-care reform projects under way, and some are pointing out the latest census report is based on data that were gathered two years ago and thereby don't reflect recent efforts to expand insurance, which could actually lower the tally.

In Utah, for example, lawmakers the past two years have increased funding for and removed the enrollment cap on the state/federal Children's Health Insurance Plan that provides medical insurance to kids in working families who don't have medical benefits through the workplace.

The figures also could be worse, given the fact that employer-provided medical plans have rapidly declined nationwide, and Utah is leading the way.

A year ago next month, the Economic Policy Institute, a nonprofit, nonpartisan economic think tank, reported that the portion of Utah workers younger than 65 covered by an employer-based insurance plan dropped 8.9 percent between 2000 and 2006, the biggest drop in the nation.

Dollar figures in the trillions needed from taxpayers to bail out the stalled-out U.S. economy are staggering but less than the $2.2 trillion Americans pay in health-care costs each year.

Institute economist Jacob Hacker said a portion of what's spent for the world's most expensive health-care system does in fact buy some excellent medical care. What it mostly goes for, however, is "a medical industrial complex that is enormously wasteful, ill-targeted, inefficient, unfair and falling apart."

According to the state Department of Health, comprehensive health insurance premiums in Utah have risen nearly 70 percent since 1999, or about 9 percent each year. The number of Utahns who have coverage has declined 13 percent since then.

The census survey covers all states and counties across gender, age and income as well as race and ethnic origin.

"In any case, this is the most extensive look ever at county-level demographic characteristics of people with and without health insurance coverage," said Lynn Blewett, director of the Census Bureau's State Health Access Data Assistance Center in Minneapolis.

"Despite some minor data shortcomings, this provides unprecedented information on how health insurance coverage varies county to county and state to state."

The data show that in Utah, Daggett County has the highest proportion of uninsured — 27 percent; while Carbon County has the lowest — 12 percent. Along the Wasatch Front, the percent of uninsured range from a low of 13 percent in Davis County to a high of 18 percent in Utah County, with Salt Lake and Weber counties falling somewhere in between.

E-mail: jthalman@desnews.com