Bob Herbert points out that 2007 isn’t beginning very well for the exiled people of New Orleans, and Paul Krugman realizes that the American health care system is a disgrace. Happy New Year, and let’s make sure Congress rolls up its collective sleeves and gets off its collective butt and gets to work.

First up, Mr. Herbert:

I’ve heard the concern expressed dozens of times by New Orleans residents who are poor and black and still living in enforced exile from their wounded city: Maybe they don’t want us back.

You hear it again and again and again, the tone of voice varying from sadness to anger to resignation, but always laced with the unmistakable pain of feeling unwelcome in one’s own home. I’ve come to think of it as the New Orleans lament.

“They are not trying to bring us home,” said Geraldine Craig, who is living in a federally sponsored trailer encampment in Baton Rouge. “Just the opposite. They’re telling us to find housing here.”

“It hurts,” said Mimi Adams, a woman who wore out her welcome with relatives in Houston and Atlanta but has no idea when she might return to New Orleans. “Even if I could find a place, the rents are too high,” she said. “They’ve gone up a lot. I’m told they don’t want us poor folks back, that they’re making it a city for the well-to-do. That’s what I’m hearing.”

Sixteen months have passed since the apocalyptic flood that followed Hurricane Katrina. More than 13,000 residents who were displaced by the storm are still living in trailers provided by the Federal Emergency Management Agency. Another 100,000 to 200,000 evacuees — most of whom want to return home — are scattered throughout the United States.

The undeniable neglect of this population fuels the suspicion among the poor and the black, who constitute a majority of the evacuees, that the city is being handed over to the well-to-do and the white.

If you talk to public officials, you will hear about billions of dollars in aid being funneled through this program or that. The maze of bureaucratic initiatives is dizzying. But when you talk to the people most in need of help — the poor, the elderly, the disabled, the children — you will find in most cases that the help is not reaching them. There is no massive effort, no master plan, to bring back the people who were driven from the city and left destitute by Katrina.

Only the federal government could finance such an effort. Neither the city of New Orleans nor the state of Louisiana has anywhere near the kind of money that would be required. “You’ve got a lot of people who don’t have a place to stay,” Gov. Kathleen Blanco told me in an interview on Friday, “and they’re spread all over creation.”

The federal government has not come close to meeting the challenge of this overwhelming humanitarian crisis. Instead of a concerted, creative effort to develop housing and organize the return to New Orleans of the poor and working-class families who were the heart and soul of the city, the government focused to a large extent on rolling out travel trailers to temporarily house an embarrassingly small percentage of the people in need.

“FEMA spent a lot on trailers,” said Governor Blanco, “trailers that are falling apart right now. And they spent as much money on those trailers in many cases as you would on putting a new house in place.”

The simple fact is that no one at any level of government, city, state or federal, has shown the leadership that was needed in response to this astounding tragedy. I tried to talk about this last week with the mayor of New Orleans, C. Ray Nagin, but he and his chief press aide were on vacation.

The most candid official I spoke with was Raymond Jetson, the chief executive of the Louisiana Family Recovery Corps, an independent, nonprofit group set up by the state in the wake of the storm.

“The most daunting aspect of the recovery is the human recovery,” he said, “and at this point it has certainly not received the resources or the attention that it needs.”

What was readily apparent in the aftermath of the botched rescue was the damage to the levees, the ruined homes and the city’s devastated infrastructure. “I don’t think,” said Mr. Jetson, “that the reality of what was happening in the lives of people and families was as apparent.”

The situation remains desperate for thousands of displaced residents. “Working families are finding it difficult to re-establish their households,” Mr. Jetson said. “People who are out of state want to come back home. The clock is ticking on the people who are living in the FEMA trailer communities. You have some people who are totally isolated from resources. And the emotional well-being of a significant number of people and families is literally in peril.”

This is how the new year is starting out for the victims of the great flood of 2005.

Next up, Paul Krugman states the obvious about the American health care system, that it’s a disgrace.

The U.S. health care system is a scandal and a disgrace. But maybe, just maybe, 2007 will be the year we start the move toward universal coverage.

In 2005, almost 47 million Americans — including more than 8 million children — were uninsured, and many more had inadequate insurance.

Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, “remain uninsured as a matter of choice.”

And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. People have been denied insurance for reasons that range from childhood asthma to a “past bout of jock itch.”

Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the U.S. health care system.

Americans spend more on health care per person than anyone else — almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?

Part of the answer is that our fragmented system has much higher administrative costs than the straightforward government insurance systems prevalent in the rest of the advanced world. As Anna Bernasek pointed out in yesterday’s New York Times, besides the overhead of private insurance companies, “there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.”

In addition, insurers often refuse to pay for preventive care, even though such care saves a lot of money in the long run, because those long-run savings won’t necessarily redound to their benefit. And the fragmentation of the American system explains why we lag far behind other nations in the use of electronic medical records, which both reduce costs and save lives by preventing many medical errors.

The truth is that we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.

If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.

Such a system would leave people with the right to choose their own doctors, and with other choices as well: Medicare currently lets people apply their benefits to H.M.O.’s run by private insurance companies, and there’s no reason why similar options shouldn’t be available in a system of Medicare for all. But everyone would be in the system, one way or another.

Can we get there from here? Health care reform is in the air. Democrats in Congress are talking about providing health insurance to all children. John Edwards began his presidential campaign with a call for universal health care.

And there’s real action at the state level. Inspired by the Massachusetts plan to cover all its uninsured residents, politicians in other states are talking about adopting similar plans. Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the nation as a whole.

But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.

But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.

Now we have another chance for fundamental health care reform. Let’s not blow that chance with a preemptive surrender to the special interests.