HEALTH-CARE spending in the United States is going up by about 10 percent a year. In 1990, such spending reached $666.2 billion. That's some $2 billion a day, or almost $3,000 a year for every person in the country. Is all this spending paying off?For people not covered by current private health-insurance plans, the answer is no. A major thrust of reform is to assure that everyone - the poor, the unemployed - have sure access to care. Another goal is to control waste. Millions are spent on services that have relatively little practical value for patients. Is a national health-insurance program, funded entirely by government, the answer? Coverage gaps would be closed, but the increased tax revenues needed to pay for the program are a political barrier. And dismantling the current private system would cause widespread job loss and organizational chaos. A better approach is to build on the present system. Government could give businesses the option of offering their employees private insurance or paying a tax that would be used to expand publicly funded coverage. As Brookings Institution scholar Henry Aaron has suggested, costs within this system could be controlled by state-based regulatory agencies created for that purpose. No change will satisfy everyone. Fraud will still have to be guarded against, and economic downturns will cause tensions. But a system capable of meeting the needs of a greater number of Americans is becoming a political certainty, as the Monitor's series on health care, ending today, points out. If effective care is the ultimate goal, funding reforms should be joined by a greater emphasis on preventive medicine and a recognition of the complexity of human health, with its blending of physical, mental, and spiritual factors. An American system of health care should be democratic as well as universal, open to methods of treatment not yet embraced by the medical mainstream.