[Congressional Record (Bound Edition), Volume 157 (2011), Part 1]
[Extensions of Remarks]
[Pages 201-203]
[From the U.S. Government Publishing Office, www.gpo.gov]




  THE WALK FOR HEALTHCARE: HEALTHCARE STORIES FROM WEST VIRGINIA AND 
               PENNSYLVANIA COLLECTED BY OGAN GUREL, M.D.

                                 ______
                                 

                        HON. DENNIS J. KUCINICH

                                of ohio

                    in the house of representatives

                       Thursday, January 6, 2011

  Mr. KUCINICH. Mr. Speaker, I submit the following stories, collected 
by Dr. Ogan Gurel.

       ``Tom described a situation in which he was buying two 
     batteries for a scooter. Since he was paying out-of-pocket, 
     they discounted the price $30 below the price they charged 
     Medicare. `Something fishy is going on,' he said.'' Tom--
     Chester, 7/14/2009
       ``I met Sharyn at the DaVinci salon. No, I wasn't going in 
     for a pedicure, which, with the condition my feet were in 
     wouldn't have been easy anyway. Actually, she peeked out the 
     door and asked, `Are you that doctor walking from Chicago to 
     DC?' and invited me in for a glass of water. Being busy with 
     clients, there was no opportunity to get any stories. But 
     they all were supportive of the Walk. `We sure need 
     healthcare reform,' Sharyn said, as her co-workers gathered 
     about along with the clients reclining in their chairs nodded 
     in agreement.'' Sharyn--Chester, 7/14/2009
       ``Gayla told me that she and her husband have been `very 
     lucky.' They've had employer-provided insurance through 
     Verizon--`pretty good insurance,' she told me. But Frontier 
     is buying the West Virginia assets of the company, so in the 
     transition, as she put it, they have no idea what it'll mean 
     for them. This is important because her stepson has cystic 
     fibrosis (CF). At age 23 he's a real survivor. He's done well 
     but lately, from an insurance standpoint, it's gotten very 
     complicated. Based on doctor's orders, he's strictly limited 
     to very light work, at a maximum of 30 hours a week. So 
     essentially, as Gayla told me, `He's stuck with a part-time 
     employment status. Insurance on his own is not a 
     possibility,' she added. `And he can't get SSI because he 
     actually can work a little.' And while Verizon promised to 
     cover him (as part of their employer-based coverage) even 
     into adulthood, Gayla and her husband don't know if that 
     agreement will be honored by the new company. She doubts that 
     it will be. It sounds like there are so many cracks in the 
     system, I said. `Yes. It's a real problem. And it's not 
     abstract--my son's life depends on it.''' Gayla--Hagerstown, 
     7/22/2009
       ```I've got no money for insurance,' Shirley, working 
     behind the counter at Reeve's marketplace, told me. `Just 
     Medicare, pretty healthy, I'm lucky.' She told me how she 
     didn't sign up for the AARP prescription medication plan. `It 
     didn't make sense,' she said. `AARP wasn't really paying and 
     they seemed to be getting the higher priced drugs anyway.''' 
     Shirley--Hookstown, 7/14/2009
       ``As I entered Pittsburgh, Deb, working the counter at the 
     Miley's BP convenience store, told me she has no insurance. 
     She'll only go to the doctor if absolutely necessary. 
     `Basically,' she told me, `healthcare is just not 
     available.''' Deb--Pittsburgh, 7/15/2009
       ``Robin, whose smile brightened up my day after a long day 
     walking, told me the story about her girlfriend in Chicago. 
     `She was doing well, but then lost her job. She lost her 
     health insurance and last year, at age 50, was diagnosed with 
     multiple myeloma.' So how did she deal with that? `Well, she 
     had to come up with $689/month for her insurance, the 
     hospital would not provide healthcare otherwise.' As her 
     condition got even more serious, all of their mutual friends 
     and sorority sisters (Delta Sigma Phi) have been raising 
     funds and sending her money for her care. `I guess,' Robin 
     told me, `if it wasn't for us, she could be dead.' She said 
     it without ego or braggadocio but rather out of sadness (even 
     with our bright smile) that it had to be that way.'' Robin--
     Pittsburgh, 7/15/2009
       ``Rhonda returned to Pennsylvania to take care of her 
     elderly family. She's had self-pay insurance via Highmark, 
     the major insurer in the Pittsburgh market. `It's alright so 
     long as you don't get sick.' Regarding the recent debates in 
     Congress, she also added, `If you believe anything those 
     execs put out, then you're a fool.' She had a situation last 
     year of right upper-quadrant abdominal pain. She went to the 
     ER, which was an ordeal. They started the work-up, a GI 
     consult, surgical consult, ultrasound, HIDA scan were ordered 
     and was admitted for overnight observation. She told me all 
     the tests returned negative. And then, Highmark ended up 
     denying the $7,000 for the hospital stay and all the 
     radiology consults deeming that it was all medically 
     unnecessary. `There was no way for me to know they wouldn't 
     cover it.' The hospital called for pre-approval, but the 
     insurance company still had denied it. But Rhonda fought it, 
     saying either the hospital was practicing fraudulent medicine 
     or the company was wrong. `They finally backed-off and paid.' 
     Rhonda also described a story from a friend of hers who 
     worked as a dental assistant. She had attended a conference 
     on billing which the whole point of which was how to bill so 
     the insurance company could deny the claim: what diagnostic 
     categories to use, etc. The percentage of people who would 
     not fight was estimated at 70%.'' Rhonda--Pittsburgh, 7/16/
     2009
       ``As an ambulance driver, John definitely notes that, `the 
     uninsured come to us in a more severe state. They don't have 
     a family doctor and so in the ER people end up having to wait 
     more because these critically ill patients come in.' He told 
     me it was not uncommon for them to wait six months to a year 
     before seeking any medical attention.'' John--Braddock, 7/16/
     2009
       ``As an EMT, Christina's seen diabetics without medications 
     coming into the ER two to three times a week because their 
     sugar gets out of whack. They really don't have any health 
     care access otherwise.'' Christina--Braddock, 7/16/2009
       ``Zenobia has to see a doctor regularly for her 
     prescriptions. `It's really hard, because I have no 
     insurance,' she said. `And I work hard. But since I'm part-
     time, Medicaid says I'm not eligible.' But since she's 
     working only 25 hours a week, she doesn't apparently qualify 
     for insurance through her employer either. `According to 
     Medicaid, you're working,' she said. But according to her 
     employer, `You're not working.' The cracks in the system she 
     was facing, seemed, from her expression, to be more like 
     gaping chasms, with no way out. When she heard public 
     assistance was no longer available for her, she called them, 
     crying, `Why have I been dropped?' To which they answered, 
     `You make more than $200 a month.' So she makes do with a 
     hodge-podge of different programs

[[Page 202]]

     and deals. She's able to keep her medication bill down to $60 
     a month because the pharmacy has a special plan but her 
     various other medical bills have accumulated to close to 
     $6,000. `It's all a mess, all so complicated,' she told me. 
     'And if I really get hurt, I'm pretty much screwed.''' 
     Zenobia--North Braddock, 7/16/2009
       ``At the tail end of a monstrous thunderstorm, seeking some 
     shelter, even though I was soaking wet anyway, I met Mary at 
     the Wendy's just west of Greensburg. She was there with her 
     daughter and grandson. We talked about the Walk and about 
     health care reform. Mary shared with me the story of her son, 
     Jim. `He works in a plant nursery. He's got no insurance but 
     suffers from sympathetic dystrophy, you know what that is, 
     right?' Yes, I replied. `He's self-pay but basically he just 
     suffers in pain. It breaks my heart.''' Mary--Greensburg, 7/
     17/2009
       ```You can reach out for help, but if you have no health 
     insurance you're nobody.' That's how Rebecca concluded the 
     story she told me about the death of her boyfriend. It's a 
     complicated story but basically the 24-year-old was off and 
     on in a Methadone rehab program. He was doing well in rehab 
     when his treatment was about 1/2 done, his insurance ran out. 
     Because of this, `The rehab facility, kicked him out,' 
     Rebecca told me. She explained how, with withdrawal symptoms 
     kicking in, he arrived home very sick. Two days later, near-
     comatose he was taken to the hospital where he was admitted 
     to the ICU with liver failure but, according to Rebecca, 
     they, `really didn't do anything.' At the time of his death, 
     she said, with incredulity, that the staff was joking in 
     front of her, laughing even. The trauma continued, even after 
     his death. She described how the coroner came in and started 
     accusing people. `Then a doctor arrived, and asked if the 
     decedent had insurance.' Rebecca shook her head. `No, I 
     answered. And the doctor asked if I wanted to see the body. I 
     said, yes, but he told me that they had taken it away to make 
     room for the next body.' Rebecca told me it was all very 
     sarcastic and cruel. But the nightmare was not over. Then the 
     bills started arriving. They were not married but the rehab 
     center (which kicked him out) and the hospital demanded 
     payment. `They fraudulently indicated that I signed the 
     bills,' said Rebecca. `It's been two years now and they're 
     still sending bills. Between the doctor and the financial 
     games, I never had a chance to grieve over his death.' 
     Rebecca's eyes saddened as I asked her to sign for her 
     consent. `You can reach out for help, but if you have no 
     health insurance you're nobody.''' Rebecca--Greensburg, 7/17/
     2009
       ``Ryan is a young American. 24 years old, sporting an 
     unassuming t-shirt and buzz cut, he exudes a personality 
     simultaneously reserved and forthright. He has a gracious 
     smile, offered with a twist of the head but then when he 
     looks at you, with a piercing gaze, his face turns serious. 
     As a writer, he seeks to deeply understand people, yet some 
     things, like healthcare insurance, elude even his keen 
     comprehension. Brought up in a family who never had health 
     insurance, Ryan is, nevertheless, a man with energetic 
     ambitions. After an early honorable discharge from the Army--
     for medical reasons--and a fruitless search for a job, he is 
     working to finish his first novel, Ever Street Road, a 
     parable, as he calls it, for the choices in life that one 
     makes. Yet, in this great country, bursting with infinite 
     possibility, Ryan has few, if any, choices. Infinitude meets 
     finitude--this is America. The future is but an illusion. Not 
     knowing whether there will be healthcare for all or only 
     healthcare for some, Ryan and I, sharing dinner, are focused 
     on the present and the past. This is the only thing we truly 
     know. The future, a future where the young ambitions of 
     earnest, yet thwarted souls, might reach their full 
     potential, is only a dream. Reality is how I met Ryan and 
     what brought him to run up the hill to meet me on US 30 as 
     18-wheelers thundered past. Just east of North Versailles, 
     about 25 miles beyond my initial walking point, the last few 
     miles trundled on through with pain. My feet--a jumble of 
     collapsing arches, exploding blisters, and hemorrhaging nail 
     beds--were beyond rebellion. I would have ordinarily arranged 
     a pick-up to take me to the next hotel--now about eight miles 
     east--but this had not materialized. And the transport for 
     the bag--the 70 pound suitcased monstrosity--from which I 
     live, had not been arranged. And despite the physical 
     tribulations of walking nearly 24 miles a day, the most 
     challenging part of the Walk has been the logistics. Lodging, 
     pick-up (often the bunk down place is not necessarily on my 
     walking route), and bag transport had all to be arranged. If 
     any one of these elements fell through, the Walk would come 
     to a standstill. At this point, I was not worried so much 
     about that. With the sun now setting, knowing that I would 
     soon be walking in the dark--the time when sounds become more 
     important than sights--I was worried about my survival, 
     concerned about arriving at the motel--if I made it at all--
     well after midnight. At the bottom of the hill, I had stopped 
     at a McDonald's to replenish myself with water and recharge 
     my phone batteries. I slipped on my safety vest and grimly 
     headed up the hill. A young man, gasping for breath, came up 
     beside me. Cars rushed by and instinctively motioned him 
     towards the narrow shoulder. `Are . . . are you Doctor 
     Gurel?' he asked, wide-eyed, disbelieving. I was on the 
     phone, still working feverishly to arrange transport of my 
     bag. Too tired to be surprised, I smiled at him, and nodded. 
     `I was following you on Twitter and . . . and I just had to 
     come and meet you.' I hung up the phone, and out of habit 
     continued on forward, as the young man joined me. `I'm Ryan, 
     Ryan Trump,' he added. Oh yes! From Facebook! `Yes,' he said, 
     his face twisting, searching for words to describe a 
     situation for which there was no precedent. `Wow, I can't 
     believe this.' What? `That I met you here.' I chuckled. 
     `Crazy, isn't it?' Ryan and I had exchanged some e-mails 
     during the past few weeks on Facebook, and it was strange 
     indeed that an entirely electronic friendship had 
     materialized here on the not-so-isolated Lincoln Highway east 
     of Pittsburgh. And so we talked--talked with amazement about 
     the GPS tracking technology that had brought Ryan to my very 
     spot. We talked about healthcare. But I had to interrupt him. 
     Ryan, I have a problem. `What's that?' My motel is about 
     seven miles up, in Irwin. I have no pick-up to get there. 
     Could you help out? `That's the least I can do!' I smiled 
     weakly. Deliverance, in the form of Ryan Trump, shy but 
     forthright, gracious but ambitious, had arrived. I was 
     grateful for the wonders of technology and even more for the 
     grace of initiative and real, not electronic, fellowship. And 
     so, after a couple of hours of back-and-forth driving, Ryan 
     and I delivered the suitcase and myself to the motel in 
     Irwin. But that was the present. The following evening I had 
     dinner with Ryan and we talked about the past. The present 
     and the past: while this is what we know, we spoke out of 
     hope for the future. A future with healthcare for all, and 
     not just for some. A future where the imagined infinitude of 
     possibilities cross with the crushing reality of no 
     possibility. `My family has never had health insurance,' Ryan 
     told me. `My father worked in maintenance at the hospital for 
     36 years. And we never had health insurance but we could get 
     care through the hospital.' That's good, I replied. `Then the 
     hospital closed, back in 2006, and he got laid off . . . but 
     he was close to retirement anyway.' So what do you do now? 
     `It's difficult. My mom's got a heart condition, had a heart 
     attack back in 2000. You know it could always happen again. 
     She's got four types of drugs.' How do you pay for it? `It's 
     all out-of-pocket.' But you told me that you had troubles 
     with the bank. `That's just the way it goes--you pay for the 
     medications when you can.' I shook my head. And how about for 
     you? What's it like to not have insurance? Ryan, who would 
     usually look straight at me with those forthright, almost 
     aggressive eyes, glanced down. `Well, you got aches and 
     pains, but you think, do I deal with the pain or do I go to 
     the hospital and suffer accumulated debt? I'm 24 years old 
     and my credit score is probably garbage. Can't do anything in 
     life with that, you know.' I figured, listening between the 
     lines, that Ryan had, in fact, gotten some healthcare, and 
     the `accumulated debt' he had referred to was real. How's the 
     asthma? I asked. (This was the reason for the honorable, 
     medical discharge from the service.) `Oh, that's not too bad. 
     But there was this other situation.' What was that? Ryan 
     thought for a moment, then looked up. `Well, I had a lump,' 
     he said, pointing below the table. 24 year old young man, I 
     realized that he was likely referring to testicular cancer--a 
     condition made widely known by Lance Armstrong's experience, 
     and survival. Did you get it checked out? `Well, I was 
     holding off for the longest time. But it was quickly getting 
     bigger.' My heart sank, but the fact of the rapid 
     enlargement, encouragingly suggested to me that it wasn't 
     cancer. And? `So I did go to the doctor eventually.' Ryan 
     smiled and sighed. `He said it was some sort of hydrocele.' 
     Oh yes, that's good news. `They did an ultrasound . . . and, 
     of course, I got all the bills. There was no way I could pay 
     for them so I didn't even open them up.' An odd mix, a 
     contradiction even, that with the wonderful news--namely that 
     one did not have cancer--there came delivered a message of 
     debt peonage that inspired even more despair than the dreaded 
     diagnosis itself. It was almost as if the healthcare system 
     itself was the cancer.'' Ryan--Greensburg, 7/17/2009
       ``Bob has worked for the government for 44 years. He told 
     me that he's always had health insurance (BC/BS via the 
     government plan). `Why is it not possible to make that 
     available to all?' he wondered. `It's the same plan as that 
     for Congressmen and Senators.' He added that it was a big 
     pool and that `it would bring in younger people, make the 
     insurance for all more affordable.' But, he explained, `It's 
     different with corporate America. I'm retired now but I still 
     get the same coverage as those who are still employed in 
     government.''' Bob--Greensburg, 7/18/2009
       ``Terry's here in Greensburg visiting from Philadelphia. 
     She shared with me the story of her mother's untimely death, 
     which resulted, in her estimation, from a nightmarish 
     confluence of administrative barriers and inhumane insurance 
     policies. The story goes as follows. Her mother underwent a 
     liver biopsy. This was on a Friday. As Terry explained to me, 
     'She was done as an outpatient, but even though the surgeon 
     said it was complicated, with bleeders, she was not

[[Page 203]]

     permitted by her insurance to stay overnight.' She returned 
     home for the weekend. On Sunday, she went to the emergency 
     room with escalating pain but was sent home again being told 
     it was a gallbladder problem. The pain still unbearable, she 
     returned to the ER within three hours. `From what we 
     learned,' Terry said, `there was a blood clot pressing on the 
     bile duct.' She progressed rapidly downhill from there ending 
     up three-and-a-half weeks in the ICU (battling sepsis). Six 
     weeks after the biopsy she died. Terry finished the story. 
     `If only the insurance had been more flexible, had considered 
     true medical necessity, in observing my mother the first 
     night after her procedure, perhaps she would still be with us 
     now.''' Terry--Greensburg, 7/19/2009
       ```I haven't had health insurance since '92,' Ed told me, 
     when I asked him if he had any healthcare stories. `That's 
     when Bethlehem Steel closed down--so, no insurance, for me.' 
     I nodded. I can understand. I don't have insurance either. I 
     don't think Ed really heard me as he continued, `I'm glad I'm 
     healthy because if not, I'd be dead.' Ed plays quite a bit of 
     soccer (he's wearing his soccer t-shirt now) and he told me 
     of an injury he had a few years back. He got hit pretty hard 
     at a soccer game at the Y. `Got myself a gash on my head and 
     some sort of shoulder injury.' And so he went to the 
     emergency room. When he told them he lacked insurance, Ed 
     told me that the doctor basically said, `Stitch him up and 
     send him home.' Ed had an angry look on his face. `I got 27 
     stitches but they did nothing about my shoulder.' I suppose I 
     could understand his displeasure as with all that he got a 
     bill for $2,300. `I still haven't paid it, and I never will 
     be able to,' he said. Despite these distressing stories, Ed 
     was not really as sour as his tale would make him to be. We 
     talked about quite a few other topics and he wished me well 
     on my journey, closing in now, on Washington, DC.'' Ed--
     Stoystown, 7/19/2009
       ``Karl, a volunteer Ambassador at the Flight 93 Memorial, 
     told me he doesn't believe in a government-run system. 
     According to him, the free-market is the best though he 
     acknowledged that having insurance linked to employment was a 
     problem. `Empower the individual,' Karl explained to me. So 
     how about your own situation, I asked. `We're not well-to-
     do,' he said. `I get my health insurance from the state, a 
     plan called Special Care which is in between Medicaid and 
     private insurance.' And how's it going with that? `Very well 
     actually,' he answered. `It's not connected to employment 
     status so I have the freedom to change jobs without changing 
     my health coverage.' [On a side note, Karl, in his 
     presentation to the thirty some-odd gathered visitors at the 
     memorial explained how about $40 million more was needed to 
     complete the permanent Flight 93 Memorial. I recalled how 
     anti-reform industry groups were spending (as reported by the 
     Wall Street Journal) about $1.4 million a day in their 
     selfish and grasping efforts to thwart (or worse manipulate) 
     healthcare reform. That means that about a month of that 
     spending (the time it took for me to walk from Chicago to DC) 
     would cover the remaining cost of the Memorial--a tribute, as 
     most know, to Americans who gave the last full measure of 
     sacrifice for their fellow citizens.]'' Karl--Shanksville, 7/
     19/2009
       ``Kay's a part-owner of a small business--all of three 
     people. Because of the high cost of health insurance, the 
     deductibles, and all that, 'they've got no discretionary 
     income,' she told me. They're with Highmark and the premium 
     went up $100 a month within the past few months alone. Her 
     husband has had two heart surgeries (done at the Cleveland 
     Clinic). The cost was $4,000 a day but they ended up paying 
     $700. `That was a relief,' she said. `But we're lucky. We can 
     afford healthcare insurance--barely--but that leaves us with 
     no extra money.' Clearly up-to-date on various health reform 
     proposals, she added, `It would be nice if I could deduct it 
     as a tax credit. But here's the real problem,' Kay continued. 
     `If my husband--or I--couldn't work then we wouldn't be able 
     to maintain the income to pay for any insurance. How will we 
     be able to pay for health insurance when we actually need it 
     most? That's what doesn't make sense.' I was readying to 
     leave when Kay interrupted. `One more thing. I think much of 
     these premium monies are being wasted.' How so? I asked. `I 
     went to a Pirates game and they were giving out free 
     bobblehead dolls. Guess who sponsored all that?' Who? 
     `Highmark. That's where health insurance premiums go--to 
     advertising.' And so my experience came full circle as I 
     recalled the giant Highmark billboards scattered among 
     Pittsburgh's downtown when I had been there four days 
     earlier.'' Kay--Bedford, 7/20/2009
       ``I met with Eric in Jim's living room (at the home where I 
     stayed that night). Jim had invited several neighbors to stop 
     by for a discussion of healthcare reform and Eric was 
     gracious enough to share his story with me. First, he does 
     not have health insurance. He looked into it, reviewed the 
     policies from three companies and saw that there was 
     essentially no difference among them. `It was 80/20 coverage 
     and no doctors were covered,' he told me. The premiums 
     started off at $300 a month and went up to $900 a month 
     within a year. `Worse than the cable company!' And so he 
     dropped the coverage. As it turns out, Eric did have a 
     serious health issue last year--a pituitary adenoma (a form 
     of benign, but still very dangerous, brain tumor). One 
     morning he woke up nearly blind--all he could see was a tiny 
     pin-prick of light (an extreme form of a condition called 
     `tunnel vision'). He had himself taken to the emergency room. 
     To make a long story short, he was treated at UPMC. He told 
     me `Hershey refused to talk because he had no insurance.' 
     Being without insurance, he now, after all was said and done, 
     owed $160,000. He was able to make deals with the doctors but 
     the hospital, he told me, `was never cooperative--a monster 
     to deal with. And there was no negotiation.' He told me about 
     his ongoing struggles with the hospital. `And the billing was 
     so strange,' he added. As someone who checks things out 
     carefully, he told me how an MRI at UPMC cost $7,000 but the 
     same scan, on the same machine, cost $2,000 in the nearby 
     town of Altoona. `And a single Tylenol pill cost $10! It's a 
     crazy system.''' Eric--Bedford, 7/20/2009
       ``Gloria is the owner of Hollinshead grocery. She told me 
     how the grocery, a family business, has been in Harrisonville 
     for over a hundred years. Being self-employed, she hasn't had 
     health coverage for more than twenty years, ever since her 
     husband's company went out of business. `It's just too 
     expensive to get insurance being self-employed,' she told me. 
     Three years ago, her husband had a heart attack and died. She 
     explained that paying for his care, even in the midst of 
     grieving, was not easy. `A Harrisburg doctor accepted a 
     payment plan,' and she also applied for Hill-Burton funds to 
     pay for testing and other hospital costs. `Things were not 
     easy,' she added, with a touch of melancholy.'' Gloria--
     Harrisonville, 7/21/2009
       ``Mike, a customer at Hollinshead's Grocery, lost his job 
     at Caterpillar in February and is now without insurance. 
     `COBRA was much too expensive,' he said. His unemployment 
     check was $325 a week and health coverage cost over $400 a 
     month. His children, `fortunately,' he told me, are covered 
     through the state (ACCESS program). He seemed calm as he 
     explained this predicament. `My wife just got diagnosed with 
     Lyme disease, though--a tick-bite right here in our back 
     yard.' Eyes perked up among the others sitting about the 
     grocery. He told me, `We're paying cash for the lab bill.' It 
     had originally been $307 but they were able to get it 
     discounted to $187. `The doctor's bill was $80--and that's 
     just for the diagnosis,' he added. `For the actual treatment, 
     we're dependin' on free samples.''' Mike--Harrisonville, 7/
     21/2009
       ``Martin has been out-of-work since last year. `Obviously I 
     have no insurance,' he said. He has insulin-dependent 
     diabetes and gets some healthcare through the Pennsylvania 
     ACCESS card. He explained that, `If I go back to work, 
     however, I'll lose my medical care.' That's a disincentive to 
     work, I said. `Sure is . . . I need to stay under twenty 
     hours a week to get medical care. If I work more, there's no 
     job, no way I could pay for the healthcare and medicines. I 
     can't just drop the insulin.''' Martin--Harrisonville, 7/21/
     2009
       ```I would call myself a fiscal conservative,' Jim told me 
     as we sat together discussing healthcare in his living room. 
     `I believe that health savings accounts, HSAs, and patient 
     involvement in the decisions will be important to bring costs 
     under control.' He added that in his experience, once health 
     benefits are provided, it's `very difficult to backtrack.' 
     He's worked in government for 32 years and is currently 
     retired. `Personally, I think the government plan, if made 
     available to all, would work well. I think that would be easy 
     to implement. It allows choice, there's already a mechanism 
     to collect premiums and there could be some income 
     tiering.''' Jim--Bedford, 7/21/2009
       ```I think that it's possible to have a very basic plan as 
     a public good.' Jo told me she's seen examples of that and 
     she `believes it's a good use of taxpayer money.' But she 
     also realizes how it could get out-of-hand. `It all depends 
     on how and what ``basic'' is defined as,' she said. 
     `Sometimes that's too abstract.''' Jo.--Bedford, 7/21/2009

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