President Bush, meet Lorraine.

• Author: Ehrenreich, Barbara
• Position: Flip Side - Health policy

Here's the news that rocked my little world this month: We got a message that a family friend, let's call her Lorraine, who was in an ICU, barely able to breathe on her own. In the last few weeks, there'd been some mumblings about "not feeling a hundred percent," but no hint of anything seriously wrong. The diagnosis came back in a couple of days: fourth-stage breast cancer, which has spread in a number of other organs, including her lungs. If you know anything at all about breast cancer "staging," you know there is no fifth stage.

Lorraine has no health insurance. We didn't know that. In fact, we'd been content to believe that her consulting business was going as well as she said it was. In her late forties now, she's a former accountant who never could find another decent job--also a news junkie, an avid reader, and an energetic volunteer in a number of worthy causes. But it turns out she's been struggling with the cell phone bill and the rent. A few weeks ago, unbeknownst to us, she'd moved out of her apartment and into a free room offered by one of the nonprofits she volunteers for. The cost of a mammogram--well over $100--must have been out of reach.

President Bush, in his State of the Union address, said we should each have a "catastrophic" health insurance policy for the big ticket items like breast cancer, plus a tax-deductible savings account for the little things, like mammograms. If we have to take "personal responsibility" for our doctor visits arid routine care we'll be thrifty about it--or so the thinking goes--and the nation's medical expenditures will stop spiking like an Ebola fever.

It's an old idea, going back at least to the Clintons, that the problem with the American health system is that we, the consumers, just consume too much. Make us mindful of the costs by raising co-payments and other out-of-pocket costs, and we'll stop indulging in blood workups, MRIs, prostate exams, and all those other fun things.

President Bush, meet Lorraine. Her problem wasn't that she feasted on unnecessary care, but that like so many of the forty-five million uninsured Americans, she wasn't getting any care at all. Maybe, when she first noticed the lump, she should have staged a sit-in at the nearest clinic until it sprang for a free mammogram. But her idea of "personal...