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Medicine | A New Jersey clinic may be a model for a new health-care system, but is anyone in Washington paying attention?

Issue: "MS-13: Criminals next door," June 18, 2005

ZAREPHATH, N.J.-Three years ago, if you had asked Amal Gurguis whether she was worried about a crisis in health insurance, she probably would have said no. The thirty-something mother of two small children was covered under her husband's health insurance policy, which he had through his employer.

But when her husband suffered a massive coronary on her son's second birthday, Amal's life changed. She lost her husband and joined the ranks of the uninsured.

Although the particulars of Amal's story are unique, the arc of her story isn't. And whether she knows it or not, Amal has become a rope in the tug of war between those who want the United States to adopt a single-payer, Canadian-style health-care system, and those who want to give consumers more choice and responsibility for their health care. For Amal is one of "the uninsured."

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Who are the uninsured and how many are there? The numbers are plastic, bending to meet ideological needs. The U.S. Census Bureau says 44 million, and liberals like the sound of that. The Capital Research Center's David Hogberg subtracts noncitizens, those making more than $50,000 who presumably could afford insurance, and those eligible for Medicaid, and ends up with about 12 million-and that number sounds better to conservatives. The Robert Wood Johnson Foundation notes that the uninsured tend to be younger, foreign-born, and employed.

Amal's story highlights the major problem with an employer-based health-care system: When an employee loses his job or gets too sick to work, he and his family often lose their insurance. The connection between health insurance and employment emerged from a quirk in American history rather than any grand design. During World War II, Franklin Roosevelt instituted wage and price controls. Since employers could not attract workers by raising wages, they began offering health insurance coverage as a backdoor way to increase wages. When the IRS ruled that the benefits weren't taxable, they became even more popular.

Until recently employers and employees both benefited from the constant super-sizing of benefits. Insurance plans grew increasingly generous, covering more procedures until insurance came to resemble pre-paid medical care rather than protection against unforeseen risks. Insurance shielded people from the true cost of their health-care decisions. Since it didn't matter to insured people whether they went to a doctor who charged $100 or $50-their out-of-pocket expense was the same-costs spiraled and to keep up, insurance premiums increased.

Some employers dumped their insurance programs. Others adopted "managed care" policies, which tried to hold down costs by micromanaging doctors and negotiating low reimbursements for services.

Meanwhile, people like Amal found it hard to buy individual health insurance policies. Policy-makers in New Jersey, where Amal lives, have so generously defined the benefits required for a standard policy that individual insurance is beyond the reach of all but the affluent. Individuals purchased 220,000 policies in New Jersey in 1996, but only 90,000 in 2004.

Both sides of the political divide have offered ideas about how to help Amal get access to health care. Liberals want to expand Medicare to include younger retirees and have the children's health insurance program include low-income parents. Conservatives advocate using tax policy to give individuals the same power to buy insurance that large employers have (see below). Congress in 2003 allowed individuals to create Health Savings Accounts that combine high-deductible insurance policies intended to cover major medical needs with savings accounts that allow people to save pre-tax money for routine medical needs.

But while congressional Democrats and Republicans debated big-picture ways to help Amal, a pair of northern New Jersey doctors, John and Alieta Eck, actually helped heróand were positioned to do so because of a disaster.

In September 1999, while the Ecks were in a group studying the history of Christian poverty-fighting and wanting to put their faith into action by providing charity medical care, Hurricane Floyd roared up the East Coast and left a massive trail of destruction from North Carolina to New Jersey. The hurricane caused the Raritan River to crest, flooding adjacent buildings and giving the Ecks an opportunity to rent a flood-damaged building for $1 per year if they would renovate it for clinic use.

A team from Zarephath Community Church completely redid the small building, turning it into a modern clinic with two examining rooms, two bathrooms (including one that is handicapped-accessible and equipped with a shower in case the building is later used to provide housing for the handicapped), reception, and intake rooms. Volunteers included an 80-year-old man who did all the tiling in the bathrooms. Donations from doctors and businesses furnished the clinic.

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