Karen Goroncy, a home health aide in Washington, Pa., has taken care of people for 25 years but can't afford health insurance to take care of herself.
A reader has promised to buy Goroncy insurance after she was profiled this fall in The Inquirer, and she hopes to have hernia surgery in the New Year.
But short of the generosity of readers - not a good national solution - Goroncy and millions like her are awaiting the sweeping health reform now being considered by President-elect Barack Obama.
Obama's plan, which has not been formally announced, could mark the biggest change in health care in 40 years. A central goal will be to cover 50 million Americans who don't have insurance. It is conceivable that all Americans will be required by law to have health insurance.
A principal architect of Obama's reform - Tom Daschle, nominated to become secretary of the Health and Human Services Department - has written at length about creating a powerful new board that would control health-care spending much like the Federal Reserve Board influences the nation's monetary policy.
Experts say for any plan to pass, it must contain soaring medical costs.
Obama's reform will almost certainly attract criticism that it overly expands the role of government in health care. And American history is littered with failures to revamp the system - recently Hillary Clinton's effort in 1993.
Less in dispute are the inadequacies of the current system. More than 45 million Americans had no health insurance in 2007, according to the U.S. Census Bureau, and that was before the current recession.
In Pennsylvania, for example, 145,800 working adults - an all-time high - were on a waiting list for state-subsidized health insurance in December, an increase of 15,000 since November, the Insurance Department reported.
The uninsured often struggle harder for care; they face longer waits for treatment and on average die sooner than those with insurance, studies show. And in at least two examples in this series, a lack of access to care earlier has led to more expensive treatment later.
Spending on health care, 17 percent of the nation's gross domestic product in 2009, will reach 20 percent by 2017 and "poses a serious threat" to the nation's fiscal health, said a report last week by the Congressional Budget Office.
What's more, said the report, much of that spending is of questionable benefit.
