Chyatte: Rodger, who asked that we only use his first name, has been homeless for years. He is 52-years-old and one of the 41 million Americans without health insurance. He’s been turned away many times by American health care professionals...

Rodger: You know what I think, you know what I really think? I think they just don’t give a care. If you don’t have insurance or cash money these people just don’t want to do anything for you, I mean it is just a horrible situation.

Chyatte: “These people” Rodger refers to are the entire health care system and the bureaucracy that often prevents the system from doing its job: healing the sick. Rodger has a number of health-related problems, including an aggravated gall bladder and high blood pressure. He says he can’t remember the last time he had insurance.

Rodger: If you’re homeless, you don’t have an address or a phone number...

Chyatte: But he does remember all the times doctors treated him poorly because he lacked insurance. Rodger says after one trip to a Northeast Ohio hospital, the doctor, aware that Rodger had no health insurance and couldn’t afford prescription drugs, would not provide Rodger the medication he needed.

Rodger: Hey, you’re going to tell me that hospitals don’t have medication? They have plenty of medication—it’s a hospital! They could have given me enough to get me through until I could go down to Townhall II or wherever I had to go, you know what I mean?

Chyatte: The end result? Rodger, like millions of other Americans has no health care at all, and he’s not alone in his complaints about the health care industry. It’s always been bad for the destitute, but increasingly people with jobs are also losing or choosing not to have insurance. According to the Ohio Health Department, 11% of Ohioans lack health care insurance, and that number is expected to grow with a poor economy combined with soaring medical insurance costs. Kent State University Sociologist Timothy Gallagher says America’s health system is largely a private system and employers often decide what type of coverage an employee receives.

Gallagher: When it comes to income and employment (especially), we know in this country anyway, health insurance basically is defined by one’s occupation. Primarily, we have a private sector system that is unlike any in the world.

Chyatte: Deb Klineman is the policy director for Universal Health Care Access Network or UHCAN. She says the very nature of America’s health care system is structured to create multiple disparities, but now more than ever; those elusive disparities that rarely used to affect the middle class are impacting them directly.

Klineman: The employer-based system is falling apart, primarily because health care costs are skyrocketing. The cost of health care itself, the cost of insurance, the costs of prescription drugs...it’s all going through the roof, way out-pacing inflation. So, employers are being increasingly squeezed, and find it increasingly challenging to provide their employees with health care insurance. Employees find it increasingly difficult to contribute to their insurance plans, because employers are increasingly asking for more and more from employees.

Chyatte: Gallagher says it creates a catch-22 for middle class Americans.

Gallagher: Employment status is interesting. You would think, for example, that people who are fully employed, work full-time, work 40+ hours a week would have health insurance. But, people who are poor and who are full-time workers have an uninsurance rate above 50 percent. The dilemma there is that they are working full-time in jobs that don’t offer health insurance. But what happens is this: They are making too much money and combined with their assets, that they don’t qualify for Medicaid.

Chyatte: That means of the 41 million Americans who don’t have health insurance, 20 million of them are working full-time in jobs that don’t offer health care. Klineman says this puts a strain on the whole system.

Klineman: The first gateway to getting health care is whether or not you have insurance and that has been an increasing problem not just for lower income people, but also for middle class people who traditionally did not have to worry about it.

Chyatte: Disparities in health care are not limited to occupation. That is why Bob Howard, the director of planning at Children’s Hospital in Akron, says access disparities can be a much deeper and cultural issue.

Howard: Access has to do, not just with having the insurance or having the money; it also has to do with having the trust, with feeling culturally comfortable, with otherwise being willing to avail yourself of services.

Chyatte: There are numerous studies indicating race, ethnicity, age, religion and environmental home status as common barriers to health care. Klineman says access concerns are no different in Northeast Ohio than in other areas of the country. If anything, Northeast Ohio should have better access because it has some of the top-ranking hospitals in the United States.

Klineman: If you don’t have insurance, or you are under-insured, or you have limited English speaking skills, it is a real challenge to find hospital-based care, specialty care and—in particular—primary care in Northeast Ohio.

Chyatte: Many potential solutions have been discussed within medical policy arenas; however, advocates admit President Clinton’s attempt at creating a national system was a setback. A decade later, many policy analysts believe now might be the best time to try to fix the system. A popular proposal is the single-payer model from Canada. But Gallagher says that system often gets labeled incorrectly as being something it is not.

Gallagher: The complaint that you usually hear is, “you have to wait for this, you have to wait for that.” I think that just reflects the general impatience of Americans. So, anyway, there is equitable access. Anyone who says there isn’t equitable access in Canada just doesn’t know what they are talking about. When you compare it...I mean, what is your definition of equitable access? It is equitable, in anyone’s measure. What happens is that usually these programs are labeled as “socialized.” When students discuss this in my classes, I say, “Well, what about public education? Public education is essentially a socialized institution, right? What about public highways and roads? Those are socialized institutions. I mean, why can’t we make health care work along the same lines?”

Chyatte: Rodger does not think the system will get any better and believes American politics and key players in the medical industry will not tolerate change.

Rodger: There is too much money involved. It is the insurance companies; they are the ones that are running the show. I wish we would go to a system like in Canada, or even Europe. I’ve been to Europe before; I lived in France. You could go to France and if there is something wrong with you, it doesn’t cost you one dime to go to a hospital or a doctor. I mean, it’s great. If there’s something wrong with you here, then you have to lay out on the street half dying before they will even do anything for you.

Chyatte: Policy analysts within the health care system predict the current system is unlikely to get any better until a group of middle class people feels as disenfranchised as Rodger and millions of other poor Americans.