Ray Morehead and Jason Townsend rolled the dice on health care. Both self-employed, they chose to go without health insurance to have extra money in their pockets.
"I'm in good health in general, so I just didn't think it was worth the money," said Townsend, 25.
Neither did Morehead, 43.
Then a red spot on his abdomen proved to be a staph infection. He landed in the hospital, where he found out he had diabetes.
Now he's paying off an $11,000 hospital bill. He struggles with insulin costs of $700 a month and hasn't found affordable health insurance that will accept him with a pre-existing medical condition.
"Like an idiot, I bought shoes instead of buying insurance," he said. "Like many people, I thought I would never get sick."
Townsend, on the other hand, didn't get sick. And he now has a job with health care benefits.
Their stories end differently, but they share concerns about health care costs — as do many Americans, both workers and business owners.
Respondents to three recent national polls ranked health care third — after the economy and national security or the war — among issues important in deciding their presidential vote.
Most people can point out what is wrong with health care in the United States: too many lawsuits, insurance that costs too much, benefits that don't cover enough, difficulty getting coverage.
"What voters are talking about is somebody they know that lost their insurance or how their prescriptions went up or they don't have health insurance," said Kansas House Assistant Minority Leader Rep. Jim Ward, D-Wichita.
Lawmakers at the state and federal level have proposed fixes. But most people acknowledge there are no easy answers.
"If it was a simple solution we would have found it," said Rep. Brenda Landwehr, R-Wichita, who helped develop the Legislature's health care reform package during the last session. "It is a lot more complicated than a sound bite."
Numbers tell part of the health care story:
— Health care spending in Kansas grew an average of 6 percent annually from 1991 to 2004, a little more than the national average of 5 percent, according to the Henry J. Kaiser Family Foundation. In Kansas that equaled about $5,832 spent per capita in 2004.
— The number of uninsured Kansans increased in 2006-07 to about 340,000, or 12.5 percent of the population, up from 307,000, or 11.3 percent, in 2005-06, according to Kansas Health Institute, a nonprofit health policy research group.
— Nearly half — 46 percent — of uninsured adults worked full-time in 2006-07.
— In Kansas, 71 percent of workers were covered by employer-provided health insurance in 2006-07, a 4 percent drop from 2000-01, an analysis by the Economic Policy Institute showed.
— Kansas employers paid an average of $8,176, or 74 percent of the cost, for a family premium for an employee in 2006, while the workers paid $2,983, or 27 percent on average, according to the Henry J. Kaiser Family Foundation.
Around Wichita, people's experiences largely influence what they want to see happen regarding health care.
For much of their lives, Lee Jacobs and his wife, Barbara, paid for their own health insurance because their employers didn't offer it. They opted for high deductibles, but even then, they paid nearly $500 a month for insurance.
A few years ago, Jacobs was treated for prostate cancer and chose to have a few more procedures done the same year. "I kind of grouped them together because I'd already covered my deductible," he said.
He now is covered by Medicare, which means a little more money in his pocket.
He would like to see costs linked to income levels. He also said people could help control costs by leading healthier lives. "It has to be generated within the person," he said.
Cost was part of the calculation for Townsend a year ago, when he decided not to buy health insurance as a freelancer. Had he been married, he might have thought differently, he said, "especially if I had children."
He has health insurance now as a Web developer for Jajo advertising agency. He pays 30 percent of the cost, with the company picking up the rest.
He thinks requiring catastrophic coverage makes the most sense. He compares it to auto coverage: He wouldn't expect a new alternator to be covered but would expect payment in the case of a wreck.
Suzy Damm, who is married and has three young children, said prevention should be encouraged.
Damm, who has insurance, is at the pediatrician's office at least every other month. She said her $20 co-pay isn't a burden, but she is delighted that her insurance won't require a co-pay for well-child visits and other preventive care as of Jan. 1.
It's the role of consumers to demand the best in health care, she said, rather than to rely on government. But she thinks maybe government should encourage more emphasis on prevention.
Morehead, the self-employed hair stylist who got sick without insurance, would like to see government help small businesses.
"We struggle anyway to survive," he said. "Large corporations can pay the big bucks ... (but) we feed America, too."
The Kansas Health Policy Authority, which has the task of finding solutions to the state's health care problems, has proposed helping small businesses purchase health insurance for their employees. Details are still being finalized.
"If we don't do anything for small business, they are going to continue to fall off the screen with health care," said Barbara Langner, director of public policy for the authority.
The rising cost of health care has been among the top concerns of businesses, said Tim Witsman, president of the Wichita Independent Business Association. "It's always cost," Witsman said.
His association is looking at ways to control costs and make insurance accessible to smaller businesses.
The group also is encouraging businesses to think about wellness programs, not just insurance. "Employers have to take more responsibility," he said.
Dale Baalman, chief financial officer at House of Schwan, said the business community needs to "push to make our people well," with more efforts to prevent health problems from developing.
He said his company is fortunate that it has a younger work force. That might have helped keep insurance increases smaller. Still, House of Schwan's costs for employee insurance have gone up, and employees are paying higher deductibles than in the past, he noted.
Cost are becoming "increasingly important" at Intrust Bank, said Lyndon Wells, executive vice president at Intrust Bank. "As an employer, our objective is to offer as competitive benefits as we can."
The bank has added options and tried to maintain benefits.
"I think the move is headed more toward consumer-directed health care, where more of the responsibility probably needs to be placed back on the patient," he said.
As a legislator, part of the challenge Landwehr sees is developing insurance that fits a work force that moves through several jobs in a lifetime. "We are a long ways from figuring out how do we go from employer-based insurance to individual-based insurance," she said.
One answer might be individually financed health savings accounts, she said.
Discussions about fixing the problem need to expand beyond insurance, said Ron Whiting, executive director of the Wichita Business Coalition on Health Care.
"We equate (insurance) coverage to health care and it isn't that simple," he said.
Currently, doctors and hospitals are paid for performing procedures and providing treatments, he said. The system needs to be reformed to reward good behaviors and prevention.
Both presidential candidates have health care reform proposals.
Republican John McCain's plan aims to make health insurance more affordable with a $2,500 refundable tax credit for any individual and $5,000 for any family. He would not mandate coverage.
Democrat Barack Obama's plan includes mandating coverage for children but not adults and aims for universal coverage by requiring larger employers to share costs of insuring workers.
Closer to home, the Kansas Health Policy Authority plans to continue to push for reforms in the Legislature. Last year, lawmakers passed nine of 21 recommendations, including expanded aid for poor pregnant women and poor children.
This year, the group proposes changes that could cost more than $284.2 million through 2013. It hopes ideas like expanded cancer screenings, a statewide smoking ban and money to insure more people will gain traction.
"The board felt very strongly that we can't just continue to patch the current system; we have to start to be proactive," the authority's Langner said.
It plans to seek a 75-cent increase in the tax on tobacco products to pay for the proposed changes. Support for such a tax might change, given that there could be several new legislators and it is not an election year, she said.
Sen. Susan Wagle, R-Wichita, who worked on the Senate's health care reform package last year, warns there will be little money for new programs in the next budget. She wants to see programs passed in the last session, such as an expansion of the State Children's Health Insurance Program, get the money they need. She plans to push the federal government for the money needed for that program.
Ward, the Democratic legislator, compares health care to a bridesmaid. It's always important but "there is always something that steps in front of it," such as the coal plant debate that dominated the last session.
He agrees that programs that cost money are unlikely to succeed in the next session. Ideas like making medical records electronic and more portable, which carries a smaller price tag than a premium assistance program, are more likely to succeed.
Ward expressed frustration that the state hasn't done more to expand insurance coverage so people are more likely to get treatment before illnesses become catastrophic.
"We've made baby steps but there are more people uninsured in Kansas than five years ago," he said.
