It hurts here

As medical costs rise far more than incomes, many Americans are making adjustments that can be unhealthy

The crisis in health care isn't just about the uninsured anymore. A recent New York Times report, based on studies from the Kaiser Family Foundation and the nonpartisan Center for Studying Health System Change, showed that even those who have insurance are finding expenses so daunting that some are cutting back on treatments or not acting to take medicines that control chronic conditions such as high blood pressure and diabetes.

While that's dangerous for individuals, it also has an impact on the overall health care system. People who get sicker with such conditions eventually have difficulties that require more drastic and expensive treatment.

Some 158 million people in the country are covered by employer-based health plans. But they're paying more of their own costs, and their premiums have risen, sometimes dramatically. The Center found, for example, that nearly 20 percent of families had trouble coming up with the money to pay medical bills last year. Some believe their problems will even lead to bankruptcy. Indeed, bankruptcies related to medical expenses are mounting.

Large companies can still provide pretty good coverage, the studies indicated, but there's a strain on smaller companies, where employees sometimes have much higher deductibles. And for lower-paid employees, covering the difference in what insurance pays and their own obligations gets tougher and tougher.

That's certainly true in North Carolina, where The N&O reported that insurance premiums for families rose 5.3 times faster than wages.

One family cited in The N&O story was in a Catch-22. The husband got a raise in his state job, but that raise meant his children lost their eligibility for federal health care assistance. The pay gain has been lost to insurance premiums.

Presidential candidates John McCain, the Republican, and Barack Obama, the Democrat, have plans of a sort, though McCain's depends on tax credits and the weary free-market chatter about people having the freedom to choose their own health care. That's disingenuous, because McCain would also tax employers' health care benefits, and many people, if set "free" in the marketplace, wouldn't be able to obtain insurance if they had health problems. Obama's plan is better, with more government involvement, but it would be tremendously expensive.

Politicians have all sorts of reasons for explaining why a national health care system won't work, and some reasons -- such as the shortage of primary care physicians who would have to be a cornerstone of any such plan -- are certainly legitimate. Even discussions of the issue have been stifled, by pressure from insurance and drug companies that want to maintain control of the system and their own high profits and are willing to back politicians who will go along with them.

But now the crisis of affordable health care is hitting those who actually have insurance. Who knows? Those in positions of power in Washington, and in state capitals, may actually have to listen.