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Should health insurance coverage be a universal right? And if so, what level of government should provide universal health insurance programs: the states or the national government?According to census data, 44.8 million people in the United States were uninsured in 2005, an all-time high. Young people between the ages of 19 and 29 are one of the fastest-growing groups without health insurance. Many are dropped from their parents’ health insurance plans or public insurance programs once they turn 19. On entering the workforce, they often take entry-level jobs that do not offer health benefits. Without insurance, they can end up like Ryan, whose story follows.RYAN: YOUNG, WELL-EDUCATED, AND WITHOUT A NETby Susan Starr Sered and Rushika FernandopulleOn a rainy evening in Boston, Ryan’s bicycle commute home from work led him to a path often traveled by American 20-somethings—taking jobs for the health insurance benefits they offer rather than for the career opportunities they may provide.Arriving home from a teaching job that stimulated his mind and fit into his overall career plans as an educator, Ryan entered the basement of his house to store his bicycle out of the pouring rain. As he climbed the damp stairs to leave the basement, his wet shoes slipped, causing him to fall and smash his kneecap on the edge of a stair. Ryan recalls, “I was able to walk fine, but after an hour I wasn’t . . . So I go, ‘Shucks, my knee, I hurt my knee, that’s too bad.’ But then after an hour it was very badly swollen and after a week it wasn’t getting any better. I didn’t have insurance anyway, so I didn’t do anything about it.”Ryan had been physically active all his life and remembers bouncing back easily from previous injuries. So while the pain bothered him and he couldn’t ride his bike to work anymore, he wasn’t overly concerned. But after a week with no improvement, “My father made me go to the ER.”Concerned about how he was going to pay for his treatment, Ryan was told at the hospital that he may qualify for free care given his income level. His ER visit was, in fact, covered under the hospital’s charity care program, as was his referral visit to an orthopedist whom he saw two months later when his free care application finally was processed and accepted. However, the orthopedist said that he could not do much for Ryan without an MRI, which would not be covered by the free care offered to Ryan at that time. Unable to pay for the MRI, Ryan left the doctor’s office without a diagnosis or treatment suggestions . . .“The doctor said you have to pay for an MRI, and that’s what we need to do before we operate on you. And that was hundreds of dollars,” Ryan says. “Maybe now that I’m older I would make a different decision, but I really didn’t have much money at all at the time, and I was very young and I was used to being healthy and had always been healthy. I just figured I’d just wait it out” . . . In lieu of a physician-supervised regime, he did what he could to treat the knee on his own . . .At that point, Ryan realized he would have to seek a job with health insurance in order to get appropriate care for his knee. The school where he taught offered him a full-time office job at less money per hour than he received teaching, but with benefits. Though Ryan has little interest in office work and continues to plan a teaching career, he took the office job.Ryan worked for six months before finally qualifying for health insurance. As soon as he was covered, he went to see another orthopedist. This time he was given a diagnosis: Ryan suffered from Plica Syndrome in the knee joint, an inflammation . . . in the joint that causes pain, limited motion, and leads to overall weakness of the knee.Because Ryan’s knee had not significantly improved since the accident, the orthopedist recommended surgery. After the operation, Ryan asked the doctor for guidance about rehabilitation, but says he got none. So he took it on himself to figure out the best post-operative care. He opted for physical therapy, which carried a copayment fee of $20 per visit.After several months of rehabilitation, Ryan’s knee was still causing him a great deal of pain and limiting his mobility. When he returned to his surgeon, he recalls being told that his pain was psychosomatic and nothing more could be done for him.Travel Abroad—An Unexpected Health Care OptionNot one to be kept down for long, Ryan decided to carry on with his life despite the pain. Having dreamed of travel, Ryan went to Chile to work for a while as an English teacher. While there, his knee continued to cause him pain. Then, an adult student of his offered Ryan access to his son, Xavier’s, medical insurance. Knowing Ryan was not actually Xavier, Chilean medical personnel treated him anyway. So, ironically, during the time Ryan spent in Chile, he received better care than he had received in the United States. Working with doctors and physical therapists, he finally began to improve . . .Upon his return from Chile, Ryan worked for a few years at teaching jobs that did not provide insurance. Finally, he found a teaching position that provided health coverage. Not long thereafter, however, budget cuts caused him to be laid-off. So he went back to part-time and temporary replacement jobs and, again, was uninsured . . .It has been five years since that fateful rainy night, and Ryan’s knee still bothers him . . . “I feel ill served by the system,” he says . . . “It bothers me that I’m living in a rich country and I know that I’m not really badly off, but the treatment was just really haphazard and nobody told me what I needed to know.”Ryan lived in Ireland for the first 10 years of his life and holds both American and Irish citizenship. This dual identity gives him much comfort. Ireland has a national health service, “like every other country that’s developed and civilized,” Ryan says. “If I ever get really sick,” Ryan says, “I’ll fly to Ireland, it’d be cheaper.”Susan Starr Sered, an anthropologist, and Rushika Fernandopulle, a medical doctor, interviewed uninsured Americans to find out how they fell through the health system cracks. The stories they gathered were published in Uninsured in America: Life and Death in the Land of Opportunity, 2005.What level of government should provide universal health insurance programs: the states or the national government (use the constitution to support your answer)? ................
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