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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

We're going to hear two stories now about two very different health care systems: in Britain, and here in the U.S. In a moment, we'll hear from Britain where everyone has health care, but expensive treatments are sometimes rationed.

First, to the U.S. Forty-seven million Americans don't have health insurance, and the situation is getting worse. A recent poll by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health found that one in four people say they're having trouble paying their medical bills. Health care is a big election issue, so we conducted our poll in two swing states, Florida and Ohio.

NPR's Joseph Shapiro talked with people struggling to balance their health with their finances.

JOSEPH SHAPIRO: Jeff Lucas and his wife live in a nice house in Jupiter, Florida, just a mile from the beach. They make good money. He arranges financing for business owners; she works for a state health agency. But they've got college bills for three kids and other rising costs. So they've cut back. They eat out less. They don't go so far away on vacation.

And Jeff Lucas says he's also cut back on medical care. Recently, he's put off dental work because the total isn't covered by his insurance.

Mr. JEFF LUCAS (Resident, Jupiter, Florida): I mean, I've got a tooth missing on one side of my face, you know? And we're trying to put a temporary in, but every time we try, they say, oh, you already - you've spent your limit. So I say, okay, I'll just chew on the left side.

SHAPIRO: He's not alone in that kind of decision-making. The new NPR poll with Kaiser and Harvard found that 30 percent of people in Florida say they've put off needed medical care, and 41 percent skipped dental care - just like Jeff Lucas.

Mr. LUCAS: In previous years, I wouldn't have thought twice, you know, about just getting a procedure done if I needed it. And today, if I'm faced with spending, you know, $500 or $600 to put a crown on a tooth, and if I feel that I can get by, if I could still eat fine without it, then I'm making the decision, hey, you know, I'm just not going to get that procedure done.

SHAPIRO: In addition to postponing the care they need, 28 percent of people in Florida say they ignored a doctor's advice to get a medical test or treatment. That's 11 percentage points more than when the same question was asked in a national poll three years ago. Last November, Lynda Blankenship's doctor asked her to get tested.

Ms. LYNDA BLANKENSHIP (Resident, Massillon, Ohio): So I go have this one blood test. It's $900.

SHAPIRO: Because of the high deductible on her health insurance, Blankenship, who lives in Massillon, Ohio, had to pay it all. She said the test repeated earlier ones. The results were ambiguous, and the doctor wanted to be certain.

Ms. BALNKENSHIP: So then, she asked me in March to do it again. And I just said no. You know, I'm not doing it. I'm not spending that. And she got kind of upset with me. And I thought, well, you know, you're not paying the bills, I am.

SHAPIRO: Blankenship is 61. She's covered by her husband's insurance. He gets it as a retiree. But that company insurance doubled this year to $140 a month.

Ms. BLANKENSHIP: To me, it's a nightmare. The worst thing, I think, about getting older is that you remember how good it used to be. If you didn't remember what it was like to have company-paid health care, that you didn't have a deductible to and you didn't even contribute to, then this may all seem normal. But to those of us who can remember that, we just feel like we're being robbed.

SHAPIRO: So she's tried to be a good consumer of health care and figure out what care and medicine she really needs, and what seems like excessive ordering by her doctors.

Ms. BLANKENSHIP: And so we do make individual informed or uniformed decisions about whether I can have that test or whether I can take that medicine. We have to make those choices all the time because our resources are very finite.

SHAPIRO: Of those who answered the poll, about 25 percent say they've recently chosen not to fill a prescription. About 20 percent say they've cut pills in half or skipped doses to save money. And nearly half of people who have jobs said they'd gone to work when they were sick because they worried about the financial consequences of missing work.

The poll had another surprising finding. One in four people in Ohio, and one in five in Florida, say they've got collection agencies chasing them. The most common reason: unpaid health bills. Kristin Hicks of Sarasota, Florida, got treated in a hospital two years ago.

Ms. KRISTIN HICKS (Resident, Sarasota, Florida): In my head, it was all taken care of. And we had assumed that it was over with.

SHAPIRO: But this spring, a bill came for $400, followed shortly by a call from a collection agency.

Ms. HICKS: Bam, two years later, you're still getting billed. And, you know, God knows, maybe another year from now, I'll get something else.

SHAPIRO: When people in the poll were asked what government could do to get them through the economic downturn, helping with medical bills came in near the top. Robert Blendon of Harvard, who worked on the poll, says that's striking.

Prof. ROBERT BLENDON (Health Policy and Management, Harvard School of Public Health): This fact of seeing health care support as an economic solution has not shown up in any other poll. And that is really a surprise.

SHAPIRO: Among things government should do, help with medical bills ranked second in Ohio and third in Florida. That was just behind stopping jobs from going overseas and pulling out of Iraq, but ahead of tax cuts, stimulus checks, or increased spending on domestic programs and public works.

Joseph Shapiro, NPR News.

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