Decade After Health Care Crisis, Soaring Costs Bring New Strains
Behind the numbers are people like Paul McGonnigal, 36, of Portsmouth, N.H., who lost a six-figure salary and his health benefits when his dot.com startup faltered. "I look at this situation as extraordinarily high risk," said Mr. McGonnigal, now trying to start a consulting business with his wife. "We would be financially wiped out if either one of us got seriously ill."

Maryanne McMillan of Richmond, Calif., a city planner disabled by lupus, an autoimmune disease, knows the risk too well. "My credit has gone from good to hell," said Ms. McMillan, who has struggled to piece together affordable coverage. "I feel like I'm on a high wire act when you're the sickest that you could ever imagine being in your life."

The soaring costs are driven, in part, by the biomedical revolution of the past decade, which has produced an array of expensive new treatments for an aging population, from drugs to fight osteoporosis to high-tech heart pumps. The result is a health care system filled with great promise and inequity — such as wonder drugs that many of the nation's elderly must struggle to afford.

Dr. Janelle Walhout sees the paradox every day at the community clinic in Seattle where she works. "I've been thinking lately about the mismatch," Dr. Walhout said, "between how very high-tech medicine has become, with all these genetic tests for everything, mixing your medications like fine cocktails, and our patients, who can't afford them, can't understand it, can't get interpreters to explain it and are just not accessing those things."
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