“Some men see things as they are and ask why. Others dream things that never were and ask why not.” – George Bernard Shaw

That was the thought circulating in my mind as I thought about a young friend living, for the time being, with stage-four metastatic breast cancer.

Her doctor feels she needs to be on two “specialty” pharmaceuticals that enhance the efficacy of her chemotherapy. Only one little problem: the pills cost $6,000 a month, and her insurance won’t cover “specialty” drugs.

She applied to the pill’s manufacturers, both large pharmaceutical companies, one domestic, the other foreign, for financial assistance. Their answer? “You make too much money to qualify for assistance.”

Considering the Roman philosopher Cicero’s contention that a man never really puts his mind to a subject until he writes on it, I haven’t really thought much about health care since the Clinton years.

From 1992 to 1996, I wrote about it at The Herald-Times, capping my career there with a 13-part series in 1996 called Healthcare at the Crossroads, which explored the “driving forces behind health-care reforms” in Bloomington and the nation.

Until lately, about the only thought I’ve given the subject, aside from its role in society and politics, is when I enter the amount my health insurance company deducts each month into my checkbook. I’ve gone years between doctor visits and have not submitted a claim in the eight years I've been buying my own insurance.

Well, a never-ending yen for new professional challenges, combined with an up-close-and-personal encounter with mortality (nothing serious, just expensive), have convinced me it’s time to revisit the subject of health care.

For more than 100 years, the Local Council of Women (LCW) has held significant control, on the community’s behalf, over Bloomington Hospital. On June 16 it gave up that power to pave the way for a friendly takeover of the hospital by Clarian Health Partners Inc., hopefully to improve local health care.

In return, LCW is supposed to ensure community influence through its appointments to a post-merger board. The events around the recent vote suggest LCW is not yet able to do that but could with increased community participation.

LCW founded, built and ran Bloomington Hospital throughout most of the 20th century. Eventually, the business of health care overtook the caring part, and LCW gradually ceded control to the professionals. In 1988, LCW gave Bloomington Hospital the property it was built on.

Two years ago a man came into Dr. Rob Stone's emergency room at Bloomington Hospital complaining of severe chest pains. As Stone asked about his symptoms, he realized the man was having a heart attack.

Worse, he'd suffered another one two days prior.

The man, who had lost his job and his health insurance, told Stone that he hadn't come in during the first attack because he feared the bill. This visit to the ER, and the two-day hospital stay following it, was going to cost $40,000.

"He had good reason to be afraid of the hospital facing a bill like that," said Stone.

Members of Hoosiers for a Commonsense Health Plan (HCHP) are working earnestly across the state to gain support and raise awareness for their proposed bill, which will be introduced to the Indiana State Legislature in January.

If passed, the legislation would make major reforms to today's health care system. By using Medicare as a model, the HCHP plan would use tax dollars to expand public healthcare to include everyone, including those currently without medical insurance.

"We're traveling all over the state working on this," said Dr. Rob Stone, one of the organization's three co-founders. "There are five of us who are giving talks in different settings, in different formats, all over the state."

Monroe County has reached a milestone in community health care with the opening the county's new family planning clinic, according to Charlotte Zietlow.

Although most counties in Indiana provide health care services to their citizens, this is the first time Monroe has done so, the former county commissioner said. The Monroe County Health Department had contracted out virtually all health care.

"I am very excited about the fact that we now have real health services provided by the county health department," Zietlow said. "My long-range dream is that this will work so well that Monroe County will begin to think in terms of broader primary health care. Someone has to do it."

Ask your doctor. That's why the pharmaceutical companies collectively known as "Big Pharma" spend billions of dollars each year in direct-to —consumer advertising. Whether you're insured, underinsured or uninsured, they want to convince you that you need to ask a doctor for the nostrums and potions they produce.

Global sales for the top five pharmaceutical companies topped $550 billion in 2004, according to the Media Education Foundation's new film, Big Bucks, Big Pharma: Marketing Disease & Pushing Drugs. The documentary takes a critical look at an industry that often appears to put private profits ahead of public health.

On May 1, Bloomington Hospital played host to the Midwest premiere of a pre-release version of the film, thanks to the efforts of emergency room physician Rob Stone and his wife, Karen, co-founders of Hoosiers for a Commonsense Health Plan (...). As part of "Cover the Uninsured Week," they brought the film's director, Ronit Ridberg, to town to lead a discussion after the screening.

We speak in America of our "healthcare system," but what we really have is a non-system of illness care. According to the Institute of Medicine, 49 people a day, 18,000 a year, die purely because they have no health insurance and therefore very limited access to health care.

In Indiana, over 800,000 citizens have no health insurance, and even those who do find it harder and harder to keep up. Employers cut back on the coverage they offer. Premiums, deductibles and co-pays rise, and all the while the cost rises faster than inflation, like weeds in the garden.

Some argue that things are not so bad, that there is a safety net, and somehow everyone does get care. They don't. I work in the safety net.

On a sunny Friday morning, Ma welcomes visitors to what she calls her office — the back steps of First United Methodist Church on Fourth Street. She rocks gently as she speaks, rubbing her left upper thigh in an attempt to ease the pain. It's hurt ever since she flew through a car windshield in 1978.

Her mind hasn't been the same since, either. They had to insert a pipe to drain the fluid that was pressing on her brain.

It's not easy for Ma to obtain painkillers or to get treatment for what she calls her "anger management" problem. A former nurse, Ma is homeless at 53 and has wandered from shelter to shelter since leaving Detroit for Bloomington last year.

This summer, when Bloomington Hospital announced it was closing the Title X family planning clinic it has run since 1998, community members stepped forward to make sure the 1,450 patients who visit it annually wouldn't lose the only health care service most of them receive.

"It was a broad, vocal support," said Indiana Family Health Council president Gayla Winston.

In September, the Indiana Family Health Council, a private, non-profit corporation in Indianapolis, accepted the Monroe County Health Department's proposal, ensuring the estimated $200,000 annual family planning grant will stay in Monroe County.