ATLANTA -- These days, I need more paperwork to see a doctor than I do to buy a house.
In my recent quest to see an orthopedist, I encountered a receptionist who wanted my Social Security number before she would make an appointment. Of course, she also wanted the name of my health insurance provider. (If I'd been killed on my way there, I guess the doctor could have billed my insurance company for the missed appointment.)
Once I arrived, I filled out reams of paper and submitted proof of insurance. (Some physicians require a driver's license as well.) I was asked to submit the $15 I owed as the co-pay before I saw the physician. The office apparently didn't employ security to chase down errant patients who walk out before handing over the co-pay.
If you're caught a second time driving off from a gas station without paying, your driver's license can be suspended. Maybe physicians could revoke the insurance card of any patient who drove off without settling up.
Without the insurance card, what would have happened? Would I have had to offer my house as collateral to secure an appointment?
A health insurance card is not quite as hard to come by as membership in an exclusive country club, but it has become a symbol of the divide between the comfortable and the struggling. If you have insurance, you don't hesitate to see a doctor for routine complaints -- the recurring sinus infections, the high blood pressure, the arthritic knee. And you take your children for regular checkups.
If you don't have insurance, you occupy a dangerous netherworld where you might pay a stiff fee at a drop-in clinic if your kid gets a nasty ear infection. But you ignore your own complaints until they are serious enough to merit a visit to the emergency room. By then, your health -- if not your life -- might be in jeopardy.
And that health insurance card is getting harder to come by. At least 15 percent of the population, nearly 44 million people, have no insurance.
The July labor report showed not only that fewer jobs were created than experts had expected. Many of the new jobs are in the retail or service industries and don't provide health insurance. Indeed, employers are increasingly reluctant to hire if they have to provide health insurance, which costs companies an estimated $3,000 a year per worker. That's one of the reasons so many jobs have migrated overseas: In much of the developing world, laborers don't even expect health insurance as part of their compensation.
"Health care is a major reason why employment growth has been so sluggish," Sung Won Sohn, chief economist at Wells Fargo, told The New York Times.
These days, savvy workers consider their health care benefits as carefully as base pay. If you're lucky enough to have insurance in this era of stagnant wages, you've probably found your take-home pay steadily declining as your employer pays a smaller percentage of the cost of your premiums. But you're reluctant to start your own business because you can't afford your own insurance.
You don't change jobs if your new insurance won't cover a "pre-existing condition." As many middle-aged workers know, some companies simply refuse to hire older employees who may bring to the job a history of hypertension or high cholesterol.
There isn't much any sitting president can do about the dramatic transformation taking place in the economy, in which U.S. workers are having to compete with laborers in Mexico, China and India. That shift will continue no matter what laws are passed, tax loopholes are closed or trade barriers built.
But a capable president would certainly tackle the health care crisis. Any solution would be complex and politically costly, but failure to act would be worse. The surging cost of health care is now a huge drag on economic expansion.
Whatever President Bush and his opponent, John Kerry, promise about an improving economy, not much will change without a major overhaul of health care.
Cynthia Tucker is editorial page editor for The Atlanta Journal-Constitution. Her column appears Mondays in The Sun.