We saw something of a logical conclusion this week to the problems caused when people start falling through the cracks of the health care system.
The event was somewhat invented: it was the six month anniversary of when Pennsylvania dropped its Adult Basic health care plan citing budget constraints.
Advocacy groups were using the "event" to push to revisit the issue of a state supported, low cost basic insurance plan.
We thought it was a good moment to try to gauge the impact the program's loss is having.
That brought us to the home of Bob Winslow.
Bob and his wife Marian were on the Adult Basic plan and their three kids are on the state's CHIPS insurance plan, both brought about because Bob has found only part time work and Marian has been laid off.
But now Marian needs a medical procedure that will cost as much as $30,000 here.
So lacking insurance the family made the extraordinary decision to send Marian to the Philippines, where she was born, to have the procedure done.
It will cost only five thousand dollars for the operation there plus another $1200 in travel costs.
Like many of you I am wary of the government being in private enterprise.
Public systems are often prone to bloat and inefficiency.
But when the Pennsylvania Health Access Network reports that 62 percent of former Adult Basic customers now have no insurance at all, just like Bob and Marian, it also becomes clear that the private sector is either unwilling or unable to meet the price point of a basic product people can afford.
So now tens of thousands of Pennsylvanians get up every day rolling the dice that they won't get hurt or sick. Even if they do statistics show that won't seek help until things get really bad. The plain truth is eventually they'll show up at the emergency room and eventually at least some of the costs the hospitals can't recover find their way into contracts with health insurance companies.
In other words, whether it is through higher taxes for a public plan or higher insurance premiums for having no plan, it's still my pocket. Yours, too.
For reasons both humane and financial, it's important to all of us to find an answer-- so maybe the next Marian Winslow won't have to find her health care solution halfway around the world.