The total number of Americans who have no medical insurance or do not have adequate medical insurance is enormous, believed to be well over 46 million people.
Connecticut, the state where I live, is a relatively wealthy state, but Connecticut is no exception.
According to the Census Bureau, the number of uninsured people in Connecticut in 2008 was 343,000.
This did not include the under-insured.
Unemployment in Connecticut has gone up during 2009 from 6.
6% to 8.
9%.
This did not decrease the number of uninsured.
Do you have any reason to believe that the numbers are better today? In addition, consider what I see in my own practice:

• Self employed patients who had more expensive "commercial insurance" (which generally give you a much broader coverage without the proverbial hassle) have switched to standard HMOs or PPOs.
  They can no longer afford the commercial insurance.
  
• Private paying patients switched from their usual insurance to "catastrophic insurance" where only hospital admissions and some outpatient testing is covered.
  
• Employers have placed their employees on high deductible policies, some funded through HSAs (Health Saving Accounts) which are perceived as out of pocket expenses.
  
• Some patients can afford some type of medical insurance, but choose not to buy it.
  The usual reason is that they feel young and healthy, and they simply decided to take a chance (in Connecticut, at least 60,000 people with an income of over $75,000/year had no medical insurance whatsoever).
  

When you put it all together, the number of Connecticut residents who do not have adequate medical insurance is very high; I estimate it to be more than 15%.
It's a burden on the underinsured, and it's a burden on everyone else.
Reliable surveys in the US as a whole and in Connecticut in particular have shown repeatedly that the underinsured:

• Receive fewer basic medical services
• Have more hospitalizations which could have been avoided
• Have a higher mortality rate than the insured person

It is well established that the underinsured person, who pays "retail" for medical services, pays much more than the discounted rates enjoyed by commercial insurers, HMOs and PPOs.
It is not unusual for private fees to be higher than discounted rates by as much as 50% for office visits, double for x-ray studies, triple for blood work, and quadruple for ER visits.
So, you live in Connecticut and have no medical insurance.
What do you do?

1. Do as much as you can for yourself to decrease the need for medical care.
   Prevention is paramount; obey its cardinal rule: adjust your life styles to maximize your health.
   This includes smoking cessation, keeping close to ideal weight, exercise, eating less fat, consuming more foods containing omega-3, eating less salty food, and limiting alcohol consumption.
   Don't forget that more than 40% of premature deaths are caused by faulty lifestyles, and even more disease is caused by it.
   
2. Establish yourself and your family with a physician who will take into account your ability to afford medical care and tailor programs around your affordability.
   
3. Don't wait for the last minute.
   If you have a problem, act.
   What looks like a bad cold that doesn't go away in a week could really be pneumonia.
   And it's so much easier, and so much less costly, to treat it before that emergency room visit.
   

Save that money you would have spent on cigarettes and excess alcohol (this includes beer...
) to join the gym, take a vacation, and get a comprehensive physical examination.
I'm happy to report that since the economic downturn, our office has put into place programs that take your affordability into account.
This has included limiting our office visit charges, using labs that will give deep discounts, and cost-conscious prescription writing.