I was as shocked as you to realize that during the five years that have passed since the Twin Towers disaster, an estimated 90,000 Americans have died because they had no medical insurance as compared to those who were insured. Imagine ? 30 times the number killed on 9/11! These figures were carefully estimated by the Institute of Medicine, part of the National Academy of Sciences.

How could that be possible in the wealthiest nation on earth?

I had only a vague idea of the problem confronting 41 percent of nonelderly adults with incomes between $20,000 and $40,000 who are without health insurance until I read an article by the economist Paul Krugman. When illness strikes many of these people, they avoid going to doctors until their conditions become serious. If and when they do go, they may not have appropriate medical follow up and have trouble filling prescriptions. With savings wiped out, they have difficulty surviving and may go into bankruptcy. The irony is that these uninsured, when their savings are wiped out, end up getting medical care at public expense in costly hospital emergency rooms or in intensive care. Other countries that cover medical expenses for all their citizens spend less for medical care and have healthier and longer living citizens!

How could such a condition?basic medical care? be lacking in the wealthiest nation on the planet that flaunts itself as a model of democracy and concern for its citizens? Do we not care? Or have we become a nation of the have and have-nots, with the wealthy selfishly interested in taking care of themselves while those with much less money not having the political clout to change the situation? Do those who have coverage ignore those who don't have coverage? Do people just not know? The Krugman article and the Institute of Medicine's report were in the back pages of some newspapers or not reported at all in newspapers or on television. Or have we become cynical that there can be any change when self-serving medical institutions and health insurers are more interested in their vested interests than the welfare of the entire community? Are our politicians wary of such far-reaching changes now as they were years ago when Medicare was first proposed?

I was roused to write this article, as well as to contact my Washington political representatives. Hopefully, you reading this will be similarly aroused and make your views known. When I was a child (and I'm not that ancient!) there was no social security, no unemployment insurance and the absence of the many safety nets that we now take for granted (described in my novel, ?Land of Dreams?). In my novel ?Hobgoblins,? I describe the machinations of the unscrupulous business tycoons and their bought politicians who threaten our democracy.

In this article, I hope to help alert the grass roots (and metaphorically watering them) so that the sturdy tree of medical care will have branches and leaves covering all Americans.