According to the Census Bureau, the number of Americans without health insurance rose by 1.4 million in 2004, to 45 million.

The reasons are complex. Numbers alone don't tell the full story, yet the issue's mere existence is perplexing for it's in the world's strongest economy.

In the next several columns I will look at how the rest of the world fares and whether the U.S. is still much better off or - perhaps - has something to learn. But first, some amazing stories.

Steve, at 48, was making decent money working as a machinist for an aerospace part manufacturer when the tragic events of 9/11 triggered a nationwide economic slump. People stopped flying, orders were canceled, and even his UAW (United Auto Workers) Union membership could not save him.

Luckily he was eligible for thirty-nine weeks of unemployment benefits which was eventually extended to a year and a half. All seemed well except that his medical insurance had been canceled immediately upon losing his job.

On an unfortunate day, Steve fell and broke several of his ribs. He needed a surgery and complications kept him in the hospital for three months.

During his stay, doctors made three-minute visits to his hospital room at least 25 times. They charged $80 for each. Steve remembers having had about a hundred X-rays, each billed at $175. His Tylenol was charged at $22 a couple. While these billings appeared unreasonably high, they still could not prepare him for the $800,000 total bill at the end of his care.

In his misfortune, Steve had some incredible luck on his side allowing him to continue a normal life after his recovery. Oblivious about the difference, he entered a state hospital as opposed to a private institution only because it happened to be the closest to him. This turned out to be the luckiest move of his life. Because he did not have a job nor did he own a house, stocks, bonds or anything that could be floated as liquid capital, he received a charitable consideration allowing the hospital to forgive all of his bills and then be reimbursed by the Commonwealth of Pennsylvania. Ironically, had he been employed and owned an insurance policy, his story most likely would have turned out to be disastrous.

On an average, insurance covers only about 80 percent of hospitalization which, in this case, would have left Steve with a $160,000 bill, a likely burden for the rest of his life. Furthermore, Steve would have had a good chance of having been denied payment by his insurance company on parts of the bill, thus ending up with a financial life sentence in hard labor without parole.

Roughly ten thousand miles away in the former Soviet Republic of Kyrgyztan, 22-year old Gulzat, a physicist just about to get her masters degree in applied statistics, needed a driver's license. Simple enough, but the mandatory medical tests revealed something shocking. A parasite had been living in her body, most likely from her early childhood, and was taking over her organs. The doctors didn't expect her to live much longer. There was some hope, though. If they could quickly remove the multiple sacs of eggs attached to her various organs she could survive.

However, under her country's dire financial circumstances only the privileged were known to have a chance to survive. Before a surgery could even be considered, Gulzat and her family would have to provide the doctor with indispensable surgical tools such as scalpels, syringe, needles, suture, gauze, cotton balls, and even anesthetics and painkillers. Some items would be available at pharmacies, others might have to be hunted down and bargained for on the black market. Nursing care, bed sheets, pillows and food three times a day, would also be the family's responsibility to provide. The total cost? Nearly $3,000 - in a country, where salaries were and still are measured in a few dozen dollars a month.

In her hopeless situation, Gulzat, too, met incredible luck. Riva and Bob - her former hosts from a few years before, when she was an exchange student in Michigan - donated $2,000 of their own money and raised, through their church, another $800 to save her life.

Steve and Gulzat were both lucky, but sadly, it's a lot more the exception than the rule.

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'Starlight' is the

pseudonym of Joe Szabo, editor of the Tri County Record.

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