James Kelly was a first-time patient at the clinic. At fifty-three, he’s beginning to have joint pain in his knees and shoulders. Most of his life he was an auto mechanic, but now, with the pain, he can’t crawl under cars any more. So Kelly sells cars at South County Motors in Ashland, where business has not been good. He hoped that, with the students back, sales might pick up. Kelly, who was missing some teeth, said he knew nothing about health reform. “I’ve been listening to talk radio but haven’t made any decisions about what they are saying,” he said.

Kelly has made a decision about health care, however: he knows he needs it, and went to the University of Missouri hospital. There, doctors treated him for back pain and sent him to the Family Health Center. He has no insurance. Kelly wanted to talk more, but a nurse called his name—at last it was his turn to see a doctor.

Betty Dudley came in with her grandson, Jaheim, for his back-to-school check-up. Dudley, forty-five, who works as a para-professional for Columbia’s public schools, had some opinions: “I don’t think health reform will make much of a difference, but I don’t know much about it. I depend on God to provide for my family.”

If health reform will help anyone, it would be people like fifty-seven year old Jackie Johns, who lives in a rural part of Boone County. Johns worked for thirty-nine years, mostly at a medical transcription service. She now is disabled from arthritis, and receives Social Security Disability (SSDI) benefits. She is also in Medicare’s no-man’s land—the two-year waiting period to gain eligibility for Medicare benefits. “Five more months to go,” she says. “I’m on the countdown.” The government makes disabled people on SSDI wait two years before they can get Medicare—to save money, the government says.

During the wait, people on SSDI find other ways to pay for care. Johns applied for Medicaid, but she needs to accumulate $564 in bills every month before Medicaid pays. Sometimes she doesn’t reach that amount and comes to the clinic for help, where she can pay according to a sliding fee scale. Early on in this debate, the pols talked about shortening Medicare’s waiting period, but Johns says she hasn’t heard anything about that. When she worked, she always carried insurance, but in the last few years of her work life she couldn’t afford the out-of-pocket costs required, because her deductibles were too high. “Nobody talks about the real, day-to-day problems people have affording these deductibles,” she wanted me to know. “You don’t hear them talk about how hard it is to afford the deductibles. It all gets lost in the blah blah. How long can you keep ignoring such a big signal of peoples’ problems?”

Johns seemed disillusioned, and blamed herself for not knowing more about health reform. “I think Obama’s plan is kind of vague,” she said, “but maybe I didn’t read up enough in as much depth as I should have…. For the last twenty years, I kept thinking that we’d have a revolution, but we’re too fat and lazy. National health insurance has been a dream for so long.”

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.