Everardo and Deborah have six children, ranging from 21 to seven months. He's a painter, cabinet refinisher, tile craftsman and tree trimmer. She trained to be an administrative and clinical medical assistant, earning an associate degree from Cerritos College.

But Lennox couple is homeless today, living out of a battered van, with their five youngest kids staying nearby at the oldest son's apartment. Why?

Because poor health has robbed them of their livelihoods. And without any kind of private or public insurance, their medical problems keep getting worse.

Everardo looks a good deal older than his 51 years, with most of his teeth gone and a sickly skin tone. He has long dark hair combed back over his neck along with a graying beard and mustache. But it's his tried, sunken eyes that stand out. And when he speaks, there's defeat in his voice.

"When I go to interviews, people don't hire me because of my dental problems," he reports. "I pull my teeth out sometimes because it's too much pain. One time it took three days. But the roots are still in there and the gum covered them up. So it got infected."

On a construction job seven years ago, he fell down two stories, landing on his feet. When he had surgery to put a metal plate in one heel, doctors told him his decaying teeth were poisoning his blood. But he's never been able to save up enough cash to get them fixed.

And the heel still bothers him. Whenever he works three days in a row, his foot swells up and he can barely walk. Recently, he's also noticed that he has more fevers and painful symptoms than ever.

"But I just wait until they go away," says Everardo matter of factly. "Because I need to work hard for my kids. But lately I've had more headaches, and my teeth bother me, the ones that are left, and the gums.

"I need to get them all out. It's changed the color of my skin. And they told me it's poisoning my blood, so I'd better take care of that, because otherwise I'm going to die."

Deborah, who has an easy smile and soft voice, also needs dental work. Just last night, in fact, the 41-year-old woman had such a toothache she wasn't sure if she could finish her midnight-to-9 a.m. shift as a temp making pastries for airlines. It's not the job she wants, but right now it's the only one she can find.

"I have to make money because the father of my children doesn't have a regular job," she points out. "So no matter what, I go to work."

The mother and breadwinner has a thyroid problem that could be controlled by medication. But since she and her partner became homeless eight months ago and were cut off Medi-Cal --- California's Medicaid health care program for those with limited incomes and resources --- she hasn't been able to get the prescription filled. And she says the untreated thyroid problem has led to a heart palpation, which she also needs medication for but can't afford. In addition, she has arthritis in her knees and migraine headaches.

Both also badly need glasses, but that's out of the question, they agree with knowing half-grins.

"The one thing is I have to take care of myself, and I really need Medi-Cal to do that," Deborah says. "I'm trying to get Medi-Cal at the moment, but it's really hard being homeless. But I have to take care of my five small children, and I need to be healthy and fit for that, as well as work."

Nodding, Everardo says, "It would solve our major problems, and it would be a better life after that."

18,000 preventable deaths
Everardo and Deborah are far from alone.

From 2004 to 2005, the number of Americans without health insurance increased by 1.3 million to 46.6 million, according to a Census Bureau report released in August. That means nearly one of every five persons in the nation has no kind of health coverage. The rise --- from 15.6 percent of the population to 15.9 percent --- is the highest level since 1998.

During that period, the percentage and number of uninsured children increased from 10.8 to 11.2 percent, from 7.9 to 8.3 million. It's no surprise that poor kids (19.0 percent) were much more likely to be uninsured than all children (11.2 percent) last year, but it is alarming that more than 80 percent were living in a family headed by a working adult.

One of the biggest disparities about health care coverage concerns race. While 11.3 percent of non-Hispanic whites were uninsured, 19.6 percent of African Americans and nearly 33 percent of Hispanics lacked coverage. The percentage of foreign-born people without health insurance was about 2 ½ times that of the native population.

Nineteen percent of Californians --- almost 7 million people --- had no coverage.

What do all these statistics really mean?

The Institute of Medicine concluded that uninsured adults are "more likely to experience worse health outcomes, including higher death rates, poorer control of chronic conditions such as diabetes and use of fewer preventive services."

The bottom line?

Lack of health care coverage means nagging conditions go untreated until they develop into full-blown medical catastrophes. Chest pains become heart attacks; headaches become brain tumors; urinary problems become prostate cancer. Not having health insurance, the institute estimates, accounts for 18,000 preventable deaths a year.

Moreover, families wind up in emergency rooms for minor as well as major medical problems, with hospitals bearing the brunt of this expensive care. And when they're forced to shut down their ERs, as hundreds of hospitals across the country have in the last decade, the whole community's public health takes a nose dive.

Harder to measure are the effects on an individual or family when critical decisions must be made about care for a loved one, and a major factor is cost. The shame and guilt that crops up can be immense, and last a lifetime.

'Dumped' policyholders
Recent headlines tell a litany of related distressing stories: "Health Insurance Premium Rates Increase Faster than Income, Study Finds," "More Workers Go Uninsured," "Most Uninsured Children Have a Parent Who Works," "Employers Chip Away at Retiree Health Benefits."

One recently reported practice, and arguably the worst, is "dumping."

It involves the growing number of Americans who sign up for private individual insurance policies because they're unemployed, don't qualify for government programs or aren't covered at their work place. Although the premiums are high --- averaging more than $400 a month for individual and $1,200 a month for family policies --- and the medical services covered often limited, most people feel fortunate just to have some safety net against major medical emergencies.

But the recent rise in "dumped" policyholders to avoid expensive claims has sparked closer scrutiny by government regulatory agencies along with a consumer backlash against insurance companies, especially here in the Golden State.

Blue Cross of California just settled more than 70 patient lawsuits and claims that the insurer had canceled coverage after the insured became ill. Blue Shield of California has a number of similar pending suits.

And in a mid-October decision, the state Department of Managed Health Care ruled that the Kaiser Foundation Health Plan illegally canceled coverage for a woman who needed urgent medical attention for enlarged kidney stones. This was the first time California has ever ordered a health plan to reinstate a patient's coverage whose policy was not legally canceled.

The Los Angeles Times reported this month that "all three of the state's largest health plans are now embroiled in the controversy."

Little moral outrage
But to date, there has been no massive groundswell of moral outrage against such practices.

"There is moral outrage certainly here at the Catholic Health Association of the United States where Sister Carol Keehan, our CEO, often says we need a 'revolution' in American health care," reports Jeff Tieman, director of CHA's Covering a Nation program, who recently attended a conference in Los Angeles where "the outrage was palpable. We just need to spread that outrage throughout the country and among the public."

Tieman offers a couple reasons why the outrage hasn't spread. "If you're insured, and particularly if you're healthy and insured, you may feel like this issue doesn't affect you," he points out. "And even though over 46 million people are uninsured, most are still covered. And there's a big perception gap. A lot of people think that it's only the unemployed who are uninsured. But that's simply not the case, when eight out of 10 uninsured are in working families."

Also, although the public consistently reports that they believe health care should be a basic right, many still aren't willing to pay for it or make any personal tradeoffs, according to Tieman. He says the usual stumbling block boils down to, "What is reform going to mean to me?"

Father Ed Dillon, chaplain at Marymount College in Rancho Palos Verdes, has worked with the poor and marginalized most of his adult life. He believes the nation's health care crisis is part of a much wider social problem that involves America's highly held notion of individualism over community.

"We're really evolving into a two-tiered society," he maintains. "No one seems to notice that we're so unique among the developed nations of Western Europe, Canada, Australia in not having universal health care or an inexpensive higher education system that everybody can afford.

"We're uniquely individualistic in our culture, whereas these other countries have a much more traditional culture, which is community oriented with a sense of morality of the common good. The common good is in their bones, and they would feel terrible if they saw great numbers of people like themselves without social services such as quality health care.

"The health care system has been allowed to be so cruel and unfair, with millions of hard-working people from strong, good families being without any kind of health insurance," he adds, shaking his head. "We've let it happen. What we have sought is our own personal private salvation: 'Let me, at least, survive. And if the others can't, I feel bad.' That's as far as we get. That's the individualistic sense of self."

Health care is a basic human right not a civil right, says Vincentian Father Richard Benson, a moral theologian at St. John's Seminary. Therefore, it doesn't even matter if a person is an American citizen or not, because human rights don't come from governments.

"Human rights flow from the sanctity of human life and the dignity that belongs to all human persons who are made in the image of God," he stresses.

On-the-job view
As the medical director of emergency services at St. John's Health Center, Dr. Russ Kino has an up-close perspective on the nation's health care dilemma. He and the other physicians and nurses who staff the emergency room at the Santa Monica hospital treat a "tremendous" number of uninsured patients, who use the ER as their health care provider of last resort. As a result, they wind up sicker and their care costs more. It's the reason why so many hospitals are closing their emergency rooms, he reports.

Another major problem is that health insurance plans are not passing on the money they're being paid by covered patients to hospitals and doctors. So while the cost of providing health care is skyrocketing, reimbursements to caregivers are not keeping pace.

"I think the measure of a society is how well it takes care of its most downtrodden people," Dr. Kino says. "And it's not understandable that we Americans have so much and yet there are so many people who are struggling so terribly with something as basic as their health care. It doesn't add up.

"We've put a man on the moon, and a shuttle goes up every month. We do these incredible things. Yet, we've got 46 million people without health insurance. And probably 40 of those 46 million are people with jobs who work hard and who are bankrupt when they get sick. It's just incomprehensible."

The Catholic Health Association has responded to the growing health care crisis of the uninsured and underinsured with a nationwide initiative launched in the summer of 2005. CHA's Covering a Nation focuses on promoting a public dialogue on health reform, while building a community-based consensus around the need of accessible, affordable and quality health care for everyone.

Working with the group's 58 health care systems and 1,400 individual facilities ---as well as the communities they serve --- the goal is to raise grassroots awareness of the moral and economic consequences of a failed health care system that leaves tens of millions of Americans fending for themselves when they get sick or injured.

"Our membership is a great network of grassroots people and advocates who can speak for change all over the country," says Tieman, the movement's director. "What we're trying to do is work with CHA members to have a voice in their community to engage people in dialogue on this issue, to engage local state leaders on this issue and just to make sure that a conversation is not only happening on capitol hill, but all over the country.

He stresses that the association isn't endorsing any single plan at this point because it should be something that comes "from the public conversation we're trying to generate."

When costs come before health
Maria Garcia would just like a health plan that took care of people like herself until they were 65 and can qualify for Medicare, the federal government's health care coverage program for people 65 or older, or who have a disability. The 59-year-old widow has never had health insurance, even when her husband was alive and covered by a Kaiser plan.

"It's expensive," she explains, holding up both hands. "I can't afford it."

Recently, Garcia had to pay $250 for a physical because she wasn't feeling good. Some expensive tests told her she has high cholesterol; she is supposed to go back to the Huntington Park clinic for a follow-up checkup, but can't afford it. She also hasn't been to the dentist in a long time and needs root canal work.

But what concerns Garcia the most are her eyes. At a free mobile clinic, she learned that she has both glaucoma and cataracts, and needs to see an optomologist. She's been a little reluctant to schedule an appointment, however, because she's not sure how much it will cost.

"One of the things that most worries me is my eyes," she confides. "And sometimes I really worry about one day if I get really sick, what am I going to do? It's a big thing to think about, especially as I'm getting old. I have no children and I'm by myself, so sometimes I really worry about it."

She tries to stay healthy by not eating too much meat or junk food or anything with butter on it. Meals are mainly fruits and vegetables. And when she has some extra cash, she cooks with olive oil. Exercise comes from running to catch the Green Line Metro and walking to her part-time training position at St. Margaret's Center in Lennox.

Garcia has only had to go to the ER twice, for pneumonia and another emergency she can't recall.

"I must have been a very healthy person," she says, chuckling. "But I would say, 'Oh, I have a pain right here' or 'My ankle hurts' or 'Oh, my knee.' So I could have gone to the doctors many times. But instead, I just put up with the pain."

After a moment, she adds, "I always say I'm too young to have any benefits from the government, and I'm too old to get a good job." She laughs again before becoming serious. "I'm hoping that I'll be healthy until I reach the age of 65. That's my biggest hope in life."

Editor's note: The Alliance of Catholic Health Care, which represents California's Catholic health care systems and their 59 hospitals, recommend a yes vote on Proposition 86, the ballot initiative that would help fund health insurance for the state's 800,000 uninsured children.