I've been a primary-care physician for 30 years, and these conversations have become heartbreakingly routine. Consider the 45-year-old hairdresser with severe hip arthritis, in constant pain, barely able to stand and work. He badly needs a hip replacement but, without insurance, what is he supposed to do? Or the 63-year-old paralyzed on his left side from a stroke, but who can't afford to see his doctor or buy his medicine. He knows that he is at high risk for another stroke, or worse. Feeling hopeless he told me, "I hope the next one just kills me."