During the first 30 years of my life, I had no health insurance. Neither did a lot of other people, back in those days.

During those 30 years, I had a broken arm, a broken jaw, a badly injured shoulder, and miscellaneous other medical problems. To say that my income was below average during those years would be a euphemism.

How did I manage? The same way everybody else managed: I went to doctors and I paid them directly, instead of paying indirectly through taxes.

This was all before politicians gave us the idea that the things we could not afford individually we could somehow afford collectively through the magic of government.

When my jaw was broken, I was treated in an emergency room and was given a bill for $50 -- which was like a king's ransom to me at the time, 1949. But I paid it off in installments over a period of months.

Like most young people, I was lucky enough not to have any heavy-duty medical expenses that would have required major operations or a long hospital stay.

That is still true for most young people today, which is why many people in their twenties do not choose to pay for medical insurance, even when they can afford it.

They know that, in an emergency, they can always go to an emergency room. And today the idea that you ought to pay for that out of your own pocket is considered almost quaint in some quarters.

It is not uncommon -- especially in California, with its large illegal immigrant population -- for hospitals to have to shut down because so few people pay for the emergency room care they receive.

There are, of course, people with huge medical bills that they cannot possibly pay. Believe it or not, that also happened back before the modern welfare state.

Some hospitals -- whether public or private -- could absorb such costs, with the help of donors. There were people with polio living in iron lungs, which is why rich and poor alike gave money to the March of Dimes. Continued...