President Bush, meet Lorraine.

Here's the news that rocked my little world this month: We got a message that a family friend, let's call her Lorraine, who was in an ICU, barely able to breathe on her own. In the last few weeks, there'd been some mumblings about "not feeling a hundred percent," but no hint of anything seriously wrong. The diagnosis came back in a couple of days: fourth-stage breast cancer, which has spread in a number of other organs, including her lungs. If you know anything at all about breast cancer "staging," you know there is no fifth stage.

Lorraine has no health insurance. We didn't know that. In fact, we'd been content to believe that her consulting business was going as well as she said it was. In her late forties now, she's a former accountant who never could find another decent job--also a news junkie, an avid reader, and an energetic volunteer in a number of worthy causes. But it turns out she's been struggling with the cell phone bill and the rent. A few weeks ago, unbeknownst to us, she'd moved out of her apartment and into a free room offered by one of the nonprofits she volunteers for. The cost of a mammogram--well over $100--must have been out of reach.

President Bush, in his State of the Union address, said we should each have a "catastrophic" health insurance policy for the big ticket items like breast cancer, plus a tax-deductible savings account for the little things, like mammograms. If we have to take "personal responsibility" for our doctor visits arid routine care we'll be thrifty about it--or so the thinking goes--and the nation's medical expenditures will stop spiking like an Ebola fever.

It's an old idea, going back at least to the Clintons, that the problem with the American health system is that we, the consumers, just consume too much. Make us mindful of the costs by raising co-payments and other out-of-pocket costs, and we'll stop indulging in blood workups, MRIs, prostate exams, and all those other fun things.

President Bush, meet Lorraine. Her problem wasn't that she feasted on unnecessary care, but that like so many of the forty-five million uninsured Americans, she wasn't getting any care at all. Maybe, when she first noticed the lump, she should have staged a sit-in at the nearest clinic until it sprang for a free mammogram. But her idea of "personal responsibility" was not to be a bother to anyone.

And how much does the "personal responsibility" theory even apply to the insured population? I have insurance--at enormous cost, because I'm not part of a group plan and I'm an ex-breast cancer patient myself--but that doesn't mean I choose what care I get. It's not my idea to have an annual mammogram and pap smear. The doctor had to threaten tears before I'd submit to a bone scan, and they'll have to drag me in for a colonoscopy. No one aside from the rare victim of Munchausen's syndrome goes looking for recreational medical care.

The fact is there's a big difference between the economics of health care and that of, say, costume jewelry. We the consumers control the demand for costume jewelry; we can splurge on it or leave it alone. But we have precious little control over our demand for health care. Sure, we can exercise and refrain from smoking and sky-diving and swimming with sharks. We can eat right, too (whatever that may mean, with the dietary advice fluctuating from month to month). But it's the medical profession that determines how often we need our blood drawn, our breasts squished, our cervices scraped, or any of the other nasty interventions they have to offer.

If the medical care we consume was under our own control, I'd say, sure, save up for it and use it wisely. But it's no more in our control than the wind and floods we insure our homes against.

You think it's too expensive to have universal health insurance? Let's be hard-headed about Lorraine's case. If she'd been diagnosed earlier, she might have gotten by with a mastectomy and a bout of chemotherapy instead of burning up Medicaid dollars in an ICU. She might be out volunteering for the needy right now, instead of lying in terror in a hospital bed.

Barbara Ehrenreich is a columnist for The Progressive. Her latest book is "Bait and Switch: The (Futile) Pursuit of the American Dream." Her website is www.barbaraehrenreich.com.