"Long-term care constitutes a difficult and expensive challenge in any health system. But the American patchwork, full of cracks through which people fall, has a special problem with medical expenses of all kinds bankrupting couples. A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills. M. still helps her husband and, quietly, continues to live with him and care for him. But she worries that the authorities will come after her if they realize that they divorced not because of irreconcilable differences but because of irreconcilable medical bills... 'It's just crazy,' she said. 'It twists people like pretzels.' The existing system doesn't just break up families, it also costs lives. A 2004 study by the Institute of Medicine, a branch of the National Academy of Sciences, found that lack of health insurance causes 18,000 unnecessary deaths a year. That's one person slipping through the cracks and dying every half an hour. In short, it's a good bet that our existing dysfunctional health system knocks off far more people than an army of 'death panels' could - even if they existed, worked 24/7 and got around in a fleet of black helicopters."