You might think you don't have to worry about paying for medical care if you have health insurance. But you would be wrong.
From escalating medical debt to postponed retirement, our exclusive national survey of working-age adults shows the depth of jitters even for those lucky enough to have insurance through their jobs or families:

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• 29 percent of people who had health insurance were "underinsured," with coverage so meager they often postponed medical care because of costs.
  
  
• 49 percent overall, and 43 percent of people with insurance, said they were "somewhat" to "completely" unprepared to cope with a costly medical emergency over the coming year.
  
  
• 20 percent of people in our separate subscriber survey said they were so disappointed with their HMO or PPO that they wanted to switch plans (see "Rating the Health Plans").
  
  
• 16 percent had no health plan at all, including many working respondents whose jobs didn't offer insurance, or who couldn't afford the premiums or deductibles of the available plan.
  
  

No wonder then that some said they ran up large debts, dug deep into their savings or deferred home and car maintenance to meet medical expenses, even those with insurance.

The high anxiety about health care has become an issue in several states, Congress, and the 2008 presidential race. The subject has emerged even in popular culture, in part because of Michael Moore's documentary film "Sicko," about the harrowing experiences of Americans trying to get health care.

"I've been studying the health system since the 1970s and would have told you back then that things would have changed dramatically by 2007, but they haven't," says Gerard F. Anderson, Ph.D., professor of health policy and management at Johns Hopkins University. "We are moving towards a system where only the employees of affluent large companies are going to have good insurance."

U.S. health-care costs, long the highest in the world, have risen so quickly that many people are having trouble paying their medical bills, according to the May 2007 survey by the Consumer Reports National Research Center, which sampled 2,905 Americans between ages 18 and 64.

This report, the first in a series, details how the situation has gotten worse over the past 15 years, since the country last engaged in a full-throated debate about health care. Our experts sifted through the complex issues and talked to people in our survey who said they would be willing to share their stories. Future installments will look at how the health-care system perpetuates unneeded treatments and medications, and will examine the trouble awaiting people who have to go out and find insurance on their own.