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When Carole Jaquez rides the Rx Express across the U.S.'s northern boundary into Canada, it will not be the first time she's gone to another country to try to buy affordable medications. The only difference is that this time she'll be going north of the border instead of south.

Either way, it's the same quandary: Carole, now 78, and on a fixed income, simply can't afford to pay the costs of the medications she needs. She says she'd give up eating first. The horrific thing is that she or anyone else would be squeezed into that choice.

But that's the way it goes in the U.S. these days for everybody, and especially senior citizens. Because of the rapacity of the pharmaceutical companies and health insurers, ordinary, hard-working Americans are being forced to choose between life's necessities.

Carole, a widow with two adult children, lives in Apple Valley, in the high desert above San Bernardino. Born in Los Angeles, she and her husband, Ramon, moved to Santa Fe Springs in 1957 and lived there until 1999. He was a plumber until a heart attack in 1975 took him out of the work force. Carole worked in the schools for more than two decades, in Lynwood and Whittier.

They always belonged to one HMO or another. They had just moved to Health Net in 1995 when Ramon had another heart attack, this one fatal. Carole changed to Nationwide, where she remains.

The insurance worked all right at the beginning, in part because she was in good health. But the last couple of years Carole has developed problems that require medication that does not come in less costly generic versions; asthma, acid reflux and hypertension in particular.

She needs Provacid for the acid reflux, Advair for the asthma, and other medications as well. She takes eight in all and spends more than $400 a month on top of her $160 premium.

Her income is $2,200 a month.

The financial squeeze has been excruciating. Carole's sister said to her one day, "why don't we go to Mexico" and get the medications. And so they did, to Tijuana, buying the prescription drugs for far less than they would pay here. "Right at the border they have all these drug stores," says Carole.

They once were stopped at the border, the car searched, drug-sniffing dogs, the works. But she had a prescription for the medications she had just bought in Mexico, so the U.S. Customs agent let her go with a warning. After that, she walked across the border to get her meds, rather than drive.

Carole also sent away for medications, through Rx Canada, after speaking with her son and daughter-in-law. She saved $50 a month on the Provacid and Advair alone. But again, U.S. Customs in Long Beach confiscated one of those shipments as well.

Carole doesn't consider herself someone who is doing anything illegal. "It can't be contraband," she says. "I paid for it."

She wishes she didn't have to go north and south of her own border to get the medications she feels she has earned as a lifelong, hard-working citizen. But the costs continue to outpace her income. She always runs out of money at the end of the month. And there is an emotional toll as well: the anxiety of not knowing whether vital medications will always be available.

Carole would like to see a major overhaul of the U.S. health delivery system, including the introduction of bulk purchasing, regulation of price increases, and universal health care.

She worries that dire days lie ahead, with the government tinkering with Medicare and Social Security. "Medicare, my God, if they do away with that, I don't know what will happen to everybody. A lot of people are in dire straits. How are they going to survive?"

"We are controlled by those drug companies," she adds. "We don't have the money to fight them. It will take time; it's not going to happen overnight."

Health care is "vital," Carole says. "Everybody's in the same boat." The country needs to wake up and see what is happening, Carole believes, or the consequences will be disastrous.