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For Susan Walker of Granada Hills, health care coverage is not something abstract, an optional expense that she can take or leave. For Susan it is, literally, a matter of life and death. She has had bad luck medically, with heart problems, cancer and other ailments. She has had seven surgeries.

So when she opened her mail in early December and saw the new 2004 rates from Kaiser Permanente, she panicked and then plummeted into a deep pit of depression.

Susan's premium will shoot from $319 to $493. Worse, in her eyes, is the jump in hospital stay to $200 a day. It had been free.

"I don't understand why they did this," says Susan. "The last one was from $249 to $319, so I thought it would go up a little, but not like this. Coverage is vital. It's my safety net, my security blanket. I feel as though it's been completely ripped from me now."

The only moderately good news on her health care premium front this holiday season is the fact that the increases don't affect her children. Her adult daughter is covered through her place of employment and her son, a 17-year-old high school senior, is covered by her ex-husband's plan.

Susan, who is 61, grew up in San Marino and has spent most of her life in southern California. Her health was not an issue until 1986, when she contracted cancer. She beat it, but like all cancer survivors she has had to be cautious; that caution requires constant medical monitoring. She also has had heart problems.

"The hospital fee is really frightening," Susan says. "I've had seven surgeries."

Susan looks around her and does not see any help forthcoming. Because she is not strong enough, she cannot work full time. An administrative assistant, she works 25 hours a week, not enough to qualify under her company's plan.

The cancer and the heart problems give her pre-existing conditions, making a move to a different insurer all but impossible. "I don't know what else to try," Susan says.

The premium increase, along with her general health problems, also has affected her mental health. "I was so distraught, I wanted to get some counseling," Susan says. Then she learned that the co-pay for counseling also is going up, making that, too, unaffordable.

Like the many other patients over 50 who are receiving similar notices from Kaiser Permanente this month, Susan believes the health care giant is attempting to jettison people as they age. "The older you are, the more you're going to cost them. It's age-ism. It's total discrimination," she says. "You're penalized for being older."
It's more than discrimination: it's also cruel. "We need it (health care) the most," she says. And the entire issue of health is "more nerve-wracking when you get older."

Until now, Susan has remained politically unsophisticated, but that may change. She is not just depressed and worried, she is angry. She cannot understand how Kaiser or any other health care insurer can raise rates arbitrarily. "They're not accountable to their clients?" she asks.

"We need some kind of cap" and other state regulation, Susan says. Without someone keeping insurers in line, "it's only going to get worse."

"If you want me to carry a banner, I'm ready," says this suburban Mom. "I'm ready to start a riot."