The souring state of health care has always been an issue for the working poor, but increasingly it’s a middle-class issue, too. More than a third of the uninsured have household incomes over $40,000. Thirty-five percent of households with incomes between $50,000 and $75,000 report having trouble paying medical bills and health insurance. And more than a third of those who carry both insurance and medical debt have either college or graduate degrees. It’s not hard to figure out why health care has become such a precious commodity: Family premiums have increased 87 percent since 2000, compared to an 18 percent rise in inflation and a 20 percent rise in wages. As of 2006, only 61 percent of the population had employer-provided insurance, down from 69 percent in 2000—meaning that more and more people are expected to figure out how to cover the rising costs on their own.