Thank goodness for health insurance.

That's what I thought when I was stuck in Coeur d'Alene with a malfunctioned insulin pen, and discovered what the replacement cost would be without insurance.

I couldn't get just one pen; I had to get five, and the retail price was $500. My insurance provider gave me a break, and I ended up paying only $35. But I started thinking about those with diabetes who need insulin and can't afford to pay for insurance - which strikes at the core of the political debate over Medicaid expansion.

If I had needed test strips for blood-sugar monitoring, it would have cost me another $130 for 100 small, plastic test strips. But under my Medicare plan, the test strips cost zero.

I never thought that turning 65 would be so enjoyable.

Others are not so fortunate. If it's a choice between paying the rent and getting the proper medication, the landlord wins. Democrats, such as House Minority Leader John Rusche of Lewiston, would like to see the safety net expanded for the poor. Republicans, such as House Assistant Majority Leader Brent Crane of Nampa, are not so sympathetic.

"You won't find anything in the Constitution that says anyone is guaranteed health insurance. It's not a right; it's a privilege," he said. "The problem I see in government is we're taking privileges and trying to turn them into rights. Before long, a cell phone is going to be considered as a right."

So, who are the privileged? It includes people who have jobs in which employers can afford to offer health insurance, or those who happen to be attached to a spouse's insurance plan. It includes those who are old enough to be eligible for Medicare - and young enough to appreciate it (a routine visit with my doctor costs $5). Another route is to get elected to the Idaho Legislature, where part-time lawmakers get the same benefits as full-time state employees.

As for everybody else, have a nice funeral.

Of course, the government does not escape the costs. Some money can be saved by not providing coverage for medications, but the big dollars are in the complications. For instance, people with diabetes are susceptible to heart attacks, strokes, amputations, kidney disease and long hospital stays. Surgeries and treatments, such as kidney dialysis, can run into the hundreds of thousands of dollars - and the counties often end up paying those costs.

Rusche, who predicts the Idaho Legislature eventually will consider Medicaid expansion, takes issue with Crane and some Republicans.

"Are they saying we should not do things that are smart, because we don't want to help the people who can't afford health insurance?"

Crane and his fellow Republicans are not heartless people. They just don't think that government can solve all problems, especially a federal government that digs deeper in debt by the second. It isn't Crane's fault that the "open market" dictates charging $500 for a box of insulin and $130 for diabetic test strips.

Sylvia Mathews Burwell, the federal secretary of health and human services, told governors recently that her office would help states design programs for Medicaid expansion. According to Bloomberg News, she said, "This is about your children's financial and health security, and also about the economic health of your states."

She won't be getting a call from Crane anytime soon.

"I have not heard any hue and cry from the Republican side advocating that we have got to do Medicaid expansion," Crane said. "The federal government is borrowing 42 cents out of every dollar. It doesn't make sense for Idaho to take more money from a federal government that is fiscally broke."

Another sticking point is the federal government's track record on program management.

"Federally mandated programs are not lean, mean, efficient and effective," he said. "Our Founding Fathers did not set up a republic that would be solely dependent on the federal government, but that's exactly what people want - for the federal government to find solutions. I think the Founding Fathers intended for the states to find solutions."

Crane says the solution may be raising the indigent fund for counties. Rusche says a better idea is to expand Medicaid and provide more people with health coverage.

"Morally, it's the right thing to do," he said.

Chuck Malloy is a Silver Valley native and longtime political reporter and editorial writer. He is a former political editor with the Post Register of Idaho Falls and a former editorial writer with the Idaho Statesman. Email: ctmalloy@outlook.com