On this fiftieth anniversary of Medicare and Medicaid, I realize how many are left out. A student I worked with in a medical school clerkship last year came to me for a recommendation for residency, the first such letter I have been asked to write.

He came here from South America with his mother and siblings 17 years ago - for years, his family was undocumented; now, he is finishing his PhD as he prepares to end medical school.

"Being poor there was different from being poor here. There, we lacked basic needs. Here, electricity is taken for granted. But in both places, we lacked health care."

We talked about a patient we met during our work together, a man from Mexico who was diagnosed with cancer shortly before we met him. He died a week later.

"I remember when you and me and another student talked to him in Spanish. He was so relieved to be able to communicate. And I remember when I came here, it was like people were just making sounds around me. I felt so alone."