In a bakery and cafe a few blocks south of Barnes-Jewish Hospital, the subject of health care reform is on the menu.

That's partially because the clientele includes a number of medical students, but mainly because the regular customers are gearing up for another benefit to help cafe owner Marcia Sindel pay her medical bills. She needs to have her gallbladder removed. She also needs an operation on her hand. She is already in hock for an operation she had a couple of years ago.

She is 55 and has been without health insurance for about 15 years.

She grew up in an upper-middle-class family in Webster Groves. Her father was a lawyer. Her mother was a social worker. Marcia was the youngest of five children and the only daughter. Two of her brothers are lawyers. Two are doctors. She has a master's degree in social work from the University of Kansas.

She never spent much time in social work. When her three kids were young, she ran a day care operation in her home. She then spent a year working for the state Division of Family Services in a child abuse unit, but she quit that job to make more money managing a movie rental store.

She had health insurance in those days, but it was mostly through her husband. He worked as a mechanic at a car dealership. She had a nasty bout of pneumonia in 1988 and spent some time in the hospital, but otherwise, she had no health problems.

After her divorce about a year after the pneumonia, she was without health insurance. She wasn't too worried. She was healthy and had the confidence you'd expect from somebody who grew up in comfortable surroundings and whose friends and family were relatively affluent. Lean times would be temporary.

After leaving the video rental business, she ran the off-site bakery for Bar Italia. The bakery was situated in the Forest Park Southeast neighborhood. She then bought the bakery. In 2002, she expanded the concept from bakery to coffee shop and cafe and named it La Dolce Via.

That first year, she earned about $10,000. In a sense, the cafe was like the neighborhood — filled with possibility but still struggling. In December 2004, this newspaper published a story about Marcia and the cafe. "She runs La Dolce Via on a shoestring, paying herself just enough to meet her bills."

But the cafe and the neighborhood were on the way up. La Dolce Via was soon considered an anchor in the neighborhood.

In September 2007, this newspaper mentioned the cafe as a hot place for brunch. Here is how it was described: "A neighborhood hangout where everyone, young or old, feels comfortable and welcome. ... The menu changes, but count on a varied selection of egg scramblers, such as jalapeņo, shrimp and gruyere, or eggplant, tomato and goat cheese. Of course, luscious cakes are available, whole or by the slice."

Still, it was more an artistic success than a commercial one. Although the place was lauded by local publications for its emphasis on locally produced, fresh and healthy fare, Marcia was just paying her bills. She still had no health insurance. She was a patient at the nearby Family Health Care Center on Manchester, which uses a sliding scale to determine fees.

She had back surgery a couple of years ago, and the cost was a very reasonable $4,000. Friends and customers held a benefit at Llywelyn's Pub in the Central West End and raised enough to pay her medical bills. But doctors discovered polyps in her throat, and that required more surgery. She still owes $2,600 for that.

Now she has a problem with her gallbladder. Also, she has a problem with her hand that will require surgery.

So again, friends are planning a benefit at Llywelyn's. It will take place Sept. 14. Marcia hopes the benefit will raise enough to pay off her debt for the throat surgery and cover at least part of the gallbladder surgery.

One of the organizers is Gina Christopher. She lives in the neighborhood with her husband and their two small children. Her husband is in a program in which he will earn a Ph.D. and a medical degree. She was at the cafe when I visited Friday morning, and when I asked her thoughts on health reform, she said we needed to do something.

She said that dependents cannot buy in to the medical students' insurance. She said she had a difficult time getting a policy after her first child was born. "And we're young and healthy," she said.

Marcia just shook her head. "We need universal health care," she said. "This is just crazy."

In the meantime, we have fundraisers.