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Marion Hicks was for many years a hospital chaplain in Atlanta, Ga., working the night shift. Two years ago, she left to join her sister, June Preston, in Douglasville, PA. June had been an office manager. The sisters are getting by in retirement, except when it comes to health care.

"If we didn't have to have all these expensive medicines, we'd do fine," Marion says.

Both are on Medicare, with AARP as their supplemental. They have no coverage for prescription drugs, and are paying out-of-pocket. "We tried to get something (to help defray expenses); the government says it gives seniors a break. But our income has to be so low that my Social Security plus my retirement from the hospital is too much," Marion says.

The situation has grown more serious as the sisters grow older. "We try to be frugal," Marion says. "We just can't go over" the budget. They have developed stratagems to save costs. "Our local drug store, we can't go there." They have found a place, Sam's Club, 19 miles from their home, that sells medications much more reasonably because it buys in bulk. It's a 38-mile round trip, a long drive for a retiree on Pennsylvania's soon-to-be-icy roads.

Marion also asks doctors for samples. "I call up, I'm begging for medicines all the time; it's a shame." On other occasions, she simply foregoes taking one of her medications. Both sisters are diabetic, and June is insulin-dependent. One of June's prescriptions is $100 a month, and the two sisters combined spend in the hundreds of dollars.

She considers the Rx express "a sheer blessing." She hopes to get medicine for diabetes in Toronto, as well as Plavix for a heart condition. Marion, like others on the train, also wants to let the world know that the way the United States treats good, productive, solid citizens when they reach their golden years is almost criminal.

"I've worked since I was 12 years old," Marion says. "I would have thought I could have a prescription plan that is affordable" when I retired. "Those of us in the middle class who have worked hard and saved some money for our later years, we have to spend it on medicine." Marion has many friends who can't afford medicines at all.

She is critical of everything from the federal ban on bulk purchasing to the exorbitant prices pharmaceutical manufacturers charge the government, all of which drive up the costs to consumers. "The manufacturer charges ridiculous prices just because it's a government program. They're wasting the government's money."

Meanwhile, Marion says, the country has evolved to the point where "you have to to be rich to get good health care. I think it's pathetic."