Once there were three classes in America. Now there are two.

You are rich or you are poor.

How do we tell the difference? It's quite easy:

• In the 19th century the rich were fat. Prosperity meant you had enough to eat.
  
• In the 20th century the rich were thin. Prosperity meant you could control what you ate.
  
• In the 21st century the rich can age.
  

It's access to health care that now divides the rich from the poor. If you've got a good health care plan, or can even afford to go beyond it for cash, you're rich.

If you can't, you're poor. Are you in an HMO that says "no" like one of David Spade' s Capital One ads? You're poor. Are you attracted by these new "pretend health care plans" that say if you're young and healthy you've got "found money" and you don't have to pay for others' problems? You're poor. Work for Wal-Mart and you're not a manager? Don't let their adoption of their own "pretend" plan kid you, nor their talk of how you're an "associate," you're poor.

The divide -- the key to the divide -- lies in preventive care. Specifically the drugs you need to stay out of the hospital.

I'm lucky. I'm rich. Thanks to my wife, and her health care plan, I can get Lipitor for my cholesterol, Diovan for my blood pressure. My son can control his anger, my daughter can control her acne. We even have eyeglasses and regular dental check-ups.

I know, wow. If she left me, or were fired tomorrow, I'd be on the other side of the divide within moments. My prosperity rests on a knife edge. We call this middle class.

My point today is that the divide is getting deeper, and wider, every day, in every way. Many of the "race differences" we spot on the street, here in Atlanta, are really just differences in class. What's the average life expectancy? What's the median age? These are life-and-death questions.

At some point this will become obvious to a lot of people. And if you think the political divide is intense now, wait until it truly becomes a matter of life-and-death.

Because the trends that have made health care the class divide are continuing. More and more of us require more and more prescription drugs to stay out of the hospital. These drugs are expensive. Their price responds to neither Moore's Law nor the laws of mass production. Every day brings a new medicine, something new to be stopped or prevented. And the rich "talk to their doctor," while the poor wait until they're sick, get in the ambulance, cost 100 times whatever to treat, and die anyway.

This is today's status quo, and that status quo cannot hold. Emergency care is becoming unaffordable. That's what these "pretend health care" plans are all about, getting people out of the systems through which they help pay for that emergency care. There are fewer and fewer critical care hospitals, more and more mistakes, and one fine day (maybe today) doctors won't be able to stitch things together. The ambulance won't come, the acute care won't be given, people will die in the street, or their homes, the promise of Hippocrates forgotten. We can't rely on doctors to solve all of society's ills, we just can't.

In fact, of course, this is already happening. Drop by any barwhere ER doctors get together, after the second or third beer, and if you offer to buy a rand you'll get this truth.

Wealth and poverty are life and death in America. Welcome back to the 19th century.