We've all read or heard horror stories of folks with terrible diseases and no insurance. And we all know the plight of the working poor - those who slave in dead-end jobs with no health benefits.
But I think even today, many of us in the "middle class" think something like this: "Boy what a sad story, we really should do better. Single payer is the right way to go. I'm sure glad I have safe insurance"
But the fact is folks, in today's world of corporate cost cutting and free market health care - nobody is safe - not you, not me, not anybody. For my personal story to illustrate this, follow on...
Quick introduction: I'm a registered nurse, working in Cardiac Rehabilitation. My health habits are well above average - normal weight, lots of exercise, good BP, good cholesterol. I'm a former competitive cyclist and long distance runner and still cycle an average of about 150 miles a week.
Last summer, looking at the number of things I wanted to do and the likely number of years left in my life, I decided it was time to shift balance a bit. My wife and I have always practiced a frugality that is way out of the American mainstream: no credit card debt, mortgage paid off, started a retirement account almost as soon as I got out of school.
So at 56, I can't quite afford to not work, but I could work less and get by fine.
So I decided to go to "per diem" status at work. That basically means irregular hours and giving up benefits, with a small increase in the hourly rate to partially offset the lost benefits. Now I'm not one to risk going without insurance, so I carefully studied the options. My wife is a bit older than I, and has now reached Medicare age, so she was no problem. For myself, I concluded that I was actually a good candidate for one of the high deductible plans paired with a health savings account that the right love to push.
Now I won't go into here all the reasons that these are terrible public policy - that's a whole 'nother diary. But they basically can work for someone who meets all of three criteria:
- Healthy
- Pretty well off - enough money to meet the high deductibles if you have to and enough income so the tax deduction actually matters
- Medically sophisticated enough to make good choices about what health care you do need.
Well, I figured that pretty well descirbes me, even though it doesn't fit a lot of people. So I thought that was the ticket and the price was manageable, even at my age - $235 per month. With my super good health history, I didn't think qualifying would be a problem.
But I outsmarted myself a bit. I decided to keep my employer's insurance under COBRA for a few months so I could get a few routine things taken care of: see the dentist, the eye doctor, get some new contacts - and see my dermatologist for a routine check-up. It was the last one that got me. She found a little Basal Cell Skin Cancer on my nose - not big enough that I had even noticed it. But because of where it was, it needed a fairly sophisticated procedure to take off, and a little tiny skin graft.
So I got that done, decided that was about the last thing on my list and went to get my new high deductible plan. But, no - because of that little thing on my nose, I have now joined the ranks of the uninsurable. No individual health plan available at any price.
Once again, I am luckier than a lot of people. I can continue my insurance under COBRA until next January. And because I am an RN, one of the most in demand professions around, even at 56 I'll have no trouble getting a job with benefits again if I must. (Heaven forbid I should be a computer professional looking for that benefitted job at my age.) But that's not what I want to do with the next few years! It infuriates me to be in the only wealthy country in the world where I need to shape my life choices around the need for health care.
Rather ironically, I've been an activist for single payer for years. And I know that the incremental approaches on the table right now are all disasters. But I also can't help noticing that many of them do include some form of guaranteed issue and community pricing - which would solve my immediate problem quite nicely - while still leaving lots of others out in the cold. Talk about mixed feelings!