Health Insurance and Health Care Access Are Not Synonymous...

... and my own life story illustrates why.

In 2006, I was uninsured. No -- I wasn't shirking on an adult responsibility; instead, I had a pre-existing condition, no employer-provided coverage, and no means to pay for an individual plan at the "high-risk" rate. Thus, when I came down with an intractable infection that landed me in the hospital several times over the course of two months, I was handed a bill that totaled over $20,000. Just for a point of reference, I made about $26,000 – $30,000 a year. My hospital tab was 2/3 of my highest annual salary.

But here’s what happened next: My mother and I informed our local hospital that I could not pay their bill, and they referred me to a hospital charity set up to deal with cases like mine. This charity took a look at my income and my necessary outlays (car payment, student loan, etc.) and decided to cover 75% of my medical expenses. The remaining 25% was spread out over a few years of monthly payments.

During my gap years, I was always able to access care. Not only did a voluntary organization assist me in the instance described above, but I also had an in-town rheumatologist who charged me a very reasonable "out-of-pocket" rate for office visits and an arrangement with a major pharmaceutical company that ensured I could get a very expensive biologic mailed to my house free of charge.

Fast forward to 2017. Obamacare has helped me pay for an insurance plan, and it's pretty generous on paper. Standard preventative care is fully covered, while specialist co-pays are dirt cheap. Trouble is, I can't see my in-town rheumatologist anymore. Instead, I had to start over with a specialist the next county over, and it's damnably difficult to get a convenient appointment with her because she - and my primaries too - are consistently booked solid. In short, while I am now lavishly insured, access is now difficult.

Here's the upshot: When crafting health care policy, we shouldn't worry about insuring everyone. That's not the real issue. The real issue is that some people are having trouble accessing medical care -- and simply roping everyone into a national insurance scheme may not actually solve that problem. Please keep this under consideration while discussing Obamacare and/or its possible replacements. 

Brief Responses to Irritating Memes I: What the Hell's Wrong with GoFundMe?

During previous election seasons, I used to respond to social media nonsense on a fairly regular basis. Given that we are in the midst of yet another disaster election season, I think it's time I re-institute the practice. Oh, and what do we have here? Well, gee, I think it's a perfect place to start:

We can debate the pros and cons of government-run health care until the cows come home. What I actually want to address is this meme-maker's evident aversion to private charity. What exactly is wrong with using crowd-sourcing to raise funds for a person in medical trouble? For me, GoFundMe is a potential alternative to statism and a beautiful example of the genius de Tocqueville observed in his writings on American volunteerism. Friends and family coming together and pooling their funds to help a person in need is wonderful -- and not necessarily inferior to the faceless bureaucracy of the welfare state. As I wrote years ago:

I have been in a welfare office before. In 2006, after a long illness that required repeated hospitalizations, I was without health insurance and facing a $30,000-plus medical debt that I would not have been able to pay even if I had cut out every single luxury from my budget. What I remember most about the experience was the austerity of the waiting room – the rows of uncomfortable plastic chairs – and the human isolation. We didn’t talk to each other; there was no sense of human solidarity in suffering. I understand that a welfare office must exist to handle certain contingencies, but I will never understand why some people consider such a place to be preferable to a private and/or religious charity. The latter presumes that you are a human being with dignity and treats you as such; charity workers ask you about your family, may share a meal with you, and are, on the whole, more willing to go the extra mile for you because they are there voluntarily. A government social worker, on the other hand, may be a caring and compassionate person in his or her everyday life, but he or she is also frequently overworked and laboring under a bureaucratic machinery that, by its very nature, doesn’t presume your dignity simply because the sheer size of the caseload prohibits such interaction. To put it another way, to the government, you are a series of numbers (income, debts, bills, etc.).

The left is always looking for ways to depersonalize the social safety net -- and frankly, I don't understand the urge.