About 6 years ago, I flipped over my bicycle and shattered by collarbone while training for a triathlon. My riding partner and my wife rushed me to the emergency room, where she spent 30 minutes filling out the forms.
After being admitted, I was administered to by a terrific doctor, nurses and technicians and given a shot that made me happy to be, well, just happy. I was incapacitated for a week between the pain and drugs but went weekly to an orthopedist who tracked the healing. I had wonderful group insurance that covered all the major expenses with just a few co-pays.
About 6 months later I was on a business trip in Marseille, when I slipped on wet marble and - you guessed it - shattered the same collarbone.
I went to my room as the hotel called the hospital. Ten minutes later two doctors (not EMTs) were in my room with a portable x-ray, pain relief and a ride to the hospital (when they pronounced it re-broken). On the ride, they took my name and address. At the hospital I was trussed up, given another shot and then taken back to the hotel. I needed no insurance, no long forms to fill out - they treated me because that's what you do when a person is hurt or sick.
("Cut! End of Happy Reel A. Put in Not-So-Happy Reel B.")
About a year and a half ago - I decided to pursue the American Dream (no, not a date with Lindsey Vonn -- not having a boss) and started a communications consulting full time. I've gotten lucky a few times working with talented people in technology start-ups so I had some runway to do this. I was also able to rely on COBRA (VERY expensive) for 18 months - hoping in that time, I'd get a break after the president passed health care reform, the top priority on his agenda.
But when health care reform got short-circuited, I figured it was time to search for individual health care for my family and me.
And this is where it gets weird. My family and I are pretty healthy. Blessed with fairly good health insurance, we have done yearly physicals, tests when appropriate and limited medications when needed. My wife suffered from migraines years back and there were my collarbone incidents. My son has seafood allergies and my daughter very mild asthma. But that's about it.
Then came the big shock.
We go online and fill out a request for coverage from Anthem. Typical policy, co-pays for primary care, $1,500 deductable etc. Hit the button and before I could close the computer screen - you have mail - DENIED. A week later I was finally able to talk to an underwriter who said the sleeping pills I had for my semi-regular trans-Atlantic flights brought the hint of mental instability (because the diagnosis was "insomnia") but I could apply for "reconsideration" with a doctor's note. I declined.
Just yesterday we got the wonderful news that UnitedHealth has approved a policy. Shock number two. There's a small deductable ($10,000), no co-pays on anything. In other words - everything is out of pocket before $10,000, and oh, those migraines my wife had years ago: there's a rider on her head. That means, any head related issues - traumas, tumors, headaches - will not be covered and can not even count toward the deductable. Remember those sleeping pills? Well, if I need counseling - forget it - all out of pocket (people who know me will be particularly concerned about this).
As I said earlier - I've been lucky - blessed with good health, a healthy family and a very good income. I can afford to pay most medical out of pocket (I mainly wanted the policy for the $3 million cap), but could most people? And being relatively frugal, will I forgo a suggested test now and then to save money?
My brother, who's 45 and has worked for a small auto repair shop for 20 years, has never been insured (except for the rare occasions his wife worked in retail). And there are millions and millions more out there like my brother. He has bad teeth and has not had a medical physical since his 30's. If he ends up in the hospital - or gets a debilitating disease - he will lose everything, end up a ward of the state (and that will cost us all).
According to the American Journal of Medicine, 60% of those who file for bankruptcy, do so because of medical bills. My father - who immigrated from Hungary in the 1950's -- worked his entire life, only to lose everything after the early onset of Alzheimer's. He was too young for Medicare, so he was stripped of all his assets to be put on Medicaid (and thank God for that safety net).
I mentioned the America Dream and I do not want to sound like I'm whining. Yes, I knew the risks when I left full-time employ with all its many benefits. But there must be millions of people in America who do not have the "runway" to pursue their dreams precisely because of the fear of no insurance. Isn't America where we encourage risk-taking (see mortgage-backed securities), and where we root for the little guy? Not to mention, the "little guy" may be the future. As larger companies begin to back away from insuring their employees, and as the temp and consulting markets begin to grow exponentially, the number of uninsured is bound to grow.
I strongly believe that we have the best health care providers in the world but despite what some claim, is it really the best health care system in the world?
By Joseph Eckert
Special to CBSNews.com