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I’m lucky enough to live in a city with multiple, excellent choices for health care and even more fortunate that I’m able to afford them. I say that because when I first moved to this city and started visiting doctors I quickly learned that there are two kinds of doctors in Los Angeles. Ones who accept insurance and ones who have decided that rather than spend time fighting with insurance companies they’d rather spend time with their patients so they don’t. Specifically, and repeatedly, a number of doctors I found in town told me this – “Insurances companies don’t want me spending more than 10 minutes with my patients, and I can’t do my job to the best of my abilities in only 10 minutes so I don’t take insurance and then I get to spend as much time with my patients as I think is needed.” My pediatrician, my ENT, My sports medicine doctor, my dentist – all told me similar stories. They went to school to learn how to practice medicine and when 20-30 years down that career path an insurance company notified them that they could no longer spend the time with their patients that they felt they needed to they cut the insurance companies out of the equation.

But this was all up front so I knew what I was getting into. I set up a recurring transfer with my bank so that each month I’d put X dollars into a specific savings account that I knew was just for doctor visits. This certainly would have been useless if I was hit by a bus, but as a relatively healthy active guy in his mid-30’s (at the time) it covered the bases for what I needed quite well, and when I needed it I felt that I got the best health care I possibly could. My doctors were thoughtful and caring and took time to give me choices, explaining the potential outcomes of every potential route. This was a starkly different feeling I’d ever gotten from a doctor previously where I’d always felt rushed in and out, and prescribed some course of treatment without any understanding what or why. Of course, now I understood why, those doctors were trying to meet the demands of the insurance companies.

Skip ahead to 2015. I’m now legally mandated to buy health insurance and as noted by many others the low premiums translate into massive deductibles. And to be clear “low premium” is still a few hundred dollars a month. It’s about the same as I used to squirrel away in my health savings account. Which I still have to do by the way, because my doctors still don’t accept insurance. So I could dump them and go to another doctor who does accept insurance and then it would balance out right? Wrong. Because until I hit that giant deductible I’m still paying out of pocket. So where as before I was paying out of pocket for health care, now I’m paying out of pocket for health care and health insurance that I can’t take advantage of unless I get super sick.

Earlier this year I had to make an emergency room run late one Sunday night. Whew, I thought. At least that health insurance wouldn’t be a total waste. A few months and bills later and the end result works out to basically I pay $6,000 and my health insurance pays $200. Because it turns out they don’t cover 99% of anything done in an emergency room. This is on top of the now twice as much as I used to have to spend every month on health costs.

And again, I’m fortunate enough to be able to afford it. But lots of people aren’t. People are forced to have insurance but still can’t afford to go to the doctor. This is a mess. Single payer is still seems like the only reasonable solution.

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