My medical insurance "premium" went up.  Again.  I'm 42, healthy, and self-
employed; I need insurance only for a real catastrophe such as serious disease,  head trauma, or spinal cord injury.  If I see a doctor for something routine, I'm glad to pay directly.  Thus, I selected a policy with a $5000 deductible; only with a major problem would I or my family ever call the insurance company.
         I was pleased to spend $35 a month for this most basic coverage when I signed up last year.  Now, 16 months later, it's up to $65 and I wonder when it'll go up still more.  Meanwhile, the company has sent me voluminous and confusing information about more and more services that aren't covered, or that would need special "preauthorization."
         Please note that I call this "medical insurance"--not "health insurance."  I do, also, have a low-cost Health Plan, based on common sense and my study of health:  I eat a low-fat, whole foods, mostly organic diet; I enjoy regular moderate exercise (both aerobic and stretching exercises); I express my feelings; I maintain fulfilling emotional ties with family and some close friends; I drink purified water; I sleep well; I spend some time outdoors each day; I periodically visit places in wild nature; I don't smoke, drink alcohol, or watch television; I laugh often; I do work that I enjoy and believe is good for the world; I'm frugal with money; I wear my seatbelt; and I floss my teeth.  That's my Health Insurance Plan.  I'm still working on it:  drinking more of that filtered water, giving up caffeine, starting again to meditate, and singing and dancing more would all be good--but still I'm happy with it at this point.
         While my Health Plan pays huge dividends every day, my medical insurance costs feel like money down the drain--but I'm convinced I must have it, "just in case."  It's easy to see how millions of people, including children, have no coverage at all.
         Even millions of people with jobs have no coverage, particularly those who work one or more part-time jobs or who work in small businesses.  Many companies are using more part-time and temporary workers, largely to avoid buying expensive insurance for employees and their families.
         It puzzles me why medical insurance should be tied to your job, anyway.  What, really, have they to do with each other?  It possibly made sense in the past, when people often stayed with one company for many years.  But now, with companies constantly buying and selling each other, with "downsizing," and with whole types of work being virtually eliminated or exported overseas and new kinds of work emerging overnight--who can plan on holding a "stable" position for 20 or 30 years?  Today, creativity often demands a job change, but dependence on medical insurance from an employer can squelch people's growth in their work, particularly if they have children needing coverage.  People are especially discouraged from job changes if they or a covered family member have a "preexisting condition" needing medical treatment, since such conditions will often
not be covered by the new insurance for at least a year.  Understanding these problems, Bill Clinton has mentioned the need to make medical insurance more "portable," but little progress has been made.
         My own frustrations have left me hoping for a Canadian-type system.  I  don't know if that approach is really best, but I'm certain that something must change, and we should be looking all over the world for ideas.  For several years, I've been conducting an informal poll:  whenever I meet Canadians, I ask how they like their system of access to medical care.  So far, most seem well pleased; one proudly showed me his card, boasting "I can be seen in any clinic in the country."
         In any case, I distrust our own media's sometimes instant dismissal of the Canadian system, calling it "socialist" (i.e., bad).  I must point out that we have socialized medicine right here in the USA, at least for people over 65.  It's called Medicare, and is currently in big trouble due to the same skyrocketing costs I'm experiencing.
         Why are costs rising so quickly?  Our population is aging, and older people
generally use more medical services.  More significantly though, our medical system often fails to actively promote health, instead responding only after disease strikes.  This is tragic on both an individual and societal level, because "an ounce of prevention" truly is worth "a pound of cure."
         Modern medical treatment is based on using science and technology to cure (or at least "manage") disease and injury.  Along with this "interventionist" world view, financial pressures drive medical research to focus mainly on the search for profitable "cures," instead of for the underlying principles of health.
          Basking under our often unquestioning esteem, medical science each year
performs phenomenal amounts of research and produces more and more sophisticated (and expensive) drugs, tests, and procedures, which are then offered to the (insured) public.  The fruits of this research have been astonishing (the virtual elimination of polio, to cite just one example), but we have reached a point of diminishing returns, and this approach no longer addresses the larger needs of our people.  For example, I question the wisdom of pouring so many resources into the generally disappointing "War on Cancer" research, thinking that some of the money would better address the devastation of cancer if it were spent on public health measures applying what we already know to prevent and minimize cancer.  We'd eliminate lots of cancer with major commitments to stop-smoking programs, better nutrition education, and programs to minimize carcinogens in our food, water, and physical surroundings.  In cynical moments, I wonder if much of the taxpayer
money now spent on medical research actually constitutes a kind of welfare for the
scientific establishment, with little "trickle-down" to things that improve our health, and with many discoveries "spun off" to private companies for highly profitable applications.
         Our society faces hard choices, and delay only makes the problems worse.  Would you spend a couple hundred thousand for a dramatic surgery and hospitalization to extend my life 3 or 4 years, or would the money go farther with the public health measures mentioned above, or with prenatal care to get babies and mothers off to a good start?  Neonatal intensive care is expensive indeed...
         Resources are not infinite.  We should get the best value for our health care
dollars.  Currently, a large proportion of Medicare money is spent on highly  complex treatment of patients in their last few weeks of life.  Why not spend less money, earlier, to improve both health and quality of life for older people?  Unfortunately, death has become a "growth industry," sometimes at the expense of the supposed beneficiaries, who can experience much pointless suffering.  This happens because our technical knowledge merges with our denial of death and desire to "conquer" it, all within an atmosphere where dramatic medical treatments have been highly profitable for the providers.
         Hillary Clinton raised our hopes for "health care reform," but the concept fizzled.  What happened?  Just "follow the money."  Fortunes are being made, and institutions enjoying the golden flow are unlikely to embrace fundamental change, but rather can use their substantial influence to prevent it.
         Medical care has been very profitable, especially since public dollars really started flowing when Lyndon Johnson gave birth to Medicare in the 1960s.  Pharmaceutical companies, for example, have been top performers in the stock market for years.  The purpose of large corporations, including insurance and other corporations related to medical care, is to maximize shareholder wealth.  That is simply their nature.  Not-for-profit medical organizations are sometimes virtually indistinguishable, because they must compete for survival by "maximizing market share" within the overall profit system.
         Libertarian theorists may disagree, but I see no reason to believe that medical
companies maximizing their profits will necessarily also maximize public health.  In Greek, "demos" means people.  In a democracy, "We the People" are in charge.  Health is our most precious asset, and must not be sacrificed to the wealth-hunger of the few.
         I hope we won't need to agonize over the complexities, exclusions, and high costs of our insurance coverage for too many more years.  I hope doctors will not have their hands tied by distant insurance company managers.  I hope there is a continued resurgence of interest in basic care and health promotion (or "wellness"), and a corresponding decrease in the glamour and profitability of technical and expensive "heroic" medicine.  I hope we can accept that death is normal, is not a "defeat," and can be borne with dignity and acceptance.  In the meantime, I hope more of us will question how we have given others the power regarding our health, and will instead follow a low-cost, common-sense Health Insurance Plan of our own creation.