I do not have health insurance at this time, and I have not had for some years. The job I have now, working to administer a small nonprofit, does not offer insurance as a benefit, and I some time ago realized that the possible penalty for not having insurance would be less than the price of insurance for me. Said price, given that exactly two practitioners in my county accepted the insurance I had at the time (and my own nonprofit was one of them), was not worth paying when I had the insurance, and it was damned well not going to be when my expected premium was set to go up while both my copay and deductible also rose. No, I am on the “don’t get sick” plan that I had back before the Affordable Care Act was passed, and I’ve been lucky enough so far that that’s been all I have needed.

I’ve been lucky, too, that my wife works a job that does have health insurance as a benefit. Indeed, her tenure with her employer and her consistent performance in her position have led to her insurance being paid for by the company–along with our daughter’s. Knowing how much such premiums are, I am aware of just how large a benefit it is, and I appreciate it greatly, even if I am not so sanguine about the system that makes it so–or, at times, about the specifics of the benefit itself. Because, even with the substantial outlay from the employer, the insurer through which my wife and daughter are covered seem unable to get their act together. More, even when they give consistent information–which is not always–that information does not necessarily work to our good. Medical care in the United States is the price it is, and our paychecks are only what they are; I’ve been able to save some money up, and I’ve been able to pay some debts down, but a surgery that runs to tens of thousands of dollars before insurance pays and is still close to ten thousand after it does is not something we can easily absorb.

I am happy to have the option to pay, truly; the alternative, the procedure not happening, is not one I would have preferred to entertain. But I know that I cannot ever be in need of procedures of my own; with as much a blow as it is to have it done on someone who is “insured,” it would be far, far worse for me. And I am not willing to have my family suffer such a blow–or the smaller series of them that it would take to offset the single large one.

Help with the out-of-pocket maximum?