To fall sick in the United States is to undergo a unique rite of passage. Each sick person discovers the ordeal of trying to get a diagnosis, of attempting to access treatment, and of being extorted every step of the way—of realizing that we do not, in fact, have a healthcare system. Beliefs that the healthy can hold lightly no longer make sense—the belief, for instance, that health insurance will provide. The sick soon learn that insurance, even “good” employer-provided insurance, does not protect them from outrageous bills, and that paying through the nose is no guarantee of timely, humane, or even competent care.
In order to get medical treatment, Americans have to deal with one of the most opaque industries in the world. The 28 million people who do not have health insurance are locked out of affordable care almost entirely. The 50 percent of Americans who get insurance through their employers have little say in the coverage they end up with: the employer chooses the plan, or sometimes a couple of different plans; most employees will never see how any of this is decided, despite the fact it will determine which doctors they can see, the monthly premiums they’ll pay, and the deductible and out of pocket costs that will hit them if they get really ill.
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