Before I was diagnosed with NHL, I took it for granted that I had health insurance. I had always worked, and the companies I worked for always provided health care coverage. I never gave much thought to those without health insurance, nor what might happen if I should lose my job. After all I really didn't even need insurance. I was always healthy, in great shape, and never got sick or injured.

I also thought that I had good health insurance, but I never really had to use it. Sure I had the occasional doctor appointments for my annual physical, the occasional infection, minor bike crash or other simple matters like that, but nothing with any long term impact.

But then a very unusual thing happened. I actually got sick. Can you believe that? How could I get sick? I was always healthy, ate right and was in great shape. I couldn't get sick, or so I thought.

That was a wake up call. Too bad it couldn't have been something less drastic to wake me up, but it wasn't. I came to the realization then, that there were actually a lot of sick people, very few of whom I'm sure ever planned on getting sick either. As I found out, it's not that unusual.

But now that I did get sick, my health insurance was going to be put to the test. Just how good was the health insurance plan my company provided? I found out very quickly that not all health insurance, and not all health care is the same.

The clinic we had enrolled with (this was a managed care plan - HMO), only had one oncologist on staff, and he was part time. It took almost 6 weeks to get an appointment to see him. Here I was, diagnosed with a terminal illness, and I had to wait 6 weeks to get an appointment, and my wife even worked for that clinic as a nurse. As far as I was concerned that was an eternity. I could have died by then, I thought. Of course, as I later discovered, my insurance company would have been very happy with that outcome.

I finally did get to see the oncologist, but when I pointed out some potential discrepancies between the diagnosis and the actual lab results (during that waiting period, I discovered just how much information is available on the internet), and requested some additional tests, he simply stated, "you don't need no stinkin' tests, you've got CLL, deal with it". OK, he didn't actually say it that way, but that's what I inferred from his response.

Welcome to the world of US health care, where profit is more important than care, where profits are made not by providing care, but by figuring out how not to provide care. Fees to doctors are negotiated, and extra costs can cut into bonuses at the end of the year. And don't think that PPO's are any better than HMO’s. Doctors are still paid in the same manner, it's just that with a PPO you can more easily select another doctor when you’re not satisfied, but generally have to pick up a greater portion of the cost of health care for that benefit.

Fortunately, the company I worked for switched insurance plans, shortly after my diagnosis of CLL, so I didn't have to deal with the old insurance or the doctor any longer. But what was really fortunate, even though the cost to the company for my health insurance was reduced significantly, the service was anything but inferior. (See previous post).

When I pointed out the discrepancies in the original diagnosis, the oncologists and staff went out of their way to verify the diagnosis. Of course it didn't turn out as I had hoped, being diagnosed with Mantle Cell Lymphoma (MCL), a potentially more aggressive disease, at least I knew the diagnosis was correct. Plus my MCL hasn't acted in a very aggressive manner just yet.

And even though the new insurance plan I am on is a managed care plan also, it is administered as a not-for-profit entity. While it is still important to control costs in order to be able to invest in new technologies, to continually improve the quality of care, (which I believe my plan accomplishes extremely well), proper diagnosing and treating the patient efficiently and effectively appears to be of greater concern.

I got lucky, my company switched plans. Of course that is rare, and changing plans on your own is not that simple either. Most people are tied to their employer plans, and unless they have significant wealth, they are stuck with that plan, good or bad.

Not only that, if you are sick, even if you have significant wealth, it is unlikely you could switch plans even if you wanted to. Health insurance companies are not required to provide health insurance to anyone. Health insurance is a for-profit business, and it’s not good business practice to insure someone who may cost you lots of money.

You're stuck with your employers plan, that is, as long as you are employed. After that, you're pretty much on your own. Sure there is COBRA and HIPPA, but you'll have to pay for the coverage out of your own pocket. And if you're unemployed that isn't always that easy. Plus, once your COBRA runs out, you have to obtain insurance on your own. The health insurance provider you were with is under no obligation to continue to insure you. The contract they had was with your employer, not you.

If you're healthy, you’ll likely experience little trouble finding insurance. You may be shocked at the cost, but at least you'll be able to purchase insurance. But if you're sick, or have a pre-existing condition, it won't be that easy. In most states, you will be put into a high risk pool where you can purchase insurance. The benefits are generally not as good as your original policy, and the cost will be considerably higher than a typical plan. But there are a few states where the purchase of insurance is not guaranteed, and you will either be forced to spend your life savings getting the necessary care, or simply die.

Many in this country think that is fair. Many believe that even though you have always had health insurance, you should not be entitled to continue to purchase insurance, on your own and under the same terms, simply because you are no longer employed. Many think that if you get sick, it's your own fault, and it was due to the life style choices you made. If you didn't save enough money during your lifetime, that was your fault also, and it's just your tough luck.

I don't believe that is fair. But then I’m sick, and my opinion may be biased. Of course I can afford to purchase insurance on my own even at a higher cost. What do you think?