In which I let specifics speak for themselves.

Hmmm ... you sound poor.

A good friend who I've known for a very long time just announced she can no longer pay her US health insurance. She is a married woman with no kids. I won't comment, here are the pure unadulterated facts of her case:

It was $500/month with a $7500 deductible per year for each of us, before any payments kicked in. Most hospitals here won't take you, unless it an absolute emergency, until you reach the deductible, which is impossible to save for, because you're paying $500 a month already.

Also, if a drug was not available in generic form, we had to pay full price until we met an additional $1000 deductible per year.

Our copay was $35 per doctor visit (normally it's around $90 if you pay full price), and half the time the insurance wouldn't pay for any lab work, extra tests, etc. anyway.

So we held out as long as we could, and then we let it go. We're not the only ones. There are many uninsured people in theUS, it's just a fact of life.

(when asked to clarify she added)

What I mean by deductible. We have to pay $7500 before the insurance kicks in. Then they pay 70% or 80% of the remainder – depending on which doctor/hospital you use, leaving you to pay the remaining 30% or 20% however you can manage. And this is for each of us.

So say I have to have surgery – I pay my $7500 and the insurance pays their percentage and I make up the difference. Then in the same calender year, the husband needs surgery. We have to come up with an additional $7500, then the insurance and then we have to pay the rest of that. At the same time, we're somehow supposed to continue paying $500/month to keep the insurance going. Not to mention that now, because we've actually used the insurance that we were paying for, the next time we renew, they're going to jack up the price per month for the next year, because now you're in a higher risk category. And if you move into a higher risk age group (which eventually is going to happen, unless you die and then the whole point is moot anyway) it will go up yet again. (Both factors are relevant to why we are where we are and unable to pay for it anymore) You just can't win. It's a huge racket – has nothing to do with people's health and everything to do with how much money they can make.

Now, if it were an emergency – heart attack, appendicitis, etc (something that must be dealt with immediately) they would take you right away, then deal with the deductible, percentages etc. But then, without insurance if it's an emergency, the hospital has to take you anyway.

Here are the pure and unadulterated facts of my fathers last 20 years of intense involvement with the Irish healthcare system:

Before he died Dad was very involved in setting up cancer support systems for men (prior to Dad setting up Men Against Cancer 20 years ago there was was only general or female specific support groups) One of the things that shocked him when speaking at international conferences was the number of folks in the states who had been literally made bankrupt by their or their loved-one's cancer. In his experience of counselling men and health care professionals, that simply does not happen here. For the record, Dad was a medical card holder for his entire illness (that is the bottom tier of our health care system – those whose earnings are low enough or those who are old enough (65?) to qualify them for free health care ) He suffered from an acute, ongoing, incurable, expensive desease. Towards the end of his life he had gone through at least 4 different consultants and God knows how many specialists. He was a huge drain on the resources of our health system. He was never going to get better. He was a money pit. Over the 20 years of his treatment, he got incredible, personalized, specialist treatment for his entire, long, horrible illness. Sure Dad spent a lot of time on trollies in crowded A&E wards – but here's the rub, he would have had to do that anyway, private insurance or not – because if you are an emergency patient you have to go through A&E  - but I was with him every step of the way and he was treated with respect and care, kindness and often (very often) something that felt very close to love. He was never, ever given up on, and when it came to the end,  everything that could be done to make him comfortable and give him dignity was done – even to the extent of sending a hospital bed to his house so that Mam and I could care for him more easily.

And he never once had to worry about the expense. Never. Not once.

Those are the facts. Here are my own personal thoughts.

Yes, we pay huge taxes here, but in doing so we support those who are too ill/too old to support themselves – this will include ourselves one day, or those we love. Sure the health system is falling apart due to incredible wastage and mismanagement – but the French/Northern European systems are not, how come we never have those systems held up to us as examples of how to make it work? (My theory? It's because big business makes no money out of those systems, that's why.) It seems to me that the alternatives which we are constantly being offered here in Ireland (insurance companies, private health care etc) offer a far worse scenario to the public that our present crumbling system. But I guess our politicians feel that handing our healthcare over to big business is easier than reorganising it so that money is not wasted.