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What are the choices in 2009 for someone to needing healthcare or preparing for when they do? This map crudely shows the choices and paths.

1. You can take the "No Insurance Way" this road leads to 3 other choices:

      (a) The "E.R Road". This is when you rely upon the emergency room only
             type care. It  passes through the "Time Swamp" where time passes
             slowly while you wait for treatment .How slow depends upon how many
            others are also taking this way the day you arrive, how many Doctors are
            on duty, how bloody serious your condition is compared to the other
            waiters. It also involves playing Doctor Roulette since you never know
            which Dr is in the chamber that day. Once you are in the que, be
            thankful for all they do for you, they do what they can with the limited
            resources they have. 

      (b) The "Cash Road". This is when you have lots of money and say,"I will
            pay my own way if I need treatment."  What a nice attitude to take,
            however be sure that you have lot's and lot's of money that you dont
            need, ever again as you will soon part  from it. Example: Suppose
            healthy you are invited unexpectedly into an accident on the highway
            (since we are discussing roads and highways) and you are seriously
             hurt and need to be Care Flighted to the hospital by Helicopter. That
            little ride is going to cost you about $12,000, now this is just the
            transportation,the real cost  comes later with the actual treatment, the
            xrays,the tests,c-scans,the tests, surgeries,tests, re-hab, and tests.
             Well you get the general idea, be prepared to spend some cash.

       (c) The "Cobra Road: What is Cobra anyway?The Consolidated Omnibus
             Budget Reconciliation Act of 1985 (COBRA) enables certain individuals
             with employer- sponsored coverage to extend their coverage if certain
             "qualifying events" would otherwise cause them to lose it. Employers
              may require COBRA-qualified individuals to pay the full cost of
              coverage and coverage cannot be extended indefinitely. COBRA only
              applies to firms with 20 or more employees. Translated:  Cobra allows
              you to keep  your present insurance if you get laid off, but you pay the
              full premium, your half and the half the employer was paying for you.
              Since you were already paying 2 times too much, under Cobra you
              will pay 4 times  too much.

The "No Insurance Way" is lovely and cheap as long as you never get sick or have an accident your whole life. If like all of the rest of us you do get sick or have an accident, then you will eventually go through the "Desperation Desert" where the days are long and hot, where vultures circle and sand fleas bite your ass on your way to recovery

  (2) Taking the "The Private Insurance Way" leads up the "Mountain of
        Premium" where you must climb higher and higher premiums all the time.
       According to the  United States Census Bureau, some 60% of Americans
       are covered through an  employer, while about 9% purchase health
       insurance directly.[2], but these numbers  are rapidly changing. Why?
       Costs for employer-paid health insurance are rising rapidly: since 2001,
       premiums for family coverage have increased 78%, while wages have
       risen 19% and inflation has risen 17%, according to a 2007 study by the
       Kaiser Family Foundation.The Insurance Companies have raised rates so
       high that the enrollments have dropped, so they raise them some more to   
       compensate. With this logic, when we have all dropped out of enrollment
       and only 5 people remain insured, the Insurance companies will have to
       charge the last 5 about a billion each month in premiums. These premiums
       are passed on to the employers too, who pass it on in the cost of their
       goods. So we all pay  for the high premiums at the grocery store, the
       clothing store, and for everything that is produced and we buy. It is
       ridiculously naive  to  say our insurance is fine as it is, no matter who you
       are.The fact is, the  Insurance Companies  can not regulate themselves,
       they must satisfy their Wall Street investors or be punished. Their position
       is precarious because  they will soon take a hit from one side or the other,
       from the public or from Wall Street.

             (a) Once through "Premium Mountain" you come to "Refusal Valley".
                   This is where an Insurance Troll guards the way. He will question
                   you to find out if you had a  pre-existing condition when you bought
                    insurance. Well,I dont know, my grandfather died of something at 85
                    and  his father died of something at 78  so it seems that I may
                    have  some  pre-existing condition that causes old men to die of
                    old age.Hey, back in the day, would man eating Velociraptors have
                    been considered a pre-existing condition?
                   If the Claim Adjuster at the Troll Booth decides you had a
                   pre-existing condition, then he sends you down the exit to the
                  "Pre-Existing Condition Road" which is a one way gravel lane
                   back  to the  "No Insurance Road."

            (b) If you pass, or I should say pass the pre -existing test, he sends    
                 you down a long  and round about way to your choice of either,
                  Mt PPO, or Mt Non PPO. PPO has nothing to do with natural
                  body functions but  stands  for Preferred Provider Organization.
                  It is hospitals, Clinics, and Doctors who have made deals with the
                  Insurance Companies promising not to cheat the Insurance
                  Companies like the Insurance Companies cheat them, let  us all
                  be fair to the Insurance Companies. I have been told that the
                  of people Mt PPO supposedly charge you less because the
                  Insurance troll's sister writes their reimbursment checks at her
                  own liesure pace. Finding out what appeases her is a full time
                  endeavor. If you choose Mt Non PPO,the trolls sister will not
                  be pleased and will not pay for many of the tests, procedures
                  and treatments these nonist's proscribe and provide.
         
            (c) You made it this far, now one more gauntlet and you are home free.
                 You now must pass between two more mountains , Mt. Co-Pay and
                 Mt. Deductible. The height of these two depends on the height of
                 your premium. The more precious the name of your plan (Platinum,
                Gold,or Silver ) the more it costs.Hence the formula: the more your
                premium costs the lower your copay and deductible. The deductible
                being how big a bag of money I must spend for treatment for myself,
                and then my family before troll sister will even pick up her
                reimbursement pen. What I spend out of pocket accumulates in my
                deductible bag  until such amount equals my deductible toll. Every
                year you are one year older so your deductible bag is emptied and
                you start over from  zero. Think of it as spring cleaning of your
                deductible bag.If it doesnt make sense to you then you are not
                thinking like a troll. The Copay is usually a small amount for
                psycological purposes to remind you that this flagrant use of your
                benefits is noticed and a small penalty must be paid, this stuff is
                not free you know. However if you go the Non PPO route the
                penalty will be very steep because you have like gone from shop
                lifting to bank robbery of the insurance coffers.
                             
                Next you go  through the "Hard Times Pass"  where sister troll
                finds some way to give you a hard time, it's her last line of defense
                against you asking for re-imbursement from the insurance company.
                Keep going and there you are your at the gate of hope.

            (d) The entrance to "The Healing Square" That  marvelous place of
                  medicine enclosed by the four walls of healing, the Doctors wall
                  the Medicine wall,the Treatment wall , and the Therapy wall .
                  Here work the angels of mercy who dedicate their lives to the
                  healing of others. Hope,comfort,relief,and recovery grow here.
                  May you and your family find this place when you need it.
                  Onward to the  "Land of Wellness".


(3)  There is the possibly of  "The Public Option Way" now under discussion. This way leads over the "Lower Mesa" of premium Mountain.  The premiums are lower here because all of the people insured and not, will be able to buy insurance as part of large pools with bargaining power. Allowances will enable  those who cannot afford insurance, to be covered. It will help those of us who already have insurance by forcing our current providers to lower their premiums to stay competitive or lose our business. We wont be hostages anymore. We need this road paved now!

(4) As you can see with the "Single Payer Way" it is a straight path to Healing Square and is therefore the most desirable route of all. This road will take all of us to build, a lot of obstacles stand in the way that must be cleared or blasted through. Single Payer will be one of the most important accomplishments America has ever achieved. May we have it?

Dondi the amatuer cartographer