Everyone (including California's "Governator") seem to think that universal access to insurance will solve the health care crisis. Everyone also seems to conveniently forget that insurance is not the same thing as health care. What insurance does is that it gives us access to certain amounts of pre-approved types of health care, at a cost that is spread out over time and over a large pool of people, with the intention of supporting a large administrative staff and ensuring profits for the insurance company's shareholders.

Now, those insurance folks have us all coming and going--patients and providers alike! If we opt for "pay as you go," then the health care providers (the hospitals, more so than the physicians--physicians are often very happy to negotiate good terms for a cash payment up-front) will mercilessly price-gouge us, effectively making hospital services unaffordable. In order to help control their costs (and keep up their profits), insurance companies will negotiate reimbursements to their preferred providers that are as low as possible, and, in addition, they review each and every charge that is submitted to them, downgrading the reimbursement code that has been submitted to them whenever it's feasible to do so (e.g.,, "In our opinion, that patient may not have needed an 'extensive exam,' so we're only going to pay you for a 'brief exam'!"); when that happens the physician has to either protest the decision and re-submit the claim, or s/he has to "eat" the difference. Oh, and did I mention that they'll often stretch out the time they take to reimburse their providers as long as possible, so as to "work the cash flow"? And if a patient or his/her physician wishes to try what is considered to be an unorthodox treatment modality, it will rarely be covered by insurance, thus effectively limiting/eliminating "consumer choice."

My point? If medical care were affordable, then no one would need insurance for anything more than "major medical" expenses. We could pay out-of-pocket for routine medical care, and everyone would be happier...that is, the patients and the physicians would be happier. The insurance companies, however, would lose their cash cows--which they are profitably milking on both ends (forgive the pun/mixed metaphor).

What a shame that Ms Leavy died so prematurely for no reason other than the lack of proper healthcare. I hope that all the politicians looking out for the "little guy" remember this story and the thousands like it throughout this nation. Mr Conason, I'm sorry for your loss.

Our daughter died on August 31, 2006, two weeks after her 27th birthday. She had no health insurance. The medical examiner believes she may have had an arrythmia problem, a "tachy" heart. Maybe if she had insurance, she would have gone to the doctor when she wasn't feeling well. She was never so sick to go to an ER but maybe a doctor. We will never know. I do know I will not support any Democratic candidate who doesn't promise to get health incurance for everyone in the US. My condolences on the loss of Maria. Fifty-two is too young.

I managed a nonprofit organization for several years. Some people I know used to joke about the executive director having a "class system" for his nonprofit workers--that as a matter of ideology they should be underpaid to reflect the earnestness and simple honesty of their work, admired for their martyrdom.

Older and wiser now, my sense is that this view is prevalent among the powers that be in the nonprofit sector. Conason's telling of Leavey's life is an archetypical narrative. Perversely, board directors and executive directors underpay and under-reward their employees to fit them into this pleasing narrative scenery.

the only way that everyone can have quality health care is if those with money subsidize it, in some form, for those who don't have money.

I'm sorry for Joe's loss and everyone who knew her. The world may truly be a worse place for the loss of Maria.

But did she lack insurance because she honestly could not possibly afford it, or did she lack insurance because she never got around to it or thought it'd be too expensive and figured her health was fine so she didn't need it?

I'm not meaning to ask this specifically of her, but of many people who are without. Access to health care certainly needs to be improved, but there is not just one class of uninsured person in the United States. There is still a divide between "can't no matter how much they want to" and "won't because they don't see the value of it". I think that part of the objection to universal healthcare goes like this: A lot of the folks who go without might not get it through work, but they are earning enough to pay for individual insurance. It might not be great coverage or cheap, but it would not be enough to bankrupt them if their other expenses were kept to a reasonable level.

It's very easy for some of these things to go unnoticed even if you're insured, but I think there are a lot of folks out there who don't realize how important health insurance actually is. Is it really the government's fault if someone who wouldn't be eligible for group health care anyway--by being self-employed--doesn't devote $200 a month to health insurance? I do believe that those in lower income brackets should get help on this score, but you don't need to make millions of dollars to get health coverage.

For a 50-54 year old woman in my state, anyhow, I can find at least one adequate plan which comes in at under $200 a month or $2400 a year. If you're self-employed, the cost is also tax deductible. Notably, the IRS does *not* let you deduct health insurance if you're just working for an employer who doesn't want to give you benefits. So that'll cut your effective cost further if you're a self-employed consultant. Maybe she really was doing so poorly that she couldn't swing that even with the tax break... but a lot of people who go without insurance could.

If nothing else, I suppose, let this be a warning for those who've been putting off getting insured. Yes, coverage should be available to all. But if it's already available to you and you haven't availed yourself yet, it's time you did.

(Before anybody jumps on me, I don't think failure to procure health insurance, whether you can afford it or not, makes anybody less of a good person or diminishes the work one does in one's lifetime.)