Last night I dreamt that my husband was diagnosed with metastatic melanoma.

He was lying on an exam table for some reason when the nurse spied a large, red spot on his head (he’s not bald, but in my dream he was!) and said “Oh my, that doesn’t look too good.” The doctor then looked and said “It’s a melanoma. I’ll take it off.”

Immediately the doctor excised the melanoma as well as some cervical (neck) lymph nodes, which were also cancerous. The melanoma had spread.

As I watched the operation, I thought Oh, please let this be a dream. I was sure it wasn’t.

My other line of thought during the dream was How much is this going to cost? Really. I was thinking of chemotherapy and our enormous deductible and the tens of thousands of dollars that must be required to treat such an ominous disease. I was wishing my husband or I had a job that offered a fabulous group health insurance plan with a low deductible, low co-pays, and a low out-of-pocket maximum.

Then I awoke and realized, thankfully, that I had been dreaming after all. (I also realized I am maybe too obsessed with the high cost of health care.)

But others face this nightmare as reality every day. They face not just a loved one being diagnosed with a life-threatening illness, but with finding the resources to pay for the life-saving treatment.

And the simple truth is that having health insurance does not necessarily shield one from financial hardship or bankruptcy.

Why? Because insurance plans are not created equally. Health insurance through a large group, such as an employer, offers plans with the lowest monthly premiums and the lowest deductibles. The costs are lower because large groups of workers are relatively young and healthy.

Individual health plans, for the rest of us, vary from state to state, but in general have higher monthly premiums, higher deductibles, higher co-insurance, and offer less coverage. The costs are higher because the “risk pool” includes more unemployed and sick individuals.

If my melanoma nightmare became a reality, my family would be expected to pay $10,000 per calendar year towards treatment before the deductible and co-insurance requirements were satisfied.

In 2014, the Affordable Care Act (ACA) will attempt to lower the cost of individual health plans through the much talked about “exchanges.” Whether the exchanges will succeed or not is a matter of some debate.

What if we did away with employer-based health insurance entirely?

What if everyone–the healthy, young, working, “low risk” and the sick, old, unemployed “high risk”–belonged to one big “average risk” insurance pool?

Perhaps those now covered by an employer plan would pay more on average, but no one would again need fear losing their health insurance because they lost their job or chose to change their job.

The real nightmare is the control that the high cost of health care wields over our lives, isn’t it?


Frugal Nurse


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