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Thoughts on Medical Insurance

06 Oct 2026 by KRAG

The Meme

This post is my reaction to a meme going around slamming medical insurance. Promoters of this meme compare medical insurance to ticket scalpers, and the meme states that medical insurance has no reason to exist. The text of the meme is:

A notable aspect of private health insurance is the absence of any reason for it to exist. It does not contain costs, expand coverage, or expedite care—it makes those all worse. Its sole function is to profit as a rent-seeking middleman between patients and providers.

I take issue with almost every part of that text.

Personal Context

I worked for a medical insurance carrier for 35 years, as a programmer, analyst, and project manager. I spent most of my decades working in the Claims Payment and Provider (aka doctor/hospital) side of things, though I had forays into the Membership side as well. (Those three areas are seen as the pillars of the medical insurance model.)

The company I worked for began as a non-profit, meaning it had no shareholders. It was started in 1917, when timber workers in the Puget Sound region decided to pay into a common fund to pay for medical costs when one of them was injured and unable to work. When I left, the company was still a non-profit; we were not unique in this, but we were definitely in the minority. Our membership was about 6 million souls across a six-state region.

During my time, for each dollar that came in, about 10% went to running the business (salaries, rents, utilities, improvements), a small portion went into legally required reserves (to pay for claims when amounts exceeded revenue, to keep premium fluctuation to a minimum), and most (80–85%) went to paying the claims for our members.

That said, I will be one of the first to support the idea that the medical insurance industry needs work. The proliferation of for-profit medical insurance companies in the ’80s and ’90s was (in my opinion) a betrayal of the basic tenets of the industry, i.e., to provide affordable medical care to a community by distributing the burden from individuals to the group, and not to maximize profits. It should be noted that also during that period, hospitals began switching from non-profit to for-profit models. Before 1970, almost all insurers and hospitals were non-profit. Now, about 70% of insurers and 24% of hospitals are for-profit.

Group Insurance Expands Coverage

The idea that medical insurance has no reason to exist (as stated in the meme) is by far the most ludicrous part of the argument. Medical insurance, like home insurance and vehicle insurance, is designed to limit the financial hit one might take should tragedy or accident befall us. Homeowners who don’t insure their house would likely be wiped out if fire took their home. States actually require us to carry vehicle insurance, because aside from damage to our own vehicle, we could be at fault and cause damage and/or harm to other cars and people. Insurance takes that financial risk and distributes it out; we hope we don’t need it, but if we do, it’s there to help us manage the costs and help those we might have hurt.

I can only imagine that a person who states that medical insurance has no reason to exist never got a bill for an uninsured emergency appendectomy or a few rounds of chemo. Those timber workers, back in 1917, knew that medical care was expensive, and that by sharing the load, each paying a smaller amount, regularly, they could create a fund (aka “reserves”) to cover costs should one of their group be injured. Costs are even higher, today, especially as shareholders demand dividends in addition to providing care.

More to the point, many medical insurers (like the one I worked for) are the processors of claims that come from the ACA/Obamacare. The government isn’t processing those claims. Insurers are. People who never had insurance before the ACA are able to go to the doctor and have their claims paid because the medical insurance industry is processing that claim.

Without group-based insurance, many people would not be able to have medical care. Injuries and diseases would go untreated. Private health insurance, therefore, on its own and as a partner with the government’s ACA, absolutely expands coverage, as a monthly premium can more easily be factored into a household budget than can a massive bill for a hospital stay.

Negotiated Rates Contain Costs

A major way medical insurance provides value is by negotiating rates of reimbursement with hospitals and doctors. Insurers negotiate with networks of doctors and hospitals to bring down costs; the doctors and hospitals get access to the insurer’s large pool of patients, and the patients are charged a lower amount than if they’d walked in off the street without insurance.

Example: Last year I had a heart attack. EMTs (bless ’em) took me to the ER, and I spent a couple of nights in the hospital while I was stabilized and had a stent put into one of my arteries. The hospital charged me $66,415 for the stay and care I received. However, my insurer had negotiated a lower rate with that hospital, and the reduced (or “allowed”) amount was only $15,278. That’s a 75% reduction in the original charge. Then the insurer paid most of that reduced amount. I still owed a chunk, about a grand, but without insurance I would have been on the hook for over $66k.

Someone please explain to me how that scenario is not an example of containing costs.

Expertise to Expedite Care

The charge that medical insurance does nothing to expedite care, well, that’s a crapshoot, as performance on this metric can be all over the place. The sheer complexity of the industry—and oh, it is complex—is a major source of frustration to members. So while many insurers really suck at this part of the job, others put a lot of effort into assisting their members when things get tangled up.

Whether it’s a competent cadre of customer service folks who willingly help you intercede with a hospital’s billing and administration sectors, or it’s a managed-care agent who helps coordinate all of the various aspects of a complicated course of treatment, things can go a lot easier with an expert to guide you, and many medical insurers provide these services. Sadly, it’s not a given, but most insurers regularly poll their members, and there are industry organizations (like the NCQA) the sole purpose of which is to track the clinical quality, patient experience, and accreditation of plans.

The Irony of the Meme

The upshot of the meme that got me started on all this is that we should do away with private health insurance—a thing that has no reason to exist—and replace it with Medicare for All.

Medicare for All is . . . health insurance.

Medicare is health insurance, it’s just funded by the government. But those Medicare claims? They’re processed by private health insurers.

Wrap-up

Personally, I’m all for Medicare for All. I’d like to see all the for-profit medical insurance industry completely overhauled, especially where mega-conglomerates control the entire ecosystem of the industry, running hospitals, clinics, and then processing the claims for them. At it’s heart, though, and as originally intended, non-profit insurers and hospitals were built to provide affordable care, dedicated to the patient while managing costs and making care accessible to everyone.

But to state that something that has existed for a hundred years has no reason to exist and provides no benefit is to be willfully blind to reality and the ramifications of what its absence would actually mean.

So, yeah, medical insurance is messed up, needs a lot of improvement, shouldn’t have shareholders who pervert its purpose, and should be universally available. I’d just rather have a reasoned discussion of the topic than distill everyone’s rage and frustration down to a few lines in a meme.

k

 

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Lacunae

06 Sep 2026 by KRAG

[
[
[        thunder from a clear sky
[
[
[myriad ways to say farewell but none can
[
[  words break, thoughts shatter, lay unfinished
[                                                inside my skin
[
[there is no part of my universe with which you are not entangled
[
[
[  empty vessels whisper unutterable truths of
[               absence
[
[ pilfered moments, stolen years
[     falling inward                building
[
[dark star of rage within my breast
[                                     you can’t you can’t you can’t
[
[swallow the gods—tin gods—that made it so
[
[cry out
[                      no sleep no dreaming no
[
[
[                                                unimaginable
[
[face close to mine, breath coupled
[                 the reverence of our
[
[        spills out onto barren steppes
[   together, only apart
[
[farewell my
[
[

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When the Magic Works

29 Aug 2026 by KRAG

Words, especially when written, contain a certain magic. Take a pen and paper. Write something down—a thought, a memory, an anecdote, a brief essay about Nutella®—and tuck it away somewhere. Then, months, years, even centuries later, if someone else finds it, reads it, they may (depending on the craft in the writing) see not only what you saw, what you described, but feel what you felt. Your words can show them more than what was, more than what you experienced, but how it affected you, how it changed you forever. The reader can feel it too, whether it’s the frisson of shared excitement or the rage of injustice or just the ineffable longing of a recognized moment of transformational beauty. It’s there. Caught in the amber of your writing.

All readers have likely had such moments. Whether it comes as a critical moment in a novel or from the heart of a poem, it’s something that sticks with us for a long time. It’s a rare thing, and to be cherished, because it’s absolutely unique to who we are and when we are. It is a human connection without connection, an ephemeral and intangible thread linking one mind and one time to another.

That . . . that is magic. Nothing less.

I had one of those moments today, from an unlikely source: Alton Brown’s collection of essays, Food for Thought: Essays and Ruminations. 

I’m not one for biographies, auto- or otherwise, because to be honest, most celebrities aren’t good writers. And while Brown is a clever guy, witty and mildly acerbic, I would never have picked up this book if my adoptive brother—a talented memoirist in his own right—hadn’t loaned me his copy with a “Read this; you’ll love it” assurance. And he was right. I am loving it.

I never would have expected to have one of those moments, though. I expected fun. I expected to chuckle and smile. I did not expect magic.

And you shouldn’t either, because while Brown’s essay, “Meals That Made Me, Part II” (his recollection of eating pizza in the Tuscan hills outside Cortona, Italy), deluged me with a flood of memories of my own days as a young man alone in a foreign land, there’s no guarantee it’ll strike you in the same fashion.

But if you have an affinity for cooking, for family culinary history, if you like your humor served wry and with a dash of the absurd, and especially if you appreciate the mixture of science and art Brown uses in his approach to educating us about food and cooking, I expect you will gobble this up. It covers a broad spectrum of his life with a scattershot of brief pieces, from his earliest days to current times, bouncing back and forth through his years in seeming random fashion, but with each piece his writing is focused and bright and funny and often beautiful in its clarity and appreciation of the life he has had.

Maybe you’ll find some magic in it, as well, but even if you don’t, you’ll have fun reading it.

k

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On the Road Again

06 Aug 2026 by KRAG

Some patterns are too big to see until you step back, until time provides you with the proper perspective.

I’ve always had a love of roadsters, those two-seater convertibles that zip along, low to the ground, cambered wheels pushing through the corners, the wind and the engine’s thrum harmonizing down the backroads. My father is responsible for this, as his own love of roadsters was infectious (he was partial to MGs, and had three of them while I was growing up). In my own life, I’ve been lucky to have two of them—a Triumph Spitfire (“Cricket”)  and a TR3B (“Pepper”)—both classic cars from a classic age when roadsters were more commonplace than they are today. Long-time readers may remember when Pepper came into our lives, and again, a decade later, when we sent her to explore new roads. That was a sad day, for both my wife and me, but a necessary one. I figured it to be a chapter closed, a period to be remembered but not revisited.

More to the point, I’d always thought that our two roadsters had been more of a “me” thing and less of an “us” thing. After all, with Cricket, I was the one rebuilding the carburettors, replacing the head gasket, and installing a new wiring harness. I was the one wielding the timing light and torque wrench. As for Pepper, when we bought her, my wife made sure I knew she saw it as a gift to me, which I accepted readily and with gratitude.

What I did not realize was that my wife has as much love for the little beasts as I do. She’d had a Triumph roadster before she met me, was a champion of the cause when we went to buy Cricket, and (as noted) was absolutely the driver behind the purchase of Pepper. You don’t have to be the mechanic to love a fine machine, but I did not see this. I’d just thought she was along for the ride, literally and metaphorically.

For the last five years, we’ve been in a cocoon. From lockdown, through my last work-from-home years, and finally through these past medical-care-intensive years of my retirement, we haven’t gone much of anywhere. No travel to speak of. Little socialization. And especially no trips around the Puget Sound region in our little roadster. Last June, though, we had a short “getaway” to downtown Seattle, and we realized how long it’s really been since we’d been out and about. We realized how much we missed it. Both of us.

And that’s when my wife suggested we look for a new roadster.

If I can do something to make my wife happy/happier, I will do it, so when she encouraged me to begin comparing vehicles, when I realized that this was, indeed, something she wanted as much as I did, well, no power in the ‘Verse could stop me.

It took some research to find a model that ticked all our boxes, but I found one that fit both my long torso and our budget: a 2016 BMW Z4. “Fenris” (yes, all of our cars have had names) is now happily berthed in the hastily cleared-out bay of our garage that Pepper used to decorate with oil from her myriad leaks.

We’ve already taken him on a few trips around town, traveling old routes we used to take with Pepper—down the waterfront, up through winding valleys, along the lake past the arboretum—and a new excitement has infected us both. For the first time, we have a reliable roadster, a comfortable roadster, a roadster where everything works.

We’re on the road, again.

k

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The Rabbit’s Hour

16 Jul 2026 by KRAG

after
one cancer scare
one heart attack
one hand surgery
one gained weight loss
I lace up my pickleball shoes
and return to the asphalt
of my suburban streets
to walk under skies filled
with the grey promise
of summer rain

it is The Rabbit’s Hour
that dawn-dim time of a summer’s morn
when the wild rabbits emerge
to munch the unmown fringe
between pastel mid-century homes
before ceding their world
to the one ushered in
by joggers with leashed labradoodles

the rabbit plays leapfrog
through curated gardens
past sword-leaf and yucca
but goes rock-still as I near
fixing me with
one onyx eye
a perfect cabochon bead
keeping me in full view
waiting

I slow as I pass
to appreciate longer
its inborn technique
of not being seen
heathered brown fur
blending with the drying grass

the eye does not blink
I am its only subject
its sole concern
its fate hanging on the breeze

the air shifts slightly
loaded with the perfect pairing
of petrichor and lavender
and as I continue onward
the nose twitches
once
twice

my pickleball shoes
have never been used
for their designed purpose
as I prefer to walk
among conifers and rhodies
when the world is sufficiently calm
for me to glimpse the place
where the rabbit world and mine
meet

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Recitative

15 Jul 2026 by KRAG

Sometimes, words are insufficient.

There are times when I write a piece—usually a longer piece like yesterday’s but sometimes just a poem—that the rhythm and speed of the words is just as important as the words themselves; it’s like rather than writing, I’m composing, and so when the piece goes out into the world I don’t want it to be read so much as performed. What the piece needs is something . . . else, something more. It needs less to have been written than to have been scored, like a piece of music.

Music has the advantage here, and those of you who have learned how to play music know what I mean. A musical score isn’t just the notes that tell you what pitch to play and how long to play them: high, low, short, long. The score is full of other instructions like how loudly to play the note or how softly, whether the notes should all be slurred together or if they should be distinct and separated. It tells us the tempo, and when it should speed up or slow down, hold back, pause, or just freeze under a fermata’s little umbrella. It even tells us the feeling of the section we’re playing, like if it should evoke agitation, sweetness, sadness, grandiosity, gracefulness.

It’s not that I want the piece to be sung; no, it should be spoken (aloud or silently), but as with that last piece, there are sections where it builds in fervor and speed, piling word upon word, crescendo, accelerando, stronger, faster, until bang! hit the sforzando on this word, and then quieter, softer, slower, and . . . breathe.

It’s a frustration not to be remedied, this missing element, especially as I know readers will often skip over sections, miss the rhythm of the words I’ve chosen, skim. Not a criticism. Folks are busy. Life is busy. Time is precious, and even if you grace me with the time to read a piece fully, thoughtfully, there’s no way it’s going to play in your head the way I’ve conducted it in mine. And, sadly, there’s no guarantee that, were I to read it aloud, it would be any better. Composition and performance are two entirely different skills. I’ve attended enough author readings to know this is true.

But, keep it in mind, maybe. Tuck that thought away, and if there’s a piece—a short essay, a vignette, a poem—that really clicks with you, go back to it, maybe even read it aloud, and see if there’s something else, something ephemeral, something hidden in the recitation that is more powerful than what mere words convey.

k

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Out of Balance

14 Jul 2026 by KRAG

There are times when something happens, something innocuous, something that, on any other day, would just be a pain or an annoyance but which, on this day, adds to all the invisible things you’ve been avoiding and tips the scales, hitting you hard, harder than seems reasonable, harder than seems rational. But really, it’s not the thing that’s causing it; it’s the collective effect of everything else—the tumult, the tragedy, the futility that surrounds us all—it’s the stuff that’s been building, the leaden weights you’ve been dragging along while you try to manage life, solve the daily problems, keep everything on track, make sure everyone’s needs are met.

And yesterday, that thing happened to me. It was a little thing, a silly little thing. Only it wasn’t little; it didn’t feel little. And it didn’t feel silly.

For a long time, I’ve written letters. To friends, to businesses, to people of note, to sweethearts. And usually, letters come back. I have received replies from presidents and royalty, authors and celebrities, lovers and family and friends. But it’s the writing of those letters that I’ve loved.

About thirty years ago, I discovered the perfect paper. I was in a stationers in downtown Seattle—one of those narrow, cramped shops that seem to have been created along with the building itself—and way in the back, past all the greeting cards and overly ornate stationery, was a selection of papers for writing letters. Shallow boxes with sheets of paper in standard US letter size (8.5″x11″), each set on an angled shelf for display and easy access. I’d never seen the like. All sorts of papers, from onion skin to vellum to parchment to bond weight to card stock, made of cellulose or linen or cotton, each in a variety of finishes, some smooth as silk, and others rough with marks of handiwork and deckled edges.

Enthralled, I reached out tentative fingers to touch them, feel their surfaces, compare one to the next. The snap of the edges, the stiffness of the curl. I found one set, ivory colored (later I learned that “ecru” was the official name for it), with ridges going across the width of each sheet. “Hold it up,” the woman at the back of the shop said. “To the light.” I did, and I saw within the paper, hidden in direct light but revealed as it passed through, the watermark: “Crane’s Crest 100% Cotton”, and vertical lines down the length. The maker’s mark.

I purchased a small bundle of a hundred sheets. On the shallow box it read: Crane & Co.

I knew about Crane & Co., from back in seventh grade when I wrote a report on counterfeiting (heavily plagiarized from Encyclopedia Brittanica). Crane & Co. are the makers of paper used to make U.S. currency. Every dollar bill was printed on paper from Crane & Co., is still being printed on their paper. And it was all made of 100% cotton. I learned about the little red and blue fibers that you could see in the clear spots. I learned about the immensely detailed engraving of each printing blank, about how on the back of a clean five-dollar bill you can read the names of the states on the upper walls of the memorial, and about how on the front of the one-dollar bill, on the escutcheon in the upper right hand corner, in the northwest curve, you can find the little spider that wove the webs that decorate the border of the entire bill. And now I had paper made by the same company, of 100% cotton. It was “laid” paper, which gave it the small but discernible ridges that crossed its width. They used to be an artifact of the process of making the paper by hand, on screened forms, but now the texture was created with plates.

Writing on this paper, though, it was different. The paper had a give to it that other papers did not. And the ridges of the laid finish made writing so easy. When I switched from a ballpoint pen to a fountain pen—I didn’t have a good one, back then, but even so—it was a revelation. The pen and paper seemed to work as a team, with the ink their medium. The ridges encouraged the nib to release the ink and the paper held onto it, just where it went down. It was a tactile experience, but even with the texture of the paper, the nib never caught, the paper rough but smooth with each stroke of the pen.

I bought two full reams of this paper, nearly 1,100 sheets when added to my first purchase, and I have written almost exclusively on this paper for the last thirty years. It was like writing on history, and once I found my perfect fountain pen (Monteverde Innova EF) and the perfect inks (Noodler’s), my letters got longer and longer. Writing letters became a meditation—the ritual of filling the pen, opening the drawer where the paper was stored, selecting the top few sheets, feeling the familiar texture, placing one sheet on the writing block, and beginning to write, “Dear . . .”—that might take a few days to complete, with a couple of hours here, another few there, giving my hand a break to rest and uncramp between sessions.

Until yesterday, when I opened the drawer and only one sheet remained.

Ah, no matter. I’ll order more.

No.

Crane & Co. had been sold, years ago, and was now owned by Monarch, and Monarch no longer made 100% cotton laid letter writing paper. In fact, during my increasingly frantic search, I learned that no one made 100% cotton laid letter writing paper anymore, not Monarch, not Neenah, not the French, not those monks in Belgium, not the old Italian family that’s been making paper since the Medicis ran Florence. Twenty-five percent cotton, yes, I could find that; 100% cotton, no.

I was bereft. Simply bereft. Something had been ripped from me when I wasn’t looking, an essential piece of me, gone.

The wall cracked, then. It broke, tumbled down upon my head, the wall I’d built and buttressed, shored up in the past months. The wall that had kept at bay all my angers. Angers over so many things: over the worsening pain in my hand as I waited six months for my surgery date; over the complicated hoard of emotions that was unearthed after my brother’s recent death; over the constant reminders of mortality not just because people I knew (or knew of) were dying, but because people my age were dying; over the crumbling of my youth; over the accumulation of yahrzeits; over the incredible stupidity of our government; over fears that this is how democracies end; over the incompetence of so-called professionals; over the fact that it’s summer now and I just hate summer.

Over the fact that I could no longer write my letters on Crane & Co. 100% cotton laid writing paper.

A little thing. A silly little thing.

Grief comes in many shapes and sizes and colors and values. It cannot be adequately defined, only estimated. It is a malleable thing, amoebic, capable of joining together small losses—a broken mug, a canceled show, a fragrance discontinued—into a medium-sized sadness, and mid-sized sadnesses into larger heartaches. The way gentle breezes can build to winds and to gusts and then to keening gales and thundering storms. Grief can do that.

Life is loss, some say, and in some ways it is true. But life is also living, and that, I think, is the greater part.

I will rebuild my ritual. A different paper. A different texture. It is, after all, a little thing.

We adapt. We move on.

We live.

k

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