Despite the passage of the Affordable Care Act, I still don’t have health insurance. With my preexisting conditions, until the federal exchange and subsidies kick in, I’m still self-pay. And that usually means self-overpay. Usually, but not always.

Over the past few months, I’ve been hunting for a good cataract surgeon I could afford. It hasn’t been easy. I’ve done background checks through the medical licensing board to find out whether providers have disciplinary actions or have been sued. I’m also interested in knowing how long they’ve been licensed, because experience is so important.

Then we get to price. I’ve called places, including a local university’s Eye Clinic, to compare costs. Just give me the cost of basic, uncomplicated surgery with a single vision implant, please. Some have refused to tell me. The university, for example, wanted a $400 payment for the first visit, and only then would they tell me the price. After I’m financially locked into getting the surgery done there.

I found two places that would give me a price. One was so far out of sight I couldn’t even consider it. I’d checked the average cost for the procedure, and this guy was at the top end of the scale. The other place gave me a price that went up went I called back to make an appointment. I could afford it, barely, and only for one eye.

So I was getting a bit down about the whole thing. I knew what the Medicare reimbursement schedule was, and it was less than half of what these folks were asking. And yet I understood that many doctors think Medicare reimbursement is way too low, especially since those payments haven’t increased in over a decade. Even doctors need to live and pay their business expenses.

My family doc gives me a 30% discount for being self-pay. My dentist does the same. And why shouldn’t they? With me they have no paperwork, no fights about reimbursement, and they don’t have to wait sixty to ninety days to get paid. My family doc is a nice man who has spent several years finding ways to treat me for less. And when I showed up at my dentist’s in January with two broken teeth, he saved them … at a lower cost than most ‘discount plans.’

But neither my family doc nor my dentist could fix my cataracts. Finally, I checked out a place my daughter had noticed about 8 miles from here. I didn’t hold out much hope, but what would it cost me to make a phone call? When they heard I was self-pay, they gave me a discount rate … about the same as Medicare would pay. I didn’t even have to ask. And I could get both eyes done.

So I want to praise at least a certain segment of our medical providers. They’re out there, these doctors who are willing to help out those who can’t afford full prices. They’re willing to take cuts, give breaks, and find a way to help. They put treating people ahead of profits, and they deserve to be commended.

We may not see single payer in my lifetime, but we’ve got to do something about a mess that transfers premiums into insurance company pockets at huge costs to providers … and to the uninsured. The ACA isn’t perfect. But it’s a good start, and we should fight to keep it.