With the passage of ACA (Affordable Care Act) Americans have more hope than they had a couple of years ago of eventually being able to afford insurance and get insurance. I won’t go into the details of that act as we’re hoping LI Mike will share his more intimate knowledge with us soon.

But we are still in a no-man’s land until 2014.

Five years ago, after a surgery that wound up costing me $20K in uncovered costs despite having insurance, I realized that paying for insurance wasn’t going to cover me at all if I had a major medical problem, like heart disease or cancer. And it was costing me nearly $12K/year in premiums. I couldn’t afford that anymore. Simply could not. So I dropped the insurance. I won’t say I wasn’t terrified because I was. But what it all came down to was the question: Did I believe I would have coverage from United Health in a catastrophic crisis? No, they’d already proved I wouldn’t.

Over the last five years that has proved to be an economically sound choice. I have spent far less on doctors and medicines that I would have paid in premiums. As my income diminished, along with that of many Americans, the choice made even more sense.

But the inevitable happened: I learned I had cataracts. I hunted around for discounted pricing and financial assistance – as I reported in an earlier Furthermore! – but I also sat here thinking gloomily, “I am going to go blind and no one can help me.”

A small inheritance, combined with a clinic that offers insurance rates to the uninsured, is now going to make that surgery possible. And it will still cost far less than insurance premiums would have cost me for the year. Indeed, it will only cost me one-third as much. Combined with the routine care I need, it will still be less than half of what I would pay in premiums, never mind the co-pays and deductibles.

But I’ve been learning some stuff about the ACA and how insurance companies are handling it now. Now they no longer overtly deny coverage for preexisting conditions, even though that rule doesn’t take effect for the uninsured until 2014. Now they ask your age. They don’t even say “sorry,” they just hang up.

Okay. Wasn’t going to pay you that $12K/year anyway.

But it made me acutely aware of what the Republicans were trying to do to Medicare with their voucher system that would pay directly to insurance companies, and not to Medicare recipients. The problem with that, of course, is that people would not have that money to spend on their own care, but would be forced to buy insurance at any price in order to get that voucher.

And the price is phenomenal. I looked into my state’s high risk pool. No way any voucher was going to pay for half the cost of that. The coverage is spotty, lots of out-of-pocket, large co-pays. And I’m only sixty. Those prices go up with age, but since we still have Medicare, they give you no idea what the cost would be if you were seventy, or seventy five.

I realize the Ryan proposal is off the table for now. I realize President Obama wouldn’t have signed it if it passed. But the last year of wondering if I was just going to have to go blind left me with a real appreciation of what we would be doing to seniors with a voucher system.

Under no circumstances can we allow such a thing to happen, and under no circumstances can we allow anyone in our government to deprive the under 55 crowd of Medicare benefits when they retire.

Most seniors, interestingly, aren’t sick. Most will have only one hospitalization in their golden years, and it will be the final one. Averaging that over the entire senior population, that cames out to about two weeks of hospital care. But insurers won’t care, because a small handful get really sick and need extensive care. Insurance companies play the odds with an eye to profit.

No voucher is going to be enough to get that coverage.