From the NYT Opinion page today.

A big excerpt:

Our database gave me the callers’ age, race, gender, date of hiring, spousal and dependent information, current coverage and hourly wage or salary. I developed a habit of crunching numbers to pass the time. A female caller made, say, $21,840 a year with a monthly premium of $225, leaving her with $19,140. Like me, she had injured her hip. Add up her deductible, co-payment, likely hospital bills, prescriptions, physical therapy and a few weeks of missed work, and she had less than $13,500 left over. I would be at my desk, thinking: “My rent is $685 a month. What’s hers?”

My next job was as a workers’ compensation claims examiner. Many claims had vague accident descriptions and no witnesses. I had one claimant, a data-entry clerk, file for wrist pain caused by carpal tunnel syndrome after having been employed for only a few days. When asked if she had experienced any symptoms before, she never wavered: “No.” Her surgeries were covered.

I was surprised, and not. I had been doing the math. It never added up. For many of these people, the only way they were going to get the care they needed was to feign being injured at work.

In workers’ comp, doctors were passive, employers were punitive, employees juiced the system, and I had to close cases. I found a physician at an independent medical examination company who almost always signed off on my cases, as long as they included appropriate leading data. I referred to him as “Dr. Fixed and Stable.” (“Fixed and stable” basically meant a patient had received sufficient treatment; it was the magic term that allowed me to close a claim.) I never met this doctor, but I sensed he was down with the game. We paid him a few hundred dollars a pop, and my cases got closed.

In 2007, I decided to give college a shot. I needed a flexible work schedule, but because of my pre-existing condition, I couldn’t let my insurance lapse. I found a job with benefits at a smoking cessation company, working nights and weekends.

Funded mostly by the ’90s tobacco settlements, the stop-smoking hotlines helped everyone, not just those with insurance or those who could manipulate the system. But luck still played a role. Radio commercials would air promising free samples of patches and gum. The phones lit up, but the samples soon ran out. I thought: Why is acquiring health care like visiting a casino? Why does it feel as though you have to win to get it?

Then Barack Obama was elected. He spent his presidency building and defending the Affordable Care Act. It was ambitious legislation, but I was concerned. The employer-driven insurance industry had no clue how to provide sufficient health care to the people who were already insured. Now we needed to include the uninsured, too?

In 2012, I had the hip replacement — a $44,000 procedure. Thankfully, I had kept my insurance coverage, as the A.C.A. wouldn’t prohibit pre-existing condition exclusions until 2014. I am still amazed that losing insurance for two months could have excluded me from medical care forever. I was proud that America would no longer be a country where a 19-year-old wondered if a lapse in insurance would leave him crippled.

Also thanks to the A.C.A., I began buying my insurance through my state’s health care exchange website. Like the healthcare.gov site, it had a rocky start and was widely panned, but I loved it. It was an actual marketplace and not a shadowy industry where brokers and H.R. departments hammered out deals. I had several insurers offering me coverage, with transparent plan information and pricing. It was almost as if they were competing.

This guy nails it.  Will anyone listen who matters?