To Live or Die Part 2: Having Insurance Isn’t the Same as
Getting Care
The cancer is gone. The nose is reconstructed. The bills? Still here.
In Part 1, I told you how getting cancer surgery became a scramble to raise money—even though I had health insurance. This time, I’m finishing that story. Reconstruction and recovery went well, my plastic surgeon
promised me the sexiest nose in Springfield, and I’m still waiting on that last part.
I also still owe about $600 on the surgery. Further treatment for the scar is considered cosmetic under my coverage, so my insurance won’t pay for it.
Then we pick up the history: Medicare and Medicaid, managed
care, employer health plans, the Affordable Care Act and the rules shaping
access today. We look at deductibles, upfront payment demands, coverage decisions and the companies handling healthcare money.
The point is simple: a service can be covered by a policy and still be financially out of reach for the patient.
I’m advocating for universal access to healthcare in the US. I’m open to different ways of getting there. We’ll examine public financing,
regulated insurance systems and a public option—and ask whether each approach actually gets people the care they need without financial hardship.
And our “What if?”: what happens to the next person who needs surgery but doesn’t have an audience, a fundraiser or friends who can
afford to help?
Research note: medical expenses and illness-related income loss can contribute to bankruptcy. Studies use different definitions and methods; this episode does not claim that healthcare is definitively the leading cause. Policy details reflect September 30, 2026.
American Academy of
Dermatology — Mohs surgery
https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery
National Archives — Medicare
and Medicaid Act (1965)
https://www.archives.gov/milestone-documents/medicare-and-medicaid-act
CMS — Medicare and Medicaid
milestones (1937–2015)
https://www.cms.gov/About-CMS/Agency-Information/History/Downloads/Medicare-and-Medicaid-Milestones-1937-2015.pdf
US Department of Labor —
ERISA
https://www.dol.gov/general/topic/health-plans/erisa
US Department of Labor —
Self-insured health plans (2026 report)
https://beta.dol.gov/research-data/surveys-reports-publications/2026-report-congress-annual-report-self-insured-group-health-plans
US Department of Labor —
COBRA continuation coverage
https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/workers-guide-health-benefits-cobra
HHS — HIPAA Privacy Rule and
the 1996 law
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
HealthCare.gov — ACA rights
and protections
https://www.healthcare.gov/health-care-law-protections/rights-and-protections/
HealthCare.gov — Annual and
lifetime coverage limits
https://www.healthcare.gov/health-care-law-protections/lifetime-and-yearly-limits/
IRS — Employer coverage
provisions and the 50-employee threshold
https://www.irs.gov/affordable-care-act/employers/employer-shared-responsibility-provisions
HealthCare.gov — Cost-sharing
reductions
https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/index.html
CMS — No Surprises Act
protections
https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-medical-bill-rights/know-your-rights-insurance
IRS — Premium tax credits and
changes for 2026
https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit
CMS — Medicaid
community-engagement requirements (2026 rule)
https://www.cms.gov/newsroom/fact-sheets/medicaid-community-engagement-requirement-certain-individuals-interim-final-rule-comment-period-cms
HealthCare.gov — Premiums,
deductibles and total costs
https://www.healthcare.gov/choose-a-plan/your-total-costs/
HealthCare.gov — What an
out-of-pocket maximum excludes
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
HHS OIG — Medicare Advantage
denials (2022; sampled 2019 requests)
https://www.oig.hhs.gov/reports/all/2022/some-medicare-advantage-organization-denials-of-prior-authorization-requests-raise-concerns-about-beneficiary-access-to-medically-necessary-care/
FTC — Prescription drug
middlemen (2025 interim staff report)
https://www.ftc.gov/news-events/news/press-releases/2025/01/ftc-releases-second-interim-staff-report-prescription-drug-middlemen
FTC — Hospital mergers and
prices: New Hanover–Cape Fear
https://www.ftc.gov/reports/effect-hospital-mergers-inpatient-prices-case-study-new-hanover-cape-fear-transaction
CMS — Historical US health
spending (2024 actual totals)
https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical
Himmelstein et al. — Medical
Bankruptcy (AJPH, 2019; survey contributors)
https://doi.org/10.2105/AJPH.2018.304901
Dobkin et al. — Economic
Consequences of Hospital Admissions (AER, 2018)
https://doi.org/10.1257/aer.20161038
WHO — What is universal
health coverage?
https://www.who.int/news-room/questions-and-answers/item/what-is-universal-health-coverage
European Observatory —
Canada’s health system
https://eurohealthobservatory.who.int/countries/canada
European Observatory —
Germany’s health system (2024)
https://eurohealthobservatory.who.int/publications/i/germany-health-system-summary-2024
CBO — Single-payer design
choices (2019)
https://www.cbo.gov/publication/55150
CBO — Public option design
choices (2021)
https://www.cbo.gov/publication/57125
Medicaid.gov — State choice
following the Supreme Court ruling
https://www.medicaid.gov/faq/2020-04-14/93246
CMS — Part D established in
2003; coverage began in 2006
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/LowIncSubMedicarePresCov/Downloads/StateLISGuidance021009.pdf
Cause of Death – 100 Seconds to Midnight explores threats that could bring civilization to the brink—and the science, people and solutions that might keep us from getting there. Everything is connected. Even your nose and a federal statute, apparently.
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“Time Off” by Damma Beatz
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