In Mike Kinsley's classic New Yorker essay on longevity, "Mine is Longer Than Yours" the writer notes that today, anywhere between 60 and 90 years is a normal life span. Though I currently have a life expectancy of 84 years and my husband 80.8, those figures are averages. For every one of my age cohort who dies before their 80s, another lives beyond them. My husband and I are at the very beginning of our lifespan countdown, but realistically, we should each expect to have a little over two decades left in our own lives. With luck and a great deal of medical maintenance, they will be rich and rewarding years.
Our current outlay in medical expenses is at least $25,000 a year, and that price is guaranteed to go up every one of those golden years ahead. Our aging bodies, though fit and nourished, require considerable upkeep and repair. Managing our prolonged existence is not only a lot of work, it is damned expensive. As a society we see universal access to health care as a primary humanitarian principle – everyone should be able to see a doctor when they're sick -- but as individuals, we exploit available medical advancements for whatever we can.
Currently, my husband and I pay about $1,100 a month for health insurance premiums, and have a $2,000 family deductible (our 21-year-old son, who is a full-time student in another state, is also covered). Though none of us has a life-threatening condition, each year we easily exceed the out-of-pocket maximum, and our insurance company kicks in a percentage of claims for treatments, pharmacy, or medical equipment.
As my friend and colleague Jan Battaile can tell you, when you have a fatal disease, there is great incentive to try anything that might cure you. Even when we are not fighting a deadly illness, we still want to feel strong and pain free. My husband and I require a sea of prescribed daily or weekly medications for allergies, migraines, thyroid disorders, high cholesterol, anxiety, sleeplessness, and osteoporosis. I would guess that instead of $200 or $300 we spend out of pocket each month, our drugs would cost close to $1,500 a month if we didn't have the co-pay option on our insurance. I bet for many couples with adult children, the pharmaceutical benefit is the most heavily utilized of their health insurance. It's worth noting that, in the current debate over reform, drug companies are not likely to significantly lower prices.

Group insurance is intended by plan administrators to meet the needs of the insured, yet maintain premiums a policyholder can afford. The cost is calculated in part by a group's "risk pool." When the risk is high, so are the premiums. Every year the combined accumulated claims of plan participants are re-calculated by underwriters and the cost is adjusted, usually upward.

For example, hypothetically, an insurance company might offer a policy limited to individuals under age 35, aimed at newly graduated college students no longer eligible under their parents' insurance. As a group, the young adults are likely to be pretty healthy, but statistically, some portion of the group will become pregnant, use drugs or drink excessively.
To a claims department, obstetrical care and drug intervention are cost codes, not treatments. To keep the risk rate low and make the premiums affordable to the traditionally low-income population, the insurer might eliminate coverage for maternity care or addiction rehabilitation (this is legal, as long as they disclose the exceptions).
Conversely, an employer that wants to lure highly creative employees may add extensive mental health coverage to their benefits package.

Insurance companies are part of the financial sector, not the health care industry. To them, people like my husband and I are bad bets. In many states, though neither particularly old nor especially sick, we would be "uninsurable." We both work as freelance writers, so we are not eligible for any employer-sponsored plans, nor do we qualify under my husband's former Writer's Guild of America group insurance. Our COBRA coverage has expired and we have not yet reached the magic age of Medicare. Though we have always been relatively healthy, we have a high utilization rate. We exercise regularly and eat nutritiously, but I am accident prone and my husband is, apparently, a Petri dish for growing viruses, so we make a lot of claims.

Fortunately, I discovered a tiny state-based public option plan a couple of years ago, and we cling to it. Our carrier, officially titled Maryland Health Insurance Plan, but administrated by CareFirst, is similar to plans available to "uninsurable" citizens in 34 states. Fewer than 200,000 Americans make use of these state-sponsored opportunities for coverage, perhaps because the plans are neither advertised nor well-understood.
The health reform legislation pending in Congress, when it is finally reconciled, will expand our insurance options, but they will still be based on risk pools, claims experience and actuarial estimates. I can't say I'm looking forward to deciphering whether any are right for us.