Jamais Cascio, one of my favorite thinkers, has written a post on healthcare that offers a useful perspective.

Fact #1: I am self-employed American. Fact #2: I have a severe, chronic medical problem. These two facts don’t mix nicely. As a self-employed worker, I don’t receive the benefits that usually accrue to salaried professionals doing similar work: employer-contribution 401K; paid vacations; and, in particular, employer-provided health insurance. I knew going in that this would be the case and decided that the other, non-material benefits of working for myself outweighed the material drawbacks. For the most part, I can provide the equivalent benefits to myself — a retirement savings account and money set aside for vacation time. But not health insurance. Because I have a “pre-existing condition,” I can’t get insured. I’ve tried. The coverage I have, through COBRA, will run out soon — and at that point, I could be in trouble. I bring this up not to elicit suggestions or sympathy, but to identify myself as someone very interested in the current health insurance reform process underway in the United States — and someone who would clearly benefit from that reform’s success.

Cascio is definitely to my left, and I don’t think he appreciates the strength of some of the criticisms of Obamacare coming from the pro-market right. But he’s definitely not alone in his basic dilemma, and conservatives would be wise to pay to careful attention to the dysfunctions of the individual health insurance marketplace. John Cochrane’s proposal for health-status insurance would do a great deal to help people like Cascio, yet it’s not the kind of policy that would work retroactively.