I’ve never been materially wealthy. I worked my way through college in a series of jobs that helped pay the rent and my tuition. My family made too much money for need-based scholarships, but too little to put six kids through college.

One of my first jobs was at what is now Brigham & Women’s Hospital. I worked 30+ hours a week in out-patient billing. Each night–and all through the day on Saturday–I sat at a typewriter and filled out the forms that would bring the hospital money from Medicare and co-insurers for patients’ bills. Eventually they put two of us to work developing a system to pay bills for the elderly.

We looked for programs that would pick up the tab for what Medicare did not pay–twenty percent of every bill. After we tried everything we could think of, we would write off what was left of the balance. It amounted to hundreds of thousands of dollars, but we knew there was no point to billing it to the patient most of the time.

Part of the reason they started the program was what happened on a Saturday morning. This woman came into the office screaming. The hospital had sent her father, a heart attack victim, a bill for $25,000. “Are you trying to kill him? He doesn’t have that kind of money. Nobody does.”

That story came back to me as I was reading two NET patients’ blogs earlier today. Sunny Carney is getting ready to head to Europe for PRRT therapy. She will have to pay for this herself because, while the treatment is standard practice in Europe, it is only now beginning trials in the US. Her situation was further complicated when her insurance company decided not to pay for a treatment she had that they had previously approved.

And it was underlined by a sentence in Lindsey Miller’s blog where she talked about her relationship with her insurance company.

Last week Mitt Romney talked about wanting people to be able to fire their insurance companies when they did not like them. That the only way most people in America can afford decent health insurance is by getting into a group at their place of employment where they have no real choice appears not to have occurred to anyone. Fire your insurance company and you will be on your own. And without Obama’s much-maligned healthcare law, pre-existing conditions would not be covered if you did

change companies.

People want us to believe we have the best health care system in the world. According to the New England Journal of Medicine, the US spends the most per capita in the world on health care. We rank 39th in infant mortality, 36th for life expectancy, 43rd for adult female mortality, 42nd for adult male mortality. We trail such economic powerhouses as Chile, Costa Rica, and Morocco.

And if you want the latest effective treatment of NET and Carcinoid Syndrome, you’ll need to go to Europe–and pay your own way.

I won’t pretend I have a solution to this. I only have two observations: (1) What we are doing is not working; (2) For at least 36 other countries, single-payer seems to work better than what we are doing.