OCTOBER 4, 2026 – Yesterday’s slow-poke mail delivery included two identical letters, one addressed to my wife and one to me, from our advantage plan health care insurance provider. The unwelcome news, viewed in stereo, was that our current advantage plans, which have worked just fine for years, will not be available for renewal on January 1. Out the window flew my plans to finish reading this month’s book club book assignment: True Grit by Charles Portis.
After reading the four-page letter a second time, I laughed at the irony of my unanticipated predicament: “true grit” is what would be required to make any kind of informed decision regarding replacement insurance.
Now, almost 36 hours later, I’m cursing afresh our nation’s Byzantine health care insurance system(s). If Franz Kafka parachuted into the heart of the beast, he’d have a field day followed by a best-seller.
Thus far—knock on wood—my wife and I have enjoyed remarkably simplified and financially manageable health insurance in the face of some major medical needs. This ignores, for the moment, the absurdly high monthly premiums we paid for years prior to qualifying for Medicare supplemented with an advantage plan, including Part D coverage for prescription drugs. Perhaps we were simply lucky to be residents of Minnesota and not be insureds of UnitedHealthcare (with its name all bunched together to prevent any extra daylight from seeping through). Or maybe too we were—and still are, for the time being, anyway—beneficiaries of a quasi-governmental insurance and payment system established by the “socialist” LBJ and “communist” Congress on July 30, 1965, when the tall Texan with both hat and cattle signed into law, amendments to the Social Security Amendments of 1965 creating Medicare and Medicaid.
What we have now 61 years later is the most convoluted health care insurance anywhere in the world. It’s a maze in the middle of a jungle surrounded by a swamp. However much we’d prefer to be entertained or productively engaged far from the task at hand, Beth and I understood implicitly the need to roll up our mental sleeves and “figure stuff out”—as soon as possible.
If Beth’s fall from a ladder onto the garage floor last December was the ultimate bone density test, understanding all the facets of Medicare Medigap Plans (coupled with PDP Plans) and Advantage Plans is the ultimate (Medicare) cognitive test. The latter has multiple layers, starting with nomenclature and definitions. Once you’ve mastered the most critical elements, you have to study all the options, costs, co-pays, coverage limits and applicable restrictions, offered across a plethora of plans offered by a bevy of insurers.
Once you’re close to drowning in bottomless information, you need to organize it and reduce it into a useful matrix by which available options can be compared and contrasted. This exercise, we discovered, becomes multi-dimensional as various additional parameter are thrown into the analysis, such as foreign travel, extended stays out-of-state, access to out-of-network providers, and the 800-pound gorilla . . . the likely trajectory of health issues that accompany aging. In this latter regard, past fades as prologue.
Before you can begin to “figure stuff out,” however, you need to access your Medicare account online. Beth logged in without incident. I hit roadblocks, which two calls to the “help desk.” To my surprise, “help” was in fact at the desk and picked up the phone without my having to ride a merry-go-round. Plus, “help” actually helped, and soon enough, I was navigating around the site at the speed of light.
After extensive study of the information online and calls to our current provider (again, without merry-go-round rides), we began to “figure stuff out” and understand Byzantium much better than we had at the outset. In this I found further irony: the most important ingredient in the process is patience . . . among us patients.
From a more distant perspective than our line-by-line analysis of each plan, the overall exercise underscores just how complicated the system has become—let alone how costly it has grown. How will others without the patience or willingness to “figure stuff out” . . . reach informed decisions? And how will the system operate as the population ages and costs overwhelm available resources?
This and so many other looming issues—from the environment to education to public health to crumbling physical infrastructure, not to mention our unsustainable fiscal condition—are what deserve our leaders’ attention . . . not triumphal arches, pyrite-lined ballrooms, campaigns of retribution, and an absurdly expensive war devoid of purpose or benefit.
All of which highlights the importance not only of the upcoming election but of how well the winners shift from campaigning to governing . . . with true grit.
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© 2026 by Eric Nilsson
