Only in America: Pre-existing conditions and their consequences

The grotesque reality of my life has been constant constraint by the need for health insurance. With a congenital heart condition and a degenerative eye condition, I married my wife while in graduate school because I was no longer eligible for my parents' group pan, and at the time few graduate programs offered group health.

My career choices were dictated by the knowledge that I needed group health: the tenuous life of an academic in a tough job market seemed too risky, so I switched to law school.

I avoided private-sector legal jobs upon discovering that many firms do not provide group insurance but expect individual lawyers to find individual health plans, so I ended up working for the state.

Fortunately, things have worked out for me so far. It was not desperate need, such as you described [in "Health Benefits Inspire a Rush to the Altar, or Divorce Court"] but a sense of obligation and responsibility that drove me to make major life decisions based on health insurance needs (I do not have family who could foot the bill for open-heart surgery).

But only in America are people with pre-existing medical conditions forced to plan every aspect of their lives around the need for group health insurance. I have often toyed with the thought of emigrating to Canada or Britain simply to escape the constant, gnawing, lifelong fear of what might happen should my group health for any reason ever lapse.

-David Tallman, Atlanta

Advice: Insurance may be available through trade and professional associations.

Read a story about a person who has become uninsurable.

Thanks to David for his source letter to the editor of the New York Times, published on August 18.