It’s a raw time to be an American without health insurance. While truly considering what the experience is like for me—a single parent—and others like me, I realized we often have so many questions about our health care experience. Ones we have no legitimate answers for. So, I decided it was time to make a list and unravel the nightmare of simply dreaming of having adequate health care.

Is care affordable enough? Accessible enough?

I worked for my local county until the mid-2000s, when I became self-employed. At that time I paid for health insurance and operated a more traditional kind of business. Back then? I could afford it. My coverage was less expensive than the plan I had previously anyway. By the time I got married in the late 2000s, though, I really needed to rely on my partner’s insurance. So, I got on it.

It was a good plan. So good we put our child on it, too, when he was born. When we later got divorced, our child got to keep that coverage but I didn’t. I haven’t had health insurance for more than 10 years now, despite having been employed the entire time. I check my options each year, during open enrollment, since I still support the notion of the Affordable Care Act—even if I can’t afford any of the plans.

As a single adult who makes “too much money” to qualify for low-cost care, I can’t afford even the lowest tier premium. Remember: My child has insurance, so I’m only shopping for one. The deductibles tied to health-related services would cost me thousands of dollars per year. There aren’t many medications I can afford, either. As a result, I simply see one doctor once per year, paying cash.

From that visit I get two prescriptions renewed. I pay cash for those, too. It’s what I can reasonably do. I’m supposed to see other doctors—a gynecologist, for example, and someone to manage my thyroid—but I don’t. I’m supposed to take other medications, as well, but I don’t. I’m not living in poverty. I make more than a lot of people do. But I’d have to answer both questions we began with: “Uh, no.”

How does the U.S. rank in affordability? Accessibility?

By almost every metric, the U.S. health care system is failing when compared to its peers. Actual strides toward health care accessibility and coverage affordability are failures, though the ACA has improved the situation. Still, according to the Kaiser Family Foundation, the number of uninsured Americans increased for a third year in a row in 2019 and included 28.9 Million non-elderly people.

Coverages losses were especially keen among children and Hispanic populations, driven by declines in non-group (i.e., HMO) and Medicaid coverage. Since the ACA went into effect in 2010, however, the uninsured rate remains substantially lower than it once was. Who’s at fault here? Well, the existing American health care system seems to spend way too much money serving too few people.

The Commonwealth Fund found that the U.S. has the highest suicide rates and lowest life expectancy among the 37 partner nations like it which comprise the Organisation for Economic Co-Operation and Development (OECD): nations from North and South America to Europe and Asia-Pacific. Yet, in terms of share of our economy, we spend nearly twice as much as the other countries do on health care.

We also have twice the obesity rate and the highest chronic disease burden. Americans enjoy fewer physician visits—maybe because fewer of us have health care access at all and maybe, in part, because the U.S. suffers from an undersupply of physicians. Either way, compared other populations, Americans suffer the highest rates of avoidable deaths and hospitalizations due to preventable causes.

Is It All Doom and Gloom?

On the flipside, American has high rates of flu vaccination among people aged 65-plus and high rates of breast cancer screening among women 50 to 69. The Commonwealth Fund also noted that a pretty large number of American women ages 19 to 64 had an easier time finding affordable health care plans in 2016 than when the ACA was first rolled out in 2010.

They were then more likely to receive early screenings (i.e., Pap smears, mammograms) versus skip or delay preventative care visits. Not so for their uninsured peers. This is clearly a study in contrasts; a portrait of access. As a nation, we seem to currently spend more money ensuring that fewer (aka niche) populations receive adequate, or at least modest, access to care.

For the majority, that means higher rates of preventable illness or even death.

[Editor’s Note: Look for Parts II and III of this special series on the state of U.S. health care in the coming weeks!]