Last night, I had a dream that I was in an airplane and it was landing and I kept looking up front at the cockpit and wanting to see outside but it was blocked, just this blue door and white walls and I had this vague sense of foreboding because I wanted to see and it was weird, wrong, really wrong that you couldn’t see out the front, couldn’t even see where you were going, but I knew we were descending and then somehow I could see below us, even though the floor was solid and there was luggage below, but I could see we were over New York City and look, there’s Columbia, and gosh these buildings seem awfully close but the pilot’s got it, we’re fine, although what airport is on Manhattan and south of Columbia, but maybe it’s just the long way to JFK somehow, the scenic route, but we’re still descending and then the left wing tilts and scrapes a building and the plane lurches down and everything goes black.

I used to die in my dreams. People told me it wasn’t possible, that you wake up before you hit the ground. But I didn’t. I hit and just stayed there, internalizing the fact that I was dead. In this dream, last night, it went black, I didn’t actually wait for the sickening clatter of the plane to the ground. But it was black and cold and silent for a while. And I was totally enthralled, had no sense of it being a dream. This is it, I thought. Moment of truth. Do I die and nothing? Or is there something? What’s next? Oh please, let there be something as I’ve always thought.

And then I blinked, fluttered, my eyes opened, and I was where I fell asleep last night, there with Alex in the guest bedroom as we’ve been camping out during a recent bizarre half-circuit power-outage. Everything was monochrome, black and white, an old-time movie of my life? Alex remained asleep as I gently left the bed, padded to the main bedroom, found my parents asleep there. Color slowly started to filter in to the picture, flecks of vibrant rain hitting the monochrome canvas of my eyes. It remained grainy, like a newsreel, my vision following the evolution of film over the course of minutes. No one woke up, no one stirred. Is this death? Wandering the hallways of your memory while the people you loved who remain alive sleep? Do you sit in the rooms of your past, slowly waiting for them to awaken by passing through themselves?

I don’t know how long I stood there, in the rooms of the apartment, breathing heavily, nervous, but also relieved to learn there was more, that the horrifying plane crash was not the final scene, before I opened the front door, was bathed in bright blinding light, and finally actually awoke. It took me thirty seconds or so to realize that the plane crash was not real, that I remained truly alive.

I haven’t been close to dying in a while. Sure, I feel like I’m going to die every time I get a migraine, at least a little (is this one so bad that it’s actually a brain tumor?), and there was that one incident a few years back. Probably the closest I’ve really been lately, though there are always driving near-misses when drunk New Orleanians run stop signs at breakneck speeds in front of me, was back in October ’09, my only really serious car accident. It turned out fine, but was a few feet from being devastating. I had health insurance back then.

I have health insurance now, ostensibly. But not really. As of January 2017, I have coverage that costs me $55 a month (with extensive subsidies – the sticker price is over $300/month) and entitles me to pay essentially sticker price for health care transactions up to $4800 before it starts helping out. I did not have health insurance of any kind from June-December 2016. I thought I would have to pay a penalty to the government for this, but I learned in January that since health care coverage would have cost more than 8% of my official annual income of $27,717.96, I was exempted from the penalty. I had spent the year in some sort of uncanny valley where I was neither entitled to subsidies on coverage nor required to abide by the individual mandate because it was so expensive. This was also true from September-December 2014, when I first moved to New Orleans and was playing poker before I got a job. I didn’t have health insurance then, nor did I have to pay a penalty. At least the government’s effort to solve hunger by forcing people to buy food did not bankrupt those people for not being able to afford food. Strangely, though, it didn’t do anything about the, y’know, hunger issue.

I went to the doctor for the first time in almost two years on Tuesday. My ear hadn’t popped for a week after I got off the plane back from APDA Nationals. I’d boarded a plane sick in Newark, had some pressure landing in Chicago, and then had my ear almost explode (it felt like – I’m sure it wasn’t actually close) while landing in New Orleans. I hadn’t been able to hear more than a muffle out of it for a week. Two days after landing, I used Alex’s Teladoc service, which I’m entitled to use through her healthcare, to call a doctor, describe my symptoms, and get some prescriptions to try to open the ear and fight off the infection. I’d nearly exhausted the antibiotics and prednisone with no relief by the time I reluctantly made an appointment to see a real physical doctor.

My “primary care provider,” such as it is (I’ve only seen one doctor multiple times in my conscious life – the phrase “my doctor” has never quite registered with me) is part of a health clinic literally around the corner from my apartment. They were in the running for the Impact 100 grant from the Greater New Orleans Foundation the year that I helped CIS win. The place is pretty, recently refurbished, with the standard over-bright waiting room and a giant LCD TV for the impatient patrons. They charged me $80 for the visit, but seemed visibly upset to do so, asking me to come back with proof of income so they could charge me less. I agreed to return for a partial refund. When I did, though, they saw my tax statement and grimaced. “We should have charged you $120,” the helpful woman at the desk said. “We’ll let it slide this time, but if you come back, your visits will be $120.”

That ear pressure wash I received at the doctor’s was definitely nice and certainly helped, though not enough to restore hearing. (It’s coming back, slowly, almost at 80% now.) But I could buy the machine for less than $120.

I did try to go to the doctor a few months ago. To urgent care, actually. Alex and I had lice. We didn’t quite realize that yet – Alex had a student with lice in her classroom, but it had been dealt with. I’m not quite sure what we thought urgent care could do about lice, but we were excited that I had health insurance again so I could do things like go to urgent care when my head was itching and we thought we’d seen suspicious bugs on my head. They quoted a price of $152 to get in the door. We politely declined and went on our way. Fortunately, within the day, we were able to spend a little less than that on two visits from a private home-visit service. A wonderful woman came out and very patiently combed literally thousands of lice out of Alex’s and my hair. It was a humbling and educational experience I thought I’d never have, at least once I made it through grade school without the specter of lice ever manifesting. It was also a reminder of what one can get accustomed to – the woman said we’d had lice for weeks, growing into a full-fledged infestation. Alex had admittedly gone to the doctor for general itchiness in that span; the doctor had missed the lice.

I recognize that the ACA has tangibly helped a lot of people. I recognize that I am not the target audience or consumer for the ACA, really, that it’s striving to help those with seriously low income or no income by getting them access to some kind of healthcare. But I also wonder about the overall degradation of what we think of as healthcare. The ACA theoretically puts in some sort of standards for what is considered health insurance to prevent scammers from dominating the market. But can we really consider a plan where it’s out of pocket until $4800 is spent “insurance”? Or, worse, “coverage”? Yes, it would be handy, though still devastatingly expensive, if I had a catastrophic accident or diagnosis. But short of that, I don’t really feel like I have healthcare coverage. I feel like I am paying $650 a year for the right to pay the uninsured rate if I actually want to see a doctor. And I’m super lucky that I live with someone with access to Teladoc. Alex and I have joked-not-joked several times about getting officially married early just so I can enjoy her healthcare benefits.

I used to look quizzically at people when they said the primary reason they had a job was for health insurance. This, of course, was in the days when pre-existing conditions were reason to terminate coverage for people (only after they’d paid months of premiums first, usually, but just as they made their first claim). Employers offering insurance could force their insurers to cover people no matter what, so people with health problems needed to work to be well. But in those days, as I recall, health insurance actually meant health insurance. Co-pays were nominal, deductibles covered pretty much everything. Maybe I was in a bubble living in California, but I didn’t think, in talking with people across the country, that my experience was that exceptional. Now, even Alex’s supposedly great health care coverage through work asks her to pay a lot out of pocket for going to the doctor, with mystery “lab fees” showing up for more than $100 without notice. When I tried to fight one of these with the insurer, the insurer literally said “you are responsible for any fees incurred by services – you can ask the doctor if there will be fees, but they probably won’t know.”

I recognize and acknowledge my privilege in this discussion. I have generally been extremely healthy. I am currently choosing to not hold a traditional day job so I can pursue a specific adventure and my writing. I live in a two-income household. I have a decent amount of savings and no debt.

However, my privilege here actually makes things worse. It’s a larger condemnation of the situation. If I am paying that much, that stymied by the system, with all my advantages, I can’t even imagine how someone with less access or less opportunity is faring. Let alone if I were someone who had some regular need to visit a medical professional. Good God.

Of course, the front line for today’s debate about healthcare in America is not about how insufficient Obamacare is, how much it’s quietly enabled a rollback of what we consider healthcare in this country, of the costs we expect the individual to bear for their own health. It is on the other side, how we can defend the paltry patchy efforts of Obamacare against a backslide into the world of terminated coverage and no guarantees. I think Obamacare is terrible, mostly for the opportunity cost of its moment in history not leading to single-payer or at least a public option, but also for the orientation around insurers as the primary player to protect and serve, part of decades of legislation being designed to serve the corporation above any actual person or other institution. But of course the idea that we would gut the few tolerable provisions of Obamacare is awful, too, even more awful, unless under some sort of accelerationism we believe that two years of that will finally usher in a world where the government treats “not dying” like it is part of the right to life.

As this first-in-years visit to the doctor reminded me, my window on youthful unfettered health is starting to close. It was my first lifetime visit where my blood pressure was above perfect, the result, probably, of gaining 60 pounds (a 51% increase!) over the last five years. Things can be done about this – I am too sedentary and still eat too much crap – but there is an unalterable gravity to the course of a human life. I will be in a position in the coming years where I should try to see doctors more, even if my questions about how to take preventative actions continue to go (as they did this visit as well) unanswered.

But the preventative question for the nation remains. The justification for keeping the ACA thourohgly ensconced in an entirely private market is that healthcare is one sixth of the economy. You can’t just go forcing such a large portion of our profit-center to compete with a service designed to actually – gasp! – meet the needs of citizens! Our shareholders would lose! And then what would the downstream impact be? After all, country clubs and luxury goods are a big part of the economy too.

The question remains: what is the role of the citizen in the country? Far from being an entity with rights, the modern perspective laden in both the ACA and the AHCA (more the latter, of course, but still), is that citizens are a resource for the economy. People exist to be mined, exploited, marketed to, money extracted for the purpose of firing up the engine of the mighty financial system. Denying the market access to that resource is unthinkable, an affront to all society, starving the lifeblood from that which we hold most dear.

Until we shift that mindset, until we get away from viewing 350 million folks as untapped oil or earthbound copper, I don’t know how we’re ever going to get around to fixing healthcare or anything else in our society. Or maybe the metaphor is more how we treat chickens. We only care about taking care of the ones still “working” for us in some capacity – who will yield productivity. The rest can die in the field for all we care. And keeping them productive is all about the quick fix – dose ’em with pills, fatten ’em up, get what you can from ’em, then move on. No one cares about the soul of a chicken, their outlook on life, how to prevent them from developing problems later in life. It’s producitivy maximization and then they’re a burden.

Sure, sure, get outraged at a potential rollback of the ACA. Call your Senator, cajole and threaten. But like lightbulb switches for climate change, recognize also that this supposed fix is both insufficient and broken. It’s a bandaid on the Titanic. It’s better to preserve it for the short term, yes, but only if we then immediately get to work on realizing the larger problems facing us, in reframing how we view our world. That we do not exist to serve the economy. And if the economy doesn’t exist to serve us, maybe it’s time to repeal and replace the economy with something that works.