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Jon Marcus, an executive recruiter, has been insuring himself for several years through Blue Shield. But endless rounds of rate hikes have his head spinning.

"I realize as I see health care costs rising, that we are all reliant on the health insurance system to afford any kind of health care need."

Marcus has been driven to sign on for catastrophic health insurance, the least expensive. Catastrophic coverage, however, is generally useful only in dire situations.

How have insurers stuck it to Marcus and others who, like him, are self-insured? The daggers are too many to enumerate. But here are some of them:

In the past three years, his rates went up: first, 14 percent, then 30 percent and finally 20 percent. Marcus once had a zero deductible; now it is $750. He had 20 chiropractic visits covered at a discount; now his insurer covers only 12. Blue Shield used to cover the lab work for his annual physical; "not any more." His co-pay has gone from $35 a visit to 30 percent of whatever the visit costs. Taking everything into account, he says his health care costs have increased 300 percent over the last three years.

The result: "I am asking doctors ahead of time what it's going to cost." Like others swirling in the vortex of out-of-control medical costs, Marcus is making health decisions not on the basis of health, but on the basis of expense.

His situation is further exacerbated by the fact that he has a pre-existing condition, which insurers will not cover. "Denying people insurance for pre-existing conditions is a common practice in the health insurance industry," Marcus says." He has a friend, a contract worker, who cannot get coverage for himself, his wife or his kids because he has the pre-existing condition of high cholesterol, which is treatable with medication. Another is in the same boat, with his family, because he has sleep apnea.

It annoys Marcus that health care providers do not ask those who work for a company the kinds of detailed health questions they ask the self-employed. "People who work at CISCO, for example, are just as healthy (or unhealthy) as anyone else," Marcus says. But "if you apply for health insurance through a job there are no questions."

Asked if he has suffered emotionally because of all this, Marcus grows impatient. "What do you think?" he asks. Is he dissatisfied? "It's not a matter of dissatisfaction; it's a matter of being screwed. They've got you. What are you going to do?"

Greed rules the marketplace, he says, and "the politicians have sold out to these companies. What happened to the capitalist system?"

There is no rational relationship between the rise in health care costs and the rest of the economy, he notes. While health care has risen 30 percent, the consumer price index has risen only three percent.

Things are getting worse, Marcus says. "With more people losing their jobs, and more people doing contract work, more people can't get health insurance. Roughly 6.5 million people in California (about 17 percent) don't have health insurance."

Insurers, Marcus says, have "abused the system." They have "too much power, outrageous rights, they can deny you coverage for almost any reason, they can raise rates for any reason, and they can even find reasons to drop you."

"I want to see health care prices, and the industry, regulated," Marcus says. "The government should totally take control. Let's face it, if you don't have your health you don't have much else. Why should we allow a system to govern our health care that places profit far above our health care? This insurance system has to change."