CAITLIN KELLY
Two precious pieces of plastic enable me to enjoy life in the United States, and neither one carries an interest rate. One is my green card, actually a pale pink, issued in 1988 when I arrived from my native Canada. The second is my health-insurance card, the lifeline suspending me above this country's twin pits of hell - medical-bill bankruptcy of treatment at a county hospital.

  The card is issued by Oxford Health Plans, a public company based in Connecticut that has lurched for the past few years in and out of upper-management disasters. For a while, doctors pulled out in droves, fed up with waiting months for payment.

  For those who don't know, it's fee-for-service health care in the United States. Emergency rooms take Visa and no provider wants to see you without a clear idea of exactly who will pay them and when. The flip side of every medical sign-in chart includes several spots where your signature commits you to full, prompt payment. Only the elderly and poor, thanks to Medicaid and Medicare, receive government-funded health care. The rest of us, whether unemployed, self-employed or working for a major multinational, must choose from among dozens of privately run, for-profit companies know (forgive the bitter laugh) as "health maintenance organizations," or HMOs.

  As a mere patient, I watched Oxford's fiascos with weary bemusement. Could I have changed plans? It isn't simple. None are cheap. And you get what you pay for - who wants discounted health care? Some plans are terribly restrictive.

  I found my family doctor somewhat randomly, through a recommendation from my radiologist. But the links were to matter greatly. HOMs control their costs by strictly limiting the physicians they use and the treatments they can offer; you can only access one HMO specialist through referral from your primary physician - who may well receive your-end bonuses for saving the HMO money. Talk about conflict of interest.

  From our first meeting, in March of 1996, I liked this GP enormously. He was warm, listened carefully, made smart and empathetic suggestions. He practically cheered when I lost weight, had low cholesterol, enjoyed low blood pressure. His nurse chatted easily with me. Somehow, he and his equally affable partner could always see me the same day, with no waiting. I felt safe and cared for, and hoped they would, if necessary, help fight my way through Oxford's legendary thickets of referrals and refusals would I ever need costly and complicated treatment or tests. Even if I didn't like my HMO or its cost, I trusted this doctor - and he only accepts one plan, Oxford.

  This first shock came in December. I'd been paying $354 (U.S.) a month, a small fortune for a self-employed freelance journalist. Overnight, it jumped 15 per cent, to almost $400 a month. When I called Oxford to complain, the bored clerk chastised me. "You're lucky we didn't raise it 25 per cent," she said.

  Many self-employed or poorly paid Americans simply skip this expense. Even with a record 4 per cent unemployment rate here, the number of uninsured people has risen from 37 million to 43 million. A recent report in the public policy journal Health Affairs noted that insurance premiums rose 8.2 per cent in 1998 - more than double the increases in the three previous years. I sure can't just increase my writing and editing rates by 15 per cent overnight. (The cost, for the self-employed, is 60 per cent tax deductible. For corporations, which typically subsidize the true cost to attract and retain employees, it is 100 per cent deductible.)

  The second shock was even worse. Despite the words "Liberty Network" on my card, Oxford informed me by letter that I cold no longer see my GP. Not even if I paid him cash or switched to Oxford's lower-priced "Freedom

Plan." Only members of group plans, not individuals, retained this right.

  My second call to Oxford got so ugly as I harangued them for a reasonable explanation, they hung up. Who would talk to me?

  My GP, of course. During a final appointment, he patiently explained. "Individual patients like you are the most expensive. The want to get rid of you as fast as they can."

  I was prepared on principle to hate my new, arbitrarily assigned physician, Dr. Weinstein. "He's a good guy," my soon-to-be former GP said reassuringly. I felt like a child bride being handed off to my 40-year-old husband sight unseen. As though we were illicit lovers, my GP agreed he would still see me, nonetheless, if I paid cash. Yes, he would "make an adjustment" financially to help me do so.

  The third shock hit in early January. Before I even met Dr. Weinstein, I injured my right knee badly and needed to see an orthopedic surgeon, impossible without Dr. Weinstein's referral. Luckily, he agreed, allowing me access to a local surgeon, one of the team physicians of the New York Rangers. ("They're playing badly these days," joshed my brother in Toronto when I told him.)

  He ordered an MRI, arranged for the same day within five minutes, and a 10-minute drive from my suburban New York home. I didn't want the surgery, a simple arthroscopy, but, after a second medical opinion, at appeared necessary. I keep calling Oxford to make sure they'll pay for everything, from lab results to anesthesia and physical therapy. With every visit, I have to fork over an additional $10 co-payment.

  I've always resented the staggering expense, relative to my current income at least, of my health insurance. But this is the cost of my choice to live here - where Americans trade much lower taxes for sharply decreased social services. My tax rate varies between 15 per cent and a maximum of 28 per cent; I'd have to earn more than $125,000 a year before jumping to the next bracket, 31 per cent.

  While the U.S. presidential candidates are so often grilled on the campaign trail about managed care and access to medical insurance, I hear horror stories of long waits and rising costs north of the border, of a owing two-tier and drastically reduced Canadian health-care system. I read that Canadians are coming south, even with their battered collars, to buy faster and better health care in the United States.

  Is my care here better than what I'd now receive in Toronto? Who knows? It's what I've bought and paid for. Cross my fingers.