My ever-articulate and energized chiropractor — while adjusting my back yesterday — also gave me her very pointed analysis of Massachusetts health reform. She hates it. She doesn’t wish to be named or interviewed, but I think her take is important, probably not isolated, and worth exploring.

She’s self-employed, around 40 (I’m guessing), with a fairly modest salary. She doesn’t qualify for MassHealth or Commonwealth Care. So she is among those required to buy health insurance on her own — or face a hefty penalty. So far, she has opted for the penalty.

When she looked into Commonwealth Choice insurance (the private kind, brokered by the Connector Board), the most affordable plan in her area would cost $200 a month. Not outrageous, so she considered it…until she checked which primary care providers in her area (Greenfield and Franklin County) took that insurance. There was exactly ONE — it was a community clinic that serves most low-income clientele. Since she is in the health field herself, she was familiar with that clinic, and she considers it so substandard that she would have to be PAID to go there. She says she was misdiagnosed there several years ago (over a sinus infection), and she says many of her own clients have had awful experiences there. On this health plan, she would have no other options. So she was absolutely unwilling to pay $200 a month for a service she would never use. The next plan, one level up, would have cost her $350 a month, and she can’t afford it. Better, she decided, to pay $100 a month in penalty. Plus, she maintains she’s “healthy as an ox”, with enough knowledge about health care that she would be able to either treat herself or find friends who could treat her.

So while she’s cracking my neck, I bring up a few devil’s advocate questions. For instance, what if she got into an accident? What if, God forbid, she developed cancer or another serious disease that she couldn’t treat herself?

Well, in that case, she says — she’d like to be able to buy catastrophic insurance. That way, she’s not paying continuously for the small stuff she doesn’t need, but for a much smaller premium and higher deductible, she WOULD be covered (as would the broader community) if something awful happened. HOWEVER, the state’s health reform law does not count catastrophic insurance as a sufficient form of insurance. In other words, she would still be considered essentially uninsured, and liable for a penalty. She is furious about this.

My chiropractor, like many others, considers health reform that revolves around private insurance a boon to insurance companies to the detriment of self-employed people — as well as others in her income bracket. She very strongly believes that, if Massachusetts or the U.S., wants to deliver proper health care to its citizens, it should adopt a single-payer system.