Q. How can you get health insurance if you're an American with a pre-existing condition? A. Live long enough.

This Sunday is an important milestone for me. It's the day I no longer risk losing health insurance.

I left my last job-with-benefits when I was 51 years old. I'd been commuting an hour and a half each day, and I was worn out. My husband had excellent health insurance, and publishing jobs were plentiful.

Six weeks after my job ended, however, the dot-com bubble burst and jobs everywhere started to dry up. In 2003, I discovered I had a great big pre-existing condition - a defective heart valve and an aortic aneurysm that would eventually require surgery. I became uninsurable except through my husband's employer (and mine, should I ever find another job). And then in 2008, the year I turned 60, the whole economy tanked. I realized I was now entirely dependent on my husband's employer for health insurance, since I would probably never again have a job-with-benefits.

I got scared. What if my husband died? Through COBRA, I could extend his insurance for three years, as long as I was able to afford the $7500+ annual premium. But that might not take me all the way to Medicare. 

And what if he lost his job? The annual premium for the two of us would come to nearly $16,000, and the insurance would run out after 18 months.

Doesn't the Affordable Care Act mandate coverage for the formerly uninsurable? Yes indeed, but there's a catch. To be eligible for the Pre-Existing Condition Insurance Plan, you have to be not only uninsurable but also uninsured for at least six months before applying, and then there's a lapse of two to six weeks before the insurance becomes effective. Going without insurance for 6 1/2 to 8 months when your aneurysm is reaching the danger zone is not a great idea.

But hospital emergency rooms have to treat you, don't they? Right, but they don't do prevention. They would not repair an aneurysm before it burst, though they would try to save you after the damage was done. Trouble is, if you wait for surgery until after the aneurysm ruptures, you will probably die, most likely in the ambulance on the way to the hospital.

Fortunately, my husband is alive and well and has a fine job with an employer who continues to provide excellent health insurance. Six months ago I had elective open-heart surgery, which means I am still totally uninsurable by pre-Affordable Health Care Act standards, but I am much less likely to die. And Sunday, I turn 63 1/2. If my husband lost his job today, COBRA would take us right up to Medicare. I can finally relax.

I am very much in favor of the Affordable Care Act, but it doesn't go nearly far enough. Repeal Obamacare? Only if our lawmakers make a serious study of why health care in Germany, France, the Netherlands, Switzerland, Sweden, Denmark, etc. costs considerably less than equivalent health care in the United States; and why those countries are getting better results than we are - and why citizens of those countries never, ever have to worry about living with a major medical condition and no health insurance at all.