I have changed health insurance plans three times in the last eighteen months. This was not because I wanted to, but because when people change jobs in America, they lose their insurance and have to sign up for new insurance. This involuntary insurance churn happens virtually nonstop to the half of Americans that use the employer-provided insurance system.

It’s a miserable experience, both because of the hassle of it all and because, each time you do it, your annual deductible — the amount of money you have to pay before the insurance really kicks in — starts over. If you have any care needs in the hazy period when you are switching your insurance over, it’s unclear which of the two insurers to charge it to or whether you need to pay for it yourself as if you are uninsured.

The upside of the system, relative to national health insurance programs, is supposed to be that you get to choose your health insurance plan. This is, of course, not true for workers employed by the many companies that only offer one health plan. But even for those who do have a choice, it is hard to believe all but a small fraction have any idea how to exercise it.