Am I going to die because I cannot afford the test?

On my way to the hospital last week, I heard a 26-year-old woman describe her experience of becoming deathly ill. When she first realized that the many bruises appearing spontaneously across her body were unusual, she was working as coffee shop to pay off school loans. With the urging of a friend, she went to see a physician. The diagnosis was acute leukemia.

Her job did not provide health insurance and she was not in a position to purchase an individual policy. However, she lived in Massachusetts where health reform allowed her to enroll in MassHealth (a public health insurance program that combines Medicaid and CHIP for low- to medium-income residents of Massachusetts). MassHealth insurance gave her access to the most current advanced treatment. Four years after her bone marrow transplant and more than a million dollars of public funds, she is well.

So well that she called an economist to ask if the million dollars was not wasted on her life.

“What is the value of my life?”

The professor informed her that the money was well spent on a person who has their entire life of earnings in the future. She felt relief and extremely fortunate to have been living in Massachusetts, the generous state, where 98% of residents have health insurance and those who cannot pay for insurance, as in her case, have it provided by the state.

Her questioning reminded me of a young woman I cared for at a free medical clinic several years ago who arrived asking, “is my life not worth $2,000?”

After weeks of persisting pelvic pain, she finally had paid $200 to see a gynecologist, and then more for a pelvic ultra sound. The doctor told her the ultra sound showed a possibly cancerous mass on an ovary and recommended a biopsy.

“How much will that cost?”

“$2,000,” the doctor replied.

“I don’t have that” she panicked. “Am I going to die because I cannot afford the test?”

Calculating that it would take more than a year and a half to save enough for the biopsy. Then it would be too late.

Luckily for this woman, the following day a free medical clinic was scheduled for those not having health insurance. Her job as a restaurant night manager did not provide its employees health insurance. Her second job did not offer her sufficient hours to qualify for health insurance. Her combined salaries were not sufficient to purchase an individual policy.

Desperate, the following evening after getting off her shift, overcoming her shame of needing free care, she registered at the clinic.

My wife, a psychiatrist, and I, a primary care physician, had traveled to volunteer at this one-day clinic. Because the patient was in a panic when she was first seen, the she was referred to behavioral health where my wife listened to her story as she broke into tears asking, “Is my life not worth it?”

Realizing that the patient’s anxiety resulted from the despair that accompanies the uninsured when faced with a serious medical problem, and the fear of the consequences of untreated diseases, my wife reassured her that she would be cared for and then escorted her to the director of the clinic. Arrangements were made for the completion of the evaluation and subsequent treatment for which she would not be charged.

Ralph B. Freidin is a primary care physician who blogs at The Unseen Patient

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