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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  • doc99

    Physicians in private practice could and would provide discretionary pro bono care if they could write off the cost on their returns. Just a thought.

  • LaPortaMA

    Parts of this argument are specious. I trust the author knows that.

    • Deloid

      I completely agree. The problems of healthcare have very little to do with these two examples.

      We have an expensive problem and though I am relatively well versed in the issues I have no answers. I do know though that we, as a society don’t take care of ourselves, over use the “system”, if socio-economically deprived tend toward noncompliance even with free health care, and as a physician who is stil an individual and part of society I also fear the cost of health care for myself and family.
      The things I would desire -healthy life styles and judicious use of medical care and less overhead (fewer administrators) will never happen.

      • Violetta V

         None of the examples in the article had to do with lifestyles. Really, people tend to blame lifestyles for everything. Look at statistics and learn the difference between absolute risk and relative risk. Yes, smoking is a single biggest thing with a 1000% increase in risk of lung cancer from about 1% lifetime risk to 10%. But then smokers die sooner so it’s questionable that the cost of their lifetime health care is higher than that of someone who lives to 100 and has all of the diseases of old age for the last 20 years.

        None of the other lifestyle risk factors come anywhere close to smoking. Maybe if you are morbidly obese, but even that is nowhere close to smoking. Hardly any bad choice increases the risk by more than 50% which means that if your risk of getting a certain condition is 1%, bad lifestyle would increase it to 1.5% i.e. the the majority of people who get these diseases would’ve gotten them anyway.

        Healthy lifestyle is a good thing, don’t misunderstand me, but a) it has nothing to do with the subject of the article and b) it does not save money.

        • pattiern

          Good lord, not you again…..

          • Violetta V

             Do you have some facts to contradict what I say or is it just an ad hominem attack?

  • ninguem

    The ones I get are upset at the cost of my addiction treatment, when the cost of my office visit is about two day’s worth of the drug they buy every day.

  • karen3

    You know, a Kaiser Permanente HMO plan around here is around $120 per month, depending on age, about the cost of cable plus a cell phone plan.  Pretty much about what the lady would have been able to save.  Its not that she can’t afford the test.  Its that she decided not to get insurance until it was too late and she had a pre-existing condition. 

    • realtimeprotocol

      KP allows you to get free quotes and shows you the price of every single plan they offer.  I didn’t do every state, but I did some with a 23-year-old female applicant living in her state’s capital or major city.  Yeah, you could get a plan for $127… with a $5,000 deductible (Georgia), $142 in CA will get you a $2,700 deductible plan, $157 in Ohio will get you a $5,000 deductible plan (I chose the plans closest to $120), and there’s an $8,000 deductible plan in VA for $209/month. 

      So, I call complete and total bullshit on your statement that lacks not only facts but compassion and understanding. Actual facts or GTFO.

  • PJ Dew

    You can’t assume people have $120 a month to pay for insurance.  When I finished school, I was broke, living paycheck to paycheck, and waiting to get full time work as a nurse.  When I finally got full time work, I had to wait 90 days for insurance.  Unfortunately, about 3 weeks into the 90 days, I became very ill and was hospitalized in the ICU for 5 days. DX:  Type 1 Diabetes.  That’s a rather expensive disease and without insurance, it’s a bit scary.  It’s not like I needed  aspirin-if I can’t afford insulin, I die.  If I can’t afford the $1/piece test strips that they want me to use a minimum of 4X per day, I get serious complications, b/c I don’t know what my blood sugars are.  I would NOT have been able to afford $120 month before that or while waiting for the 90 days.   If you’ve never been in the position of having a serious chronic disease and no insurance, and broke, you have no idea what you’re talking about.

    • karen3

      I have a serious disease, heck of alot worse that type 1 diabetes and a whole lot more expensive.  I have never gone without health insurance in my life.  paying that bill was more important than a car, housing or in some instances food.  It’s a question of priorities.  And by the way, the test strips are less than $1 a piece if you go to Walmart.  Insulin is a dollar a day with generic. That’s about $2.50 a day or $75 a month.  Work at McDonalds three hours a week and it covers that bill.Four hours a week and it covers a premium. Before Obamacare,  you could get at least a minimed with a part time job if you job hunted well and some places   had full group policies if  you paid a part of the premium.  Me being alive was a much bigger priority than anything else. But 20 somethings think they are invincible.  If you have a car, quite frankly,  you can afford health insurance.  A biopsy with any insurance, even if not covered, is a heck of alot less than $2000.

  • kullervo

    When I moved out of Los Angeles three years ago my policy was $555/month. I was forty. I’m female. I have no health issues and I don’t smoke. It had been $444 the year before. I now pay $200/month in Hawaii, but I have no prescription drug coverage. So to all the “budget for it” and “make it a priority” folks? Grrrrrr… in place of what I’d really like to say.

  • sFord48

    It really doesn’t matter if this woman can afford the $2,000 biopsy.  If the ovarian mass is benign, she is ok waiting.  If it is not, she can’t afford cancer treatment.  If her life isn’t worth $2,000, it surely isn’t worth $100,000.

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