Excerpts from Tough Times Prompt Patients to Skip Care,
by Benjamin Brewer, M.D., columnist for The Wall Street Journal, July 23, 2008

With gas prices hovering around $4 a gallon, my patients are cutting back on medical care.

A 59-year-old woman decided not to have a mammogram this year. At her age, she should be screened for colon cancer, too, but she is holding off until she becomes eligible for Medicare at 65.

Despite having some medical insurance as a self-employed cleaning woman, she is pinching pennies by scrimping on preventive care. If she develops cancer of the colon or breast she won't have saved anything. This year she is taking her chances.

… As the economy squeezes my patients, they are showing up sicker.

A patient quit smoking so he could afford gas for the 40 mile commute to work in a packaging plant. He has been living paycheck to paycheck for years and his rent just went up. …

The bad news was that he came to the office with severe pneumonia two days after refusing to let an E.R. doctor admit him to the hospital. My patient was afraid of the expense and all the time he would go without pay from work.

To make matters worse, he didn't fill the antibiotic prescription he was given either. The $50 co-payment was unaffordable, he said. This is a case when an insurer would have been better off picking up the antibiotic tab to avoid a larger expense…

When the patient came to see me, his condition had deteriorated. I persuaded him to let me admit him to the local hospital. He was in such bad shape that he was soon transferred to the ICU of a large medical center. His care will end up costing tens of thousands of dollars.

…

It occurred to me in an idle moment that I would be a lot busier if the $600 government stimulus checks had been spent on a basket of basic primary care services. That would have paid for 130 million people to have had most of their health needs met for a year…