Family Webicine

By Rod Moser, PA, PhD

Several of my friends have been diagnosed with cancer of different types. One good friend with a brain tumor has died, and the others are doing well…sort of. The battle with cancer is not their only struggle.

My old college roommate who has been battling prostate cancer for a few years now, but he has another type of cancer eating at him: namely, the economy. He is self-employed in a business that has nose-dived in the last several years due to the economy. People and companies still want his product, but they don’t have the money to buy it. Subsequently, his sole ownership company has steadily lost money and may soon fold. His repair center is his garage, his office is a spare bedroom, and his home phone is now the company phone line. He is down to the bare bones.

Through his company, he paid his health insurance, an expensive plan that costs well over $1500 a month. When you have cancer, you need good insurance, but good insurance is expensive. He reluctantly dropped his insurance, knowing that he will never be able to be insured again because of his cancer.

When people have insurance, they often have no clue as to the costs. It would be like going to the grocery store, picking out what you like, and then taking it home without going through the cashier, only to be surprised by the high bill later. Medical care in the United States is expensive; unbelievably expensive if you are the one writing the check or handing over the credit card. Lab tests are expensive. Drugs are expensive. If you ever need surgery or specialty care, you are in big trouble if you do not have a third-party payer.

At 60, my friend is too young for Medicare, and he does not qualify (as far as we can determine) for Medicaid. He is not ill enough for disability and it will be another year and a half before he can collect early social security. He has tightened his belt to the last notch and has begun to liquidate his few assets, like his beloved car. He is going to sell his house, assuming it will sell in this depressed time. His house is worth less than half of what he paid for it, so he will be lucky to pull out enough cash to support himself until he qualifies for social security. He may even sell his bicycle, the one he uses every year to raise money for the American Cancer Society. His life partner died of cancer several years ago, and he spent most of his savings ensuring the best care possible.

I have downloaded the California Medicaid forms but I doubt he will qualify. Sadly, if he was not a citizen, or was an illegal alien, he would easily qualify. If he had cervical or breast cancer, he would qualify. Prostate cancer does not qualify. If he had dependent children, he would qualify, but he never had children.

He has tried to find a job doing anything, anywhere. As a college graduate and business owner for over thirty-five years, he has plenty of valuable experience in sales and management, but no one has offered him a job. He scans the internet job boards and classifieds and has sent out dozens of resumes with no offers for even an interview. He was even turned down by a retail giant for an entry-level position. He suspects his age is his heaviest albatross.  While age-discrimination is illegal, it is so cleverly done that it would be impossible to prove.

He is unbelievably depressed, but even his depression does not qualify him for financial assistance. His friends are all scrambling to help him. One neighbor even offered to marry him so that he could be covered as a spouse on her insurance. A client is sending him some inventory that he is free to sell. The client told him that he could keep all of the money, not just his usual commission. He is loved, for sure, but he will not take gifts of money or loans. He has maxed out his credit cards just for expenses of daily living, like food.

My friend is not alone. I hear so many similar stories in my clinic every week.  Even though I have little say-so in what my group charges for medical services, I do what I can to “down-code” (charge a lesser fee than would normally be charged), absentmindedly forget to put down chargeable items, and search the clinic for sample medications. I have stacks of coupons for reduced drug costs and free drug discount cards provided by my professional association. I know all of the pharmacies that are less expensive so that I can direct those in need.

Bad things often happen to good people, but good people do have a way of recovering, not just because they have friends who care, but because they are good people.