This is an archived article that was published on sltrib.com in 2009, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
I recently saw a healthy 50-something gentleman in my clinic. He is uninsured, though he makes a good living working as an attorney. He had not seen a physician in many years and was overweight but wanted a check-up before beginning a new exercise program.
After talking with him and examining him, I found him to be in reasonably good health. He had with him a list of lab work that he had researched and wanted to receive, most of which is not indicated for a patient in his condition. Despite being alerted to this fact, he was willing to pay up to $1,500 of his own money to receive the blood work.
One test that was indicated for him that he did not anticipate was a colonoscopy. He accepted it when told about the importance of the test in his situation. However, after discovering the colonoscopy would cost around $3,000, all of it being out-of-pocket due to his lack of insurance, he understandably decided against the procedure.
Let's assume for a moment that this patient did, in fact, have colon cancer. As our system is currently constituted, once he began to have symptoms of colon cancer, no insurance company would insure him, and he would be ineligible for any government programs due to age and income. He would therefore be expected to pay out-of-pocket the expenses for a diagnostic colonoscopy, as well as possibly surgery and/or chemotherapy and/or radiation.
There would be a strong possibility that the cancer would have metastasized to other parts of the body by this time, decreasing the possibility of a positive outcome for the patient and increasing the cost of care both for him and the system.
He would not likely be able to pay the tens of thousands of dollars in bills he would face. These costs would then be shifted to other patients in the hospital system, affecting both public and private insurances, thereby leading to increased premiums and costs to numerous individuals, as well as society as a whole.
A lot has been made in the health care debate about personal mandates -- the idea that we should all be required to have insurance or else pay a fine. Those who oppose mandates frequently say that it goes against personal freedoms to legislate an individual to buy insurance. A recent New York Times article even highlighted 12 states that are considering constitutional amendments outlawing such mandates.
When a significant number of patients is unable to pay for care, such as the 20 percent of Americans currently in that situation, not only do costs increase for everyone but quality of care decreases, as limited human and material resources are drained to support those unable to financially contribute to the system.
Evidence strongly supports that these issues already significantly affect all of us, directly or indirectly. When someone without insurance gets sick, we all get to pay the price.
In all likelihood, my patient does not have colon cancer. Indeed, I hope he never does. Insurance options are available for him that would cost less per year than the money he spent on the labs and office visit in one day, and many would cover his colonoscopy.
With tens of millions of uninsured, a personal or employer mandate is necessary, along with subsidies for those who cannot afford it, in order to decrease overall personal and societal health costs. While some complain about the loss of personal freedoms for a few, avoiding mandates would lead to further unnecessary yet significant financial burdens for everyone.
Dr. Kyle Bradford Jones is a first-year family medicine resident at the University of Utah.