As Budgets Tighten, More People Decide Medical Care Can Wait

The couple decided that Doss's annual checkup took precedence because he needed it to keep his commercial driver's license. The checkup, plus blood work for a fatty liver and high cholesterol, cost $300. He persuaded his doctor to provide free samples of his liver medicine.

Helen Doss does not plan to get an annual mammogram this year, even though her mother died of breast cancer at age 56. Doss was offered a free stress test at St. Vincent Indianapolis Hospital, but she is afraid it will turn up more problems that she can't take care of.

"I'm just holding off for a year and hoping nothing happens," she said.

Their primary-care physician, Steven Wilk, is devoting more time to helping patients decide what to postpone.

"Folks are asking us to try to limit what we order or pare it down to the bare-bones minimum," he said. "As a doctor, I worry about the risk of missing something at an early stage. It could lead to more serious problems down the road."

In past recessions, health-care spending briefly spiked -- as people raced to doctors before their insurance ran out -- and then fell sharply, according to industry analysts.

"Many times in health care there's a lag of three to six months before it hits really hard," said Donald Fisher, president of the American Medical Group Association, which represents large, multi-specialty providers. "If they have a problem, they get it fixed while they still have health insurance. Then we see a decline in elective procedures, and then we really see a drop-off."

In Plano, Tex., life feels like an endless downward spiral, Victoria Freudiger said, for herself and her husband. Losing jobs meant eliminating health insurance. No insurance meant Thomas Freudiger went to the hospital when he developed pneumonia this summer. That resulted in a $363 bill they couldn't pay. Now their credit is shot.

As the economy crumbled, both started canceling preventive screenings. She hasn't had a pap smear or a mammogram for close to two years; he is overdue for a colonoscopy. They use do-it-yourself dental cement to patch their teeth and put their best face forward in job interviews. And although her doctor prescribed Neurontin for her seizures, Victoria Freudiger tries calming techniques instead of the pills.

"Instead of taking them every day, I wait until I start feeling sick, and then I take them again," she said. "Both of us are suffering mentally, emotionally and physically."

Though the burden is especially heavy for uninsured Americans, even those who have coverage are feeling the pinch as employers shift higher deductibles and co-payments onto employees.

"The reason why health care was immune [to recessions] in the past was because most people were covered under good insurance plans," said Jean Mitchell, a professor of public policy at Georgetown University. Now, "people are realizing, 'Oh my gosh, I have to pay for this out of pocket.' "

In Durango, Colo., Marsha Porter-Norton and her husband, both entrepreneurs in their mid-40s, switched to a high-deductible plan when insurance premiums skyrocketed. Their new catastrophic policy costs $479 a month, but they have to pay the first $6,000 in expenses.

She is supposed to get ultrasounds twice a year to check on the fibroid tumors in her uterus. But the couple's retirement portfolio "has taken a massive hit," and they worry about their jobs, Porter-Norton said. So, for now, she's going to wait on the $500 ultrasound.

"I'm going to take a gamble," she said.