A pedestrian passes a pharmacy store in Athens on June 13, 2012. With unemployment at 22 percent and loans virtually nonexistent, many people are doing without their drugs at all in the days ahead of the country’s elections. (Chris Ratcliffe/BLOOMBERG)

ATHENS – Ahead of a Sunday vote that could determine Greece’s future on the euro, the people of this Mediterranean nation already are feeling the harsh effects of their government’s running out of money.

From road-builders to priests to military suppliers, most walks of life have been affected by the government’s desperate bid to stanch the drain of euros from its coffers. Now health care is on the line, with pharmacists who are owed millions of euros by the government insurance system demanding in recent weeks that their clients pay the full sticker price for medicine. With unemployment at 22 percent and loans almost nonexistent, many people are doing without their drugs.

Greece’s direction will have deep ramifications for the 17-country euro zone, where leaders have just three days left to guard against the prospect that anti-bailout leaders will come to power here. The Fitch ratings agency warned on Wednesday that if Greece leaves the euro zone, the impact on banks in other struggling European countries would be “severe.”

Spain was pushed to accept a bailout of up to $125 billion to help its banks on Saturday, but the country’s borrowing costs have gone up, not down, since the aid announcement, a dire warning sign of how little investors trust Europe.

In Greece, given a pick between politicians who promise to comply with the bailout’s grinding austerity and those who say they will defy it, but risk their country’s future on the common currency, many voters say they have no good choice.

“It’s not as though the bad politicians are out and the better ones are coming,” said Mary Papakonstantinou, 75, who one day this week grudgingly slapped down a burnt-orange 50 euro bill, about $63, to buy blood pressure medicine for her husband at the cramped Athens pharmacy she has patronized for 40 years.

In better times she baked spinach pies for her pharmacists as a token of neighborliness. Now, though, she’s simply worried about being able to buy her prescriptions. Under ordinary circumstances, the state health insurance system paid her pharmacist directly. Now pharmacists, fed up by delayed payments that they worry may never come, have told their customers that they need to pay cash and try their own luck at getting reimbursement from their health insurance.

Periodic infusions of cash

Greece’s government is surviving on periodic infusions of cash from a $163 billion bailout from Europe and the International Monetary Fund. Those aid payments are on hold with Greece’s government in doubt, and Greek officials say that without more help, they’ll completely run out of money by the end of August.

That would mean no pensions, no paychecks for the more than 600,000 people on the government payroll and no aid for the troubled banks whose fearful depositors, including Papakonstantinou, are pulling out their money while they can. Greek President Karolos Papoulias said last month that depositors withdrew $1 billion on a single day after parliamentary elections in May led to an inconclusive result, though banking officials say that withdrawals have since slowed.

“We see the politicians on TV and they’re not even ashamed of themselves,” Papakonstantinou said, paging through the blue pamphlet that holds the prescriptions that keep her husband’s heart problems under control.

Of the $890 monthly pension that she and her husband collect, $125 now goes to medicine, she said. They’re also supporting their daughter, who is out of work. And though the government health insurance program is supposed to pay her back for the cost of the drugs, she said she held out little hope, since she is still waiting to be reimbursed for a request she made in December.

But pharmacists say they have little choice. Their suppliers, wary of extending credit in euros only to be repaid in weaker drachmas if the country gets booted out of the currency union, are demanding cash before they make shipments. And, though the pharmacies are receiving some reimbursements from the government, they are owed $188 million by the main government health insurance program, said Konstantinos Lourantos, president of the Pharmaceutical Association of Athens.

“Anybody who has to pay cash to buy supplies and doesn’t get money from clients will have to shut down in three months,” he said. Both he and his wife own pharmacies, and between the two of them, the government owes $200,000, he said.

The cash crunch has affected cancer patients too, according to the Hellenic Association of Women with Breast Cancer. The group says it recently counseled a woman who needed to travel from pharmacy to pharmacy in Athens to find the chemotherapy drugs necessary for her treatment because many locations are out of stock, having exhausted credit with their suppliers.

Unwitting creditors

Government defaults are rarely quite as black-and-white as payments being made one day, then stopping the next. Instead, governments prioritize how they spend their dwindling cash, paying salaries while delaying making good on other obligations.

In Greece, where much of the private sector was sustained on public-sector spending, many business owners have found themselves to be unwitting creditors of the government, as payments have languished for months while their own credit has dried up, forcing them to scale back their businesses. That has made Greece’s recession, now in its fifth year, even harder to escape.

“We just received payment two weeks ago for goods we delivered 11 / 2 years ago,” said Socrates Gavriil, whose family factory makes tents and bags for the Greek military. The delay in the $500,000 payment, along with the drying up of other orders, has forced him to shrink his employees from 40 to 5 and the government still owes him $188,000, he said.

The economic collapse has fueled the arguments of critics of the austerity program, including Alexis Tsipras, the leader of the left-wing Syriza party that is battling to win Sunday’s election. Tsipras says that austerity has depressed tax revenues and exacerbated Greece’s economic problems, and he has vowed to abandon the bailout, though he says he wants to keep the country on the euro.

European advocates of more flexibility for Greece have tried to make the case that the crisis has forced Greek politicians to take the country’s finances more seriously. Their arguments were complicated by a last-minute decision to postpone the filing deadline for 2011 taxes from two days before Sunday’s elections until a month after them, which was widely seen as an attempt to avoid upsetting voters. Depending on who is asked, the postponement was either a sign of fiscal responsibility, since it will probably benefit pro-bailout status quo politicians, or yet another instance of prioritizing political gain over the country’s bottom line.

Special correspondent Elinda Labropoulou contributed to this report.