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Jennifer Kramer, a 30-year-old book researcher, has instead tried to prepare head-on for the possibility of illness. Because she couldn't afford a whole year of insurance coverage, "I signed up with an HMO for a month and then scrambled to get all the tests and care I could in that time," says Kramer, who went through monthlong all-you-can-visit periods twice. Unfortunately, her body didn't comply with the plan. Just days before her first one-month coverage period was about to begin, she developed "a biblical case of boils," which required an immediate trip to the emergency room that cost her more than $600.
Though she also had to wait up to six weeks for some of her appointments, which limited the amount of care she could cram into a month, she managed to see a gynecologist, an internist, and a viral specialist in one short month. Still, Kramer admits her scheme is less than perfect. "It ended up costing a lot of money for what I got," she says.
J.R., an uninsured former building manager, takes more of a "by any means necessary" approach to health care. She just narrowly missed qualifying for medicaid when she applied a few months ago. "They said I made $23 too much," says J.R., who describes herself as "a sickly, asthmatic-type person" who is "too honest when I'm filling out those forms."
But even without medical coverage and a steady income, J.R. gets herself to the dermatologist and other specialists when she needs to. When asked just how she manages, J.R. recalled what she did when her asthma flared up two weeks ago. "I got sick, so I went outside and hustled me some money and went to my asthma specialist." J.R. says that she doesn't consider herself a prostitute, but "If I go outside and I see a man and I need some money, I'm going to do what I got to do."
If her tactics are relatively rare in the world of health care, J.R.'s determination and resourcefulness are not. The uninsured often report waiting for hours to get low-cost care, making inconvenient journeys to clinics and public hospitals that will treat them, and drawing on their creativity to fight for decent care.
Living on some $3,000 she earns yearly teaching kids to read and a $1400 monthly stipend she gets for her disabled son, Lucy Aponte makes too much to qualify for medicaid. Nevertheless, Aponte, who has a heart condition, found herself scheduled for surgery last year to replace her pacemaker, which was found to be defective.
But when she explained to her doctor's secretary that she had no insurance, "she said, 'You don't have medical coverage, so your surgery has been canceled,' " says Aponte. The news spurred Apontewho was teaching a literacy course at the hospital during this timeinto an all-out advocacy campaign on her own behalf, which included calling the offices of TV journalist Diane Sawyer and taking her case to the president of the hospital.
She did finally get both the surgery and, for the time she was in the hospital, medicaid. Aponte still ended up with a $1171 bill from the hospital, however, which she says she was unable to pay. Nor can she pay for a new pair of glasses, so, since she broke her old ones, she's been wearing a pair her sister bought in a department store. "They give me a headache," says Aponte. "But they're better than nothing."
Indeed, lack of health coverage often becomes a matter of comfort. Jimmy Ling, a 28-year-old father who works in a bike shop, has had lower back pain ever since high school, when "two guys hit me at the same time and I landed on my tailbone." But, because he has had no health insurance since his football days, Ling has just lived with the pain. It was only when he was offered a free X-ray as part of a health promotion that anyone noticed that two disks in his lower spine were rubbing together. The radiologist recommended physical therapy, and Ling set up an appointment, but canceled it when he learned he'd have to pay almost $200.
"I just stretch on my own as much as I can," says Ling. "It's not worth the money."
Without treatment, as much as a third of the uninsured end up getting treated in hospital emergency rooms at least once a year partly because they've missed opportunities to treat conditions in their early stages, according to a 1998 survey by the Commonwealth Fund. The uninsured also end up in emergency rooms because they don't know of another place to go.
Such is Elisa Ramos's situation. "When I get sick, I just go to the emergency," says Ramos, who is 34 and uninsured and lives "two buses" away from the one doctor she's familiar with in the Bronx. Ramos keeps the bills from these visits neatly folded in her kitchen drawer.
"There's no way I can pay," says Ramos, who lives on $1057 a month in the Hunts Point section of the Bronx. When it comes to necessities, such as the drugs she was recently prescribed for painful muscle spasms in her back, she'll find some way to find the cash, though such outlays can be painful.
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