This is N-a-s-t-y, but instructive...

Doctors remove 51-pound tumour from New Jersey woman

This really disturbed me. Not because the picture just grossed me out a bit. (and it takes a lot to gross me out. I used to look at medical books as a kid to find the nastiest pictures of the human body just to go ewwwwww at them). This disturbed me greatly because this woman, who had a fast growing 51 pound tumor growing inside her, waited 6 weeks until she could get medicare at 65, so she could pay for the surgery.  She had felt something growing but didn't have any insurance and saw no reason to go to a doctor that she couldn't pay for. 

By now, she weighed more than 170 pounds, her legs were swollen with trapped blood, she was badly dehydrated, and, scans showed, the tumour - a malignant sarcoma - was crushing her inferior vena cava, one of the main veins returning blood to the heart, and putting her life in danger. 

I remember when my mother discovered that she had ovarian cancer. It was devastating to my brother and I. But she had great insurance so she got treated. However, I remember her saying how she wanted to originally wait to take social security and medicare until she was 67 rather than 65. She could not wait. Even with her excellent health insurance, her out of pocket expenses for chemo were exhorberant. She got on Medicare as soon as she could and kept her other insurance to cover the 20% that medicare would not cover.  She was lucky. Many people don't have these options.

Dupree said he would advise uninsured patients to see a doctor immediately if they knew they were unwell no matter how near their 65th birthday might be. He said the hospital would have operated on Evelyn regardless of her insurance status, but added he did not know whether doing so would have cost her more money.

Of course they would have operated!! They are mandated to do so by law (she clearly had an emergency) and by conscience.  But for Dr Dupree to say that he doesn't know if operating before she had medicare would have cost her more money is disingenuous.  Of course it would have cost her more money!  She had no insurance and obviously no way to get insurance at that time since she knew that she was A) older and B) had a pre-existing condition, both prohibitive to getting affordable insurance and C) newly purchased insurance will not cover anything for at least the first 90 days. (yes, unlike car insurance, if you have a medical problem during the waiting period, they don't cover SQUAT!!!) 

So here is the reason for a mandate in the Affordable Care Act (aka "Obamacare"): If she already had insurance, she wouldn't have waited, cost of care would have been cheaper because the tumor would have been smaller, and there could have been an easier outcome. People argue that you cannot impose commerce on people. That we shouldn't be making people buy insurance.   However, at some point, you're going to get sick. Perhaps not as bad as this. But let me tell you, as you get older, your body does some different stuff and you need more medical attention.  Shoot, when my kid had to get surgery at 5, things weren't going too well for her either. If everybody isn't already in the system, the well essentially paying for the sick, costs will never even have  the option of going down because sick people take a lot of money to treat.  The insurance company would go bankrupt. The Affordable Care Act may not be perfect, but I would like for people (especially republicans) to tell me their alternative.