Single and uninsured:
a medical emergency

Ron Wiggins

Palm Beach Post

August 1, 2004




Deborah Cearnal, 50, a single woman living in Stuart, has been getting by nicely, if modestly, all of her life until now.

Now she is suffering sticker shock of the medical kind.

"I'm one of those people who has always paid her bills. I can't stand to have a bill hanging over me."

Now she has a biggie. June 11, working two jobs but with no medical insurance, Cearnal went to the Martin County Regional Medical Center with excruciating lower back pain. She thought she was dying.

Kidney stones will do that. She was treated and on her way home in 2 1/2 hours.

Cost: $7,000.

"The ER doctor charged me $416 for seeing me for fewer than five minutes," she wrote. "Another doctor billed $303 for reading the CAT scan."

A thoracic and pelvic CAT scan came in at $2,313 and $1,813, respectively.

In addition to charges too tedious to list here was $437 for an IV infusion and something called a direct IV push saline lock at $161. A $112 visual urine pregnancy test might have been avoided if someone had thought to ask whether it was even possible for Cearnal to be pregnant.

"I had a tubal ligation years ago," she said.

This is not about outlandish medical bills. Of course they are outlandish. People who can pay are beat about the head and shoulders to recover prodigious sums lost from those who cannot pay.

This is about the helplessness and sense of desolation that descends on a usually self-sufficient worker and taxpayer who suddenly realizes that the very roof over her head hangs on a gossamer thread that is her health.

Kidney stones? Piffle. Seven grand for a few tests? A trifle compared to what it could have been. Cearnal knows that a heart attack or stroke or cancer would have meant tens of thousands of dollars she could not possibly repay at a time when she has had to borrow from family and credit cards to make her house payments.

What happens to her home and paid-for car if she cannot work her two jobs?

Cearnal is scared and anxious, grappling with the realization that working 44 hours barely enables her to meet her obligations. One more trip to the ER, or the loss of one of her jobs, and her life is in ruins. This at 50 years old and single. This after three decades of work and self-sufficiency.

How could it happen to her?

Born in Georgia, Cearnal grew up in Jacksonville and earned a journalism degree at the University of Florida. She worked eight years at the Gainesville Sun and married a pressman; they moved to Rochester, N.Y., where she put him through a printing trade school.

"And then he dumped me," she said. They were childless, and she remained single.

Cearnal worked for newspapers in Fort Myers and Macon before moving to Stuart in 1993 to work as a news editor. After a series of arguments over editing methods, her resignation was accepted in 1994. "I was tired of moving and wanted to stay in Stuart."

For two years she worked as a probation officer. Since the mid-'90s, she has worked as a clerk-typist, welfare counselor and cashier for Dunkin' Donuts, Publix and Walgreen's Pharmacy. She's now found a career she loves (while still working weekends for Publix): test administrator for Indian River Community College.

"My boss is phenomenal, and I love the work atmosphere. The pay is good, but I can only work 24 hours a week, so I have to get in as many hours as I can at Publix on weekends."

For now, neither job provides medical insurance, and her $350 a week take-home pay just covers her living expenses, with a little left over to repay loans incurred during unemployment.

Tight as Cearnal's budget has been, it had sustained her myth of self-sufficiency. The $7,000 medical bill exploded that myth, shaking her confidence that things will be fine if she just keeps plugging away.

Now that she has experienced an uninsured medical emergency, her fear comes with a dose of self-reproach for her inability to stay insured.

And there's one more thing when she's through scolding herself for her career shortcomings. She would like it very much if we would indulge her in a small entitlement rant.

First, let it be known that Cearnal believes in the entitlement of others, paid for with her taxes. But why, she asks, can't they flow back her direction before she loses her health, her job, her home?

Like now.

Where, she asks, are the safety nets the entitlements if you will for a 50-year-old single woman who has spent three decades paying into the system: paying school taxes without children of her own in school, paying hospital district taxes to a system with no provision for workers who temporarily lose health insurance during job transition.

Take it away, Deborah Cearnal:

"As a single, childless working woman, I get no tax breaks. I make too much at two part-time jobs to qualify for food stamps or Medicaid. (During recent periods of unemployment) I put my house payments on low-interest credit cards, which I am still paying off.

"But there are times when single people need assistance, too. I'm sick and tired of being taxed for immigrant health care, public schools, child care, the rebuilding of Iraq. I wouldn't resent all the years of paying other peoples' bills if I could feel the system was there for me when I needed it."

Cearnal seemed to feel better after telling her story. She felt better still when I told her that most hospitals will negotiate down a bill for uninsured people who do not qualify for Medicaid.

Later, I wondered how much a hospital credit counselor would knock off a bill if you promised to go to another hospital next time.