A young woman in Indiana, twenty-eight years of age, seemed poised for a good life. She liked her job in a small professional office where she was respected for her consistent performance. She enjoyed the people with whom she worked and she was engaged to be married, in only a few months, to a young man with whom she was thoroughly in love. Life was happy, busy, and could hardly have been better so she paid little attention when she experienced occasional dizziness and a slight numbness in her left arm and leg. These symptoms were followed by blurred vision and headaches and, at the urging of her family and her fiancée, she went to her doctor.

Although she had no health insurance—her employer was a small business and offered no employee benefits—her physician was able to arrange for a stream of increasingly more sophisticated and more expensive diagnostic procedures and, a referral to a neurologist. The diagnosis was Multiple Sclerosis. By this time the young woman’s symptoms had progressed and her physician pronounced her disabled and unable to work. Reluctantly she quit her job—at that time she truly was unable to perform her duties–and applied to Social Security for a disability.

After a lengthy process, during which her symptoms began to abate, the application for disability was rejected by Social Security. Although she felt much better, and was able to return to work, she was told that the MS symptoms might recur and could be even more debilitating. She was now a twenty-nine year old woman whose life was not so promising. She was unemployed, thousands of dollars in debt, and lived with the fear her health could deteriorate at any time. Her fiancée had stuck by her during the ordeal but the couple was advised to postpone their wedding, as a husband would become liable for her indebtedness. Heartbroken, frightened, discouraged and deeply in debt, she filed for bankruptcy.

Eventually she found a new job – her previous one no longer available – and although she didn’t care for the work or co-workers nearly as well as her prior job, a group health plan was offered. Unfortunately her MS was ruled as a pre-existing condition that would not be covered, at least during the first year. The monthly payroll deduction for the health insurance premium reduced her take home pay by twenty percent.

This young woman had become a victim, not only of her illness, but also of the system. The healthcare providers who took the financial risk to provide care for this patient were left with little choice but to write off a portion of the charges for their service. Although not visible to the public, costs such as these must be born by the system and they fuel the fires of medical inflation. There is no such thing as a free service, and someone, somewhere must pay.