The other day I talked with my chemo nurse and others who had been part of my care. I occasionally stop in to chat briefly and to be a celebrity—the Survivor! five years out and no recurrence (yet)—and be hugged. The last time, I’d complained about my urologist, and my chemo nurse had suggested an alternative.

“What did you decide about your urologist?” she asked.

“I’ll keep him. Frankly, if this other guy is part of your network, I’ve learned that your hospital is the priciest one around.”

“And you know why that is?” she asked.

“Does it have anything to do with the new wing they just added?”

“No, it’s the indigent; everyone else is paying for their care, too. The other hospitals don’t have that expense.”

“They’re not downtown and on the bus route,” I pointed out.

She couldn’t know that I felt suddenly guilty. It’s not just the indigent who arrive in ER because by law the hospital can’t turn them away. It’s people like me, caught in the squeeze of a bad job market and medical bills, who declare bankruptcy and stiff the hospital. I chose to pay my outstanding doctor bills—doctors can turn away a patient who can’t pay—but I stiffed three hospitals that deserved payment, because they can’t reject me.

With my job situation still iffy, I now make so little money that I qualify for a discount at the hospitals. (I’m four years away from Medicare, and though I don’t make enough money to cover my bills and my health insurance costs, I make too much for Medicaid.) Someone has to make up the difference. That used to be me, back in 2006 when publishers were paying decent money and money wasn’t an issue for me.

My favorite hospital (on purely sentimental grounds; I know that sounds silly, but I spent a week there, recuperating from the surgery that removed the exploded tumor, and I traveled there regularly for my chemo for five months) is the most expensive one in our region, because it’s located near downtown, near a college campus, near low-income housing and bars where fights break out and people get hurt. The other hospitals (I go to two others where specialists are located, plus a surgery center that’s cheaper) are out in the burbs, far from the madding crowds.

Still—and this may be just a ploy to make myself feel less guilty—our local paper has featured articles on the competition between the two major health care networks in town, noting the high salaries of the administrators, the competition to build the latest state-of-the-art cancer centers (though we are only about an hour from a famous one), the ginormous new heart center, the incredibly expensive machinery, as well as a comparison of costs, which is how I know my favorite hospital is also the priciest.

            Because let’s face it, boomers are aging, and aging people get cancer, which is a pricey disease, what with surgeries, chemo, radiation, possible reconstruction, follow-up surveillance. Cancer is a business, not just a disease, with lots of stakeholders: big pharma and the companies that make the machinery, physicians, nurses, insurance companies, and, oh, yes, the patients trying to stay alive. Does your newspaper run full-page ads for hospital services and physicians groups, as mine does? I believe that doctors and nurses go into their fields to help people—but hospitals are a business, even if they aren’t supposed to be for-profit. I love the flowers and pretty fountains that become part of the landscape, but those services don’t come cheap.

It would be interesting to see what proportion of hospital income goes where; I suppose I could find that information if I were feeling like an investigative journalist. But I have my own business to run, my own next freelance project to find. I’m just sitting here, wondering, trying to deflect guilt.