We ask ourselves financial questions all the time. New house..how much will it cost? New car..how much will it cost? And we also ask ourselves this question when we have little control over the answer: Terrible illness ..how much will it cost?

The house and the car, and other big financial outlays, are usually planned. The illness isn’t, and the associated costs can’t be put off until the next year, or when the new raise comes, or when it’s simply more financially convenient. It’s most often sudden, and the financial impact is immediate. How many of us remember signing the hospital admitting forms which made us liable for the costs of treatment, scrambling for insurance cards, trying to reach the healthcare coordinators to find out just what is or isn't covered?

The financial impact of serious illness often hits when we least expect it. Many people who have worked hard most of their lives and put money away for their retirement, for example, find out when tragedy strikes that they aren’t covered for that particular illness or for a certain test or procedure, and then the payments must come from funds earmarked for other things. And even when the costs are covered under insurance plans, managed care plans and other forms of coverage, we often have to fight to get the insurer to pay the bills. The worst time to have to fight over covered expenses is when we are so emotionally and physically drained that we can’t even think straight.

The stress levels associated with serious illness are many, but by far one of the biggest is financial strain. Few of us have unlimited financial resources to help us through a crisis. In the beginning of the crisis, we muster all our financial resources, hoping that the total impact of the illness won’t be too severe or last too long. Shock after shock hits us when we find out how many of the costs are not covered. This is probably the first time that the financial implication of a serious illness becomes apparent. The stress of worrying about the ill person is increased by the stresses related to the cost of care. For example, if a family unit has been relying on two incomes to meet their needs and goals, the loss of one income, coupled with sudden heavy financial requirements, can produce overwhelming stress for everyone. This situation is only intensified when there are children in the family whose needs must be met.

There are many subjects which are discussed at the Well Spouse Support Group meetings. Emotional bereavement, feelings of anger, loss, fear and others crowd the agenda. But the financial stress associated with the illness can be the most overwhelming. Many well spouses suddenly have to understand confusing social entitlement programs, powers of attorney, retirement/disability benefits and so many other baffling subjects. Being told that you make/have too much money, are too young/sick to qualify, or not sick enough, can drive you over the edge. But, of course, well spouses persevere and tackle the problems one by one. Most often with fear, dread and because they have no other choice.

The financial toll on well spouses can be devastating. A long term illness can eat up savings, forcing nursing home placements with dependence on Medicaid. Pity the poor spouse who has to quit his/her job to care for the ill spouse, spends down all her/his money, places the ill spouse in an institution and lives a life of near poverty as a result. Of course, not every ill/well spouse situation has such terrible financial consequences. There are financially comfortable people who are able to pay all the costs of an illness, but they still suffer the emotional traumas associated with caregiving and loss.

Increasingly, the newspapers are full of stories about mismanagement running rampant in the health care field. Reading these horror stories is scary like reading about a corporation which has understated its losses and has to file for bankruptcy protection and jettisons employees, many of whom have been with the company for many years. A major provider in the New York area is giving up its Medicare and Medicaid accounts. This is very troubling for well spouses. What happens if you and the ill spouse are covered by a provider who simply decides to "give you up"? What if the illness will not be covered by another provider? When health care is run like a business, what happens to those most in need? Must they be viewed as an albatross around the profits of the provider? Well and ill spouses are subjected to the worst that life has to offer and the present state of the healthcare community is giving us sleepless nights.

Is there a cure for financial stress? Yes, lots of money. Money to hire nurses, therapists, housekeepers, nannies and a whole battalion of specialists so we can go to the movies, take a vacation, play tennis or even have a good night’s sleep. Enough money to keep the kids in private school if that's what it takes to guarantee them a good start to their education. Enough money to pay the mortgage so the house, the very roof over your heads, will not have to be sold to pay medical or nursing home bills. Money to pay for experimental treatments which might cure your dying mate. Money to buy the next box of adult diapers. Enough money so we don't have to ask, "How much will it cost?".

"Reprinted by permission of the Well Spouse Foundation, located at 63 West Main Street, Suite H, Freehold NJ 07728. Copyright 2000"