The end of the month is always difficult for Beckie Clark, 58, and when she has to choose between medicine, a costly medical test or an appointment with a specialist, she does it.
"Dr Krist said, 'If you break a fever, you need to call.' He told me, he said, 'If you have a fever we will have to put you back at the hospital.'
"And the first thing that went on in my mind was, 'Well, I am not saying anything because I can't afford to go to the hospital,'" Clark said.
For Clark and for many Americans, the economic crisis has implications for their health.
Between the 20,000 dollars of her pension fund that evaporated from the stock market and the rising cost of food and gas, Clark has a hard time keeping her head above water.
She has thought about selling her house, though it is not completely paid off, but with the housing market gone bad, it is no longer worth much.
Clark moves slowly, at the mercy of shooting back pains. She has herniated discs and has had six operations.
She still goes to see Dr Krist every week but has put off further visits to the surgeon and has stopped physical therapy sessions altogether.
And although she has health insurance, she is responsible for a portion of medical costs that far exceeds her budget.
Her doctor tries to help her, prescribing only generic drugs, for example.