The first question a doctor's office asks any new patient: "What kind of insurance do you have?" Shaneera Smith's answer, like that of millions of Americans, is: "I don't have any."
Smith and her husband, Omar, both had pretty good jobs - she as a hairstylist and part-owner of a salon, he as a mortgage broker - though they were without health benefits. But they figured they were young and healthy enough that they could skip the added expense of monthly insurance premiums, especially as they struggled to pay the rest of their bills.
Until November, when Smith felt a lump the size of a dime in her right breast.
So began an odyssey through a system where the words "self-pay" are near-anathema, where the health worries of a 32-year-old are not always heard and where lack of insurance can ultimately be the difference between life and death.
For Smith, proper diagnosis and treatment of what turned out to be very aggressive breast cancer would take months of begging doctors to see her and worrying about how to pay them, thousands of dollars on an overextended American Express card and energy that could better have been spent fighting the disease.
An estimated 47 million Americans, including 800,000 Marylanders, are without health insurance, a number that could grow with the downturn of the economy. They are not poor or elderly - government programs provide care for those groups - but often earn too much to qualify for subsidized insurance, too little to find affordable care.
Studies estimate that as many as 80 percent of them have jobs, some like Smith from dual-income families. The Smiths earned about $45,000 last year while taking care of a baby and Smith's 16-year-old adopted son.
"We should have looked into other options," Smith says now. "We were, like, we'll get it [insurance] eventually. We just never did it."
A complicated illness like cancer, which often requires batteries of tests, hospitalization and long-term care, is hard enough to navigate through with solid private insurance. But those without, or those who are covered but not as well as they need to be, are left to cobble together health care through a mix of government programs (if they are eligible), hospital emergency rooms, charity and luck, if they can land in the office of a doctor willing to take them on.
