The economy has tanked. People are getting laid off. Bank accounts are shrinking. We fear that it will get worse. All this is causing people to demand low-cost generic drugs and split pills, forgo recommended screening tests and delay elective procedures, perhaps even turn to home remedies. The number of people who have gone without a prescription or skipped a doctor's appointment for themselves or a child has increased since last year. In addition, this summer saw the first decline in prescription drug spending in almost a decade. Almost 20% of U.S. residents say they have trouble paying medical bills.

It's not just the uninsured who are affected. Even those who have group health insurance coverage are skimping because employers have raised their deductibles and copayments in order to cope with ever increasing health insurance cost. Increased out-of-pocket expenses for healthcare drive down utilization of health insurance benefits. Some that cutback in utilization is good because there was overuse of health benefits in the days of plush employer benefit plans, but there is a point where people's health will deteriorate because of forgoing preventive and routine care and result in bigger medical expenses down the road for treatment of serious illnesses.