Dear Dr. Gott: My husband and I are both self-employed. I won't even go into what has happened to our businesses these past few years. We are 56 and 57 years old. Our health insurance costs us $14,000 a year, with a $5,000 deductible. Please don't advise us to find a cheaper policy, as I continually shop around! We have no preventive-care coverage. When you and all other medical advisers recommend routine tests, you are simply talking to patients with the best medical policies provided by their employers. These are the patients who are making doctors and medical centres wealthy and causing us private payers to pay unaffordable premiums.

My husband and I do not get a routine colonoscopy. It's a $4,000 expense at our local facility. The last time we had routine blood work, it was around $500 each. I will have my mammogram this year that will cost me at least $500, but I will skip my yearly exam. I know this letter sounds as if I'm whining, and I guess I am, but I feel that the medical community recommends unnecessary tests for the privileged and makes those who can't afford it guilty.

Reply: You bring up valid points, for which I commend you. Insurance is extremely expensive and, in many instances, out of the question for millions of people. The entire country is going through difficult economic times, and when it comes to either putting food on the table or purchasing insurance, food has to win out. We've long since passed the days when a wife stayed home to care for the children while her husband went off to work. It now takes two paycheques to survive – if, indeed, both spouses are fortunate enough to have a job. The unemployment rate is about ten percent. Mortgages are going into foreclosure. Jobs are disappearing. I don't know any people who willingly walk away from a home they have worked for years to acquire. Insurance, unless provided by an employer, is often a luxury. On the flip side, employers are forced to spend more and more money each year covering their employees. It's one heck of a no-win dilemma we are all forced to face.

I would hope doctors and healthcare professionals aren't bilking the system by ordering unnecessary tests.

As a point of interest, I know of a recent case in which a gentleman complained of recent-onset headaches – something he had never had before. His physician was alarmed enough to order an immediate CT of the head. Without the X-ray, his advice might have been "take two aspirin and call me in the morning". Instead, the information obtained likely saved the man's life. In this instance, I congratulate his physician for running up the bill, as it were. It's a doctor's job to save lives, and that's just what happened in that case. And I must say there's nothing – absolutely nothing – that provides a better feeling than that!