The fluorescent lights of the urology clinic felt harsh, amplifying the silence between the three of us. Guy Johnson, all 70 years and a lifetime of hard work, sat between his brother, Gig, and me. He leaned forward slightly, hands resting on the worn cane that had become a permanent extension of his frequently-falling body. He couldn't see the sympathetic tilt of the doctor’s head—his vision, already poor, had faded to blindness over the past few years—but he could sense the gravity in the air.
“The biopsy confirmed it, Mr. Johnson,” the doctor said, his tone carefully neutral. “It’s prostate cancer.”
Guy took a slow, rattling breath. The diagnosis, while dreaded, was almost a secondary concern to what came next. Guy was already a fortress of chronic conditions: diabetes that stole his sight, kidney problems, a brittle heart that had already slowed him down, and the constant fear of another hip-injuring fall in his modest Dallas home. He still worked part-time at the local grocery store, not for a hobby, but because his meager savings couldn't keep pace with the cost of being sick in America.
The Unknowable Price of Survival
"So, what's the next step, Doc?" Gig asked, his voice cracking with protective frustration. "And please, just tell us the cost. Give us a number."
The answer was the same evasive dance that has become the signature of the modern healthcare system.
“We can’t give you a final number today. It depends on your plan’s specifics, the final treatment pathway we choose, and which facility you use,” the billing coordinator chimed in, reading from an invisible script. “Medicare can only cover a small amount of the overall cost, of course.”
“'A small amount' isn’t all,” I interjected, looking at Guy, whose face was a mask of worry. “He’s on Medicare. What’s his copay? What’s his deductible for a procedure like radiation, and what about the drugs after?”
A fresh wave of vagueness washed over us. They rattled off percentages—20% of the Medicare-approved amount for outpatient services, a new Part B deductible, a Part A copayment for any hospital stays. For a course of radiation therapy alone, a patient like Guy could easily face several thousands of dollars in out-of-pocket costs just for the treatment, even before addressing the prescription drugs.
The Lingering Debt of Hormone Therapy
The true financial burden became terrifying when discussing the recommended treatment path: a course of radiation, followed by years of hormone suppression therapy (Androgen Deprivation Therapy, or ADT).
The doctor, in an almost casual manner, heavily favored this aggressive, high-cost multimodal option. While the radiation is covered by Medicare Part B (with that standard 20% coinsurance), the follow-up hormone drugs are often covered under Medicare Part D, exposing Guy to high out-of-pocket prescription costs that can reset annually. Some oral cancer therapies can lead to initial out-of-pocket expenses for Medicare patients that are ten times higher than for those with commercial insurance, forcing many to delay or skip their medication altogether—a phenomenon known as "financial toxicity."
How do you plan for survival when the price tag is a phantom number, perpetually renewed by long-term medication?
Profit Over Patient: The Ethical Crossroads
This moment laid bare the moral conflict at the heart of American medicine: the profit motive. Doctors, often unintentionally, are funneled toward higher-cost procedures and specific clinics—referrals that sometimes have financial incentives baked into the system. The patient, already overwhelmed and with a body that is failing, is left wondering if the recommendation is for his health or the hospital's bottom line.
Is this really the "Golden Years" we were promised? For a man like Guy, whose body is a monument to chronic illness, it feels less like a golden age and more like a golden cage, where freedom is shackled by staggering, non-negotiable medical debt.
A Beacon of Hope in Dallas's Backyard
Guy lives in the Dallas area , and it was Gig who brought up a name he might recognize: Mark Cuban.
“I saw something about his company, the one that sells prescription drugs online,” said Gig. “They operate out of Dallas and offer medications at a flat, transparent price—cost plus a small markup, and a few dollars for shipping.”
While the company primarily focuses on prescription drugs and may not cover the full cost of a complex treatment like radiation, for a man juggling the daily costs of his other conditions—diabetes, heart, and kidney medications—a transparent, lower-cost option for his long-term hormone suppressants or other cancer-related meds could mean the difference between keeping his part-time job and absolute financial ruin. The generic prostate cancer drug Abiraterone Acetate (generic for Zytiga), for example, is priced dramatically lower by this model compared to the traditional retail price, offering a small life raft of transparency in a raging sea of hidden costs.
The journey ahead for Guy Johnson is not just a fight against cancer; it is a battle against a system designed to keep its prices secret and its profits maximized. It's a reminder that for many of our elders, the real illness isn't just the one diagnosed in the clinic, but the financial toxicity that comes with trying to afford a basic right to life.