I had a 50-year-old patient who had smoke several packs of cigarettes a day for more than 30 years. This had caused her skin to age and she looked more like 70. She would not pay for any pulmonary function tests for her COPD because she was saving all of her money for a face job.
Because of her aged and atrophic skin, we warned her that the skin would never look new or fresh and may not heal well because cigarettes remove all the collagen from beneath the skin which normally fills it out for a more youthful look.
However, she decided to proceed and came back about a month after the surgery. She sported a wound dehiscence (a separation of the scar) in front of her left ear with a scar forming that was about a quarter inch wide. As we had warned her, the skin she had was not very healthy and healing would be a problem.
Not spending a hundred dollars to get the usually required health care for her lungs, she spent $3500 on her face, which was not helpful.
When health insurance is touted as being unaffordable, it should be noted that the medical specialties that work outside of health insurance, such as plastic surgeons, are doing extremely well.
Thus when the government takes over health care, one thing that will happen. People will have more money to purchase unnecessary care.