While the insurance landscape will change when Obamacare goes into effect next Tuesday, crushing health care costs in New York City will surely continue driving many New Yorkers to desperate measures .

Many city residents simply forego medical and dental care entirely, sometimes exacerbating minor problems into life-threatening emergencies. Others post plaintive messages on fundraising website gofundme.com to help pay for their loved ones' strokes, cancer treatments and kidney transplants.

Some residents -- especially those with ties abroad -- travel to other countries to obtain quality care and operations at a fraction of local prices. Others engage in all manners of medically sketchy, and sometimes downright illegal, acts to save money -- trading or sharing meds, lying to obtain government assistance or importing needed medications from abroad.

For many, medical costs preclude not just insurance coverage, but proper care.

"I'm supposed to get allergy shots," but seeing a physician to obtain them is too expensive, said John Ford, 29, an uninsured trainer and founder of jkffh.com, a fitness website. Ford, who lives in Hell's Kitchen, makes do with over-the-counter meds. "They make me drowsy," but DIY treatments seem the only solution, he said.

Regional cost comparisons are scant, but federal data shows that the average family insurance premium in the metro area is $18,289 -- the highest in the continental U.S.

The Healthcare Blue Book shows $11,340 as the typical average fee providers accept as payment from insurance companies for an appendectomy nationwide: In New York City, according to a number crunching of a dozen zip codes, that average is closer to $13,617.

One 27-year-old Brooklynite, who only wanted to be identified as N.K., skimped by without health care until she became pregnant.

"No way could I afford the $600," she was told she would need for an abortion, she said. So she applied for Medicaid, deliberately neglecting to list one of her three part-time jobs to fall under the annual income limit permitted a single person in New York state ($8,994) to be Medicaid eligible. She got her abortion, then an IUD, and then, unexpectedly, an emergency appendectomy.

"I really like Medicaid: It's so easy to use," said N.K.

But health care reform means she will have to show proof of insurance on next year's taxes -- which will reveal she has been cheating the government. She is now stockpiling prescriptions and gorging on preventative care before dropping her coverage later this year to avoid being caught.

N.K. is committing fraud, said a spokeswoman for the Office of the Medicaid State Inspector General. There is no way to discern how many of NYC's 3,195,158 Medicaid recipients may be engaged in similar subterfuges to qualify for free coverage, she said. The health care exchange coming to New York Oct. 1 should help people like N.K. -- who makes about $19,000 a year -- purchase affordable insurance, said the spokeswoman.

Many women become pregnant unintentionally because they rely on cheaper, but less effective, over-the-counter birth control methods, said Dr. Linda Prine, womens' health director at the Institute for Family Health.

"The abortion rate is higher among the poor and uninsured and it's because of decreased access to effective contraception," Prine said. Patients come to her with inexpensive IUDs they have purchased from other countries asking her to insert them, but she must decline: It is illegal to implant devices that have not been approved by the Food and Drug Administration. "It's crazy, though," Prine said. "Canada has IUDs for $40, while in the U.S. they cost $400 to $800."

Prine has also treated asthma patients "gasping for air" because they cannot afford to buy their prescribed asthma drugs and inhalers. Then there are the patients who delayed obtaining care for minor infections that festered and who wind up in surgery, and, sometimes, hospitalized.

People also swap, borrow, and give away prescription medications. When the uninsured girlfriend of Steven Campos, 30, a bartender and textile designer from Bay Ridge, contracted a painful urinary tract infection, he gave her his amoxicillin prescription. "I did all the research on the internet," to make sure she took the right amount for the right period of time, he said. He knows that what he did was technically illegal, but "she was hurting real bad," Campos explained.

Skimping on care is a way of life for many New Yorkers. "We have bad things happen because people can't afford their meds," said Dr. Matt Anderson, a family practice physician in the Bronx. One insurer refused to cover the cost of prednisone for a sick asthma patient, who couldn't afford to pay for it himself. "He had to go to the emergency room and wound up being admitted," Anderson recalled.

Anderson is routinely implored by patients to write scripts for loved ones and family members. But "they're asking me to do something fraudulent, and I can't," he said.

Pascal Pagard, 40, a software developer and manager/consultant for Team Trade, was given a $2,000 estimate for an MRI of his knee after a soccer injury. The Upper West Sider opted to wait until he returned to his native France, where he was instantly provided not just the MRI, but surgery to remove detached cartilage for 20 euros, roughly $27. Not only is care too expensive here, it's bureaucratic and difficult to navigate, complained Pagard.

***

By the numbers

32%
Americans who have said they have delayed health care for themselves or their family members due to cost concerns

55%
Americans without insurance who said they have delayed health care for themselves or family members due to cost

21%
People on Medicare or Medicaid who have delayed health care for themselves or their family members due to cost concerns

Source: Gallup poll of Dec. 14, 2012

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Websites to help you save money on health care costs

One reason people have so much trouble finding affordable healthcare is the lack of price transparency. But a new website — clearhealthcosts.com — is doing the work by collecting reported and crowdsourced self-pay prices on everything from dental fillings to vasectomies. It also lists the prices that Medicare pays for certain procedures, to let patients argue for “the Medicare price”; lists caveats of what clinics do and do not offer; and boasts an informative blog.

Healthcarebluebook.com quotes the “fair price” that providers accept from insurers for a wide variety of medical, dental and audiology services, arranged by ZIP code. It also offers “binding price agreements” you can print out and take to providers to prevent runaway costs.

Searching for info on how the health exchanges will work for you in New York State? Here’s the official website: healthbenefitexchange.ny.gov.

You can also find more information about health care exchanges at exchangefacts.org.

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