The ER demonstrates the inverted priorities of American society Edwin Leap, MD | Physician | October 11, 2014

We fling open the doors of America’s emergency departments to help those who can’t afford health care. We have legislated this protection: No person can be turned away for financial reasons. This is very compassionate and represents the higher angels of our culture. Alas, it also is emblematic of the stupider demons of government. You see, the ER demonstrates the inverted priorities of American society.

In the ER, expensive tattoos abound. Piercing is ubiquitous. Almost every adult and child has a smartphone, it seems. All too many spend the duration of their ER visit glaring at the screen of said phone; barely looking up at the physician who is attempting to engage them in meaningful conversation about the reason they came for care.
Cigarettes populate purses and drug screens are notoriously positive for at least chronic narcotic pain medications, but often other substances, among them marijuana and amphetamines.
Dental care? It is regularly ignored because, in the words of my patients, “I don’t have dental insurance.” Guess what. Neither do I, and I pay a lot for insurance. Dental care has typically been a cash business. That’s why dentists, crafty guys and gals that they are, spend their time mucking around the human mouth. Floss and toothpaste? Seems a bit excessive compared to a nice new tattoo.

But, on the southern end of things, carefully groomed pubic hair is not at all out of the question. The teeth may fall out; the nether regions will be carefully tended.

It’s all about priorities: those of individuals and those of leaders. Our leaders, ever convinced that we must give medical care to those perceived to be in need, often forget that modern definitions of poverty and need may be a bit different from need throughout human history. And that if a family has an expensive cell plan, new truck and big-screen TV with satellite, it might not be unreasonable to ask them to put up a little money for their own health care.
A woman told me, recently, that her daughter (at birth) had a minor congenital abnormality that required daily application of a cream. “And I had to spend $200 of my own money!” She was aghast. As are all of those who will gladly pay anything for Oxycontin (legal or otherwise), but who are offended and downtrodden when their antibiotic isn’t free at the local pharmacy.
We can’t keep this up. We’ve created a monstrosity of entitlement. I care for the poor; I love the poor and have always tried my best to help those in genuine need. Those truly hurting.

But when cosmetics, vices and electronics are considered reasonable expenditures while the rest of us pay for necessities like prescriptions (or over the counter Tylenol and Motrin as I’m often asked to prescribe for Medicaid), then we are entering the death spiral.
Hate me if you want. The truth is unpleasant.
But it is clean-shaven.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.
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