Public Aid

I was raised in such a way that I was not really allowed to borrow things from people. A pen or a pencil was fine but anything of significant value was off limits. I remember one time we borrowed a weed whacker from a neighbor and it did not work properly. Even though it never did work in our possession we were required to replace it. My mom told me that if you are going to borrow something then you have to be prepared to replace it and that it was generally less expensive emotionally and financially to either rent or buy the needed item. 

I have also never been comfortable in receiving something that I did not pay for or earn. I would just rather pay for the item. In certain circumstances I have had acquaintances offer services or goods free of charge and I am not sure if it is pride or a sense of proper ownership but I have never been able to accept these kinds of things. It is fine to receive a gift within reason and I have no problem trading goods or services with friends. 

I think that the aforementioned feelings about freeloading makes it hard for me to deal with the patients who use public aid and or WIC. I do believe that there is a population of patients who need these services, in Chicago we have projects filled with families who truly have no other way to get any healthcare. I think originally these programs were set up for these individuals who are truly below the poverty line and indeed would perish or suffer severe consequences without healthcare offered through public aid. However there are also a large number of people who look at public aid like free samples at Sam's club and figure out a way to get public aid and make the system work for them. 

Some of these people feel that they are entitled to this free service and that they deserve it. They bring this attitude into the office as well, and in their own way demand the "free" medical services. I am sure that they do not know that the doctors who take public aid do so at an incredible loss. Public aid here in Illinois has horrible reimbursement rates for doctors and a large percentage of the time they do not pay and when they do pay, it is after 9 + months and several man hours dedicated to getting them to pay. 

I know a handful of groups who will see public aid patients as a service. It is their way of feeling like they are giving back. I do not know any who see public aid as a revenue source, inevitably it is a business loss given the low reimbursement and the labor / supply costs associated with seeing the patient. Almost every group I have come into contact with refuses to see public aid at all. However, the group I am working with now does see public aid newborns and will follow them as children. 

It is frustrating when some of these patients come in with demanding attitudes and sense of entitlement. The interesting thing is that many of these patients have their kids decked out in the latest fashions and expensive clothes yet somehow expect free healthcare. They do not realize that their "free" healthcare comes with a cost and it is paid for by the tax payers and further paid for by the doctors who do agree to see them. Also these patients are the most likely to sue according to some recent studies. 

We had a public aid day and I spent the day trying not to get caught in the pettiness but I certainly left at the end of the day with less love for patients who use public aid and WIC while they pay for their house / cars and other bills yet refuse to pay anything for healthcare and then come in with a demanding sense of entitlement. 

As a doctor I think I would rather offer up 1 - 2 weeks a year and provide free medical care in the projects or under served communities and  serve medical missions than to offer to accept public aid. This way I could assure that my service goes to those who are truly in need.