Medicaid = MasterCard; we need some change!

Emtala is just the tip of the iceberg, and it's ICEBERG DEAD AHEAD! I work in a new york city emergency room. I love what I do. I love walking into work, casting aside my prejudices, and treating everyone that walks through the door; even if I think they're crazy, even if they're frequent fliers, even if I know their drug-seeking, even if there's nothing wrong with them and they're complaining. This is why I like Emtala.

EMTALA is a law put into place to prevent emergency rooms from dumping patients without insurance to other hospitals or worse, the street. It was a good idea, but it really is only the tip of the iceberg. The hospitals need to get paid too, so the communities can continue to have medical resources that will treat EVERYONE and so those that work at those hospitals can keep having a job. And I assure you that anyone who works a job, pays their taxes, and has or is in need of medical insurance would be ROYALLY PISSED to know that many people abuse the ER with their medicaid cards - waving them about like MasterCard's. Many patients have told me they want a prescription for benadryl, or tylenol, or bandages...or they came by ambulance instead of taxi because medicaid paid for it, why should they pay cash?. Except I know full well that medicaid means me, and you, and everyone else who works and pays taxes. It's a freebie, originally designed to help people who couldn't help themselves.

I understand and have deep sympathy for people who are genuinely disabled, have multiple medical problems, are dirt poor and unable to do anything about it. But I cringe when I think of people who are deciding between paying for their seizure/diabetic/cancer/hiv medications or food...and then there are people who want Rx for over-the-counter medications so they can have their smokes, friday night out, or buy that plasma t.v. I'm not making this up, I've seen in when I worked in EMS and walked into peoples homes, and I see it in the ER. It's not that simple, and yet, it is. People do this, because they can. People use that Medicaid card like a medical MasterCard because they are in a shit place and they should at least have this, right? The laws suck; deep, deep down and from the ground up. We need reform, we need a clearer vision, we don't need another band-aid, more money, or more of the same.

I refuse to become one more cynical emergency medicine clinician against folks who use it because they can; change the system.