I offer care to anybody who can’t afford it. The system is simple. If you are in need, a letter in my office explains, you can pay what you can afford. But the letter goes on to explain that if you want me to cut your fee so you can spend your money on expensive sneakers or a vacation, I’m not going to underwrite your luxuries.

Some people find paying for their healthcare a low priority. Because of the economy in my area, there are many people out of work and I am increasingly asked to reduce my fee, sometimes significantly. I don’t mind when the need is genuine, but I’m becoming resentful of patients who ask for a discount with a hard luck story and, in the next breath, tell me they just got back from Mexico, are having problems supporting their timeshare in Florida, or are having a wedding and their dress cost a thousand dollars. There are also those who tell me they are literally broke, but who still smoke a pack of cigarettes or more per day. I’m also confused by patients who have an iPhone and premium cable but want me to cut my fee in half because “times are tough.”

I think it’s time to ask more questions, even if those patients become angry as some of them do when I confront them.

It’s all about priorities.

And I think , as a society, ours are messed up.

I would pay for health before on-demand movies.

I would be ashamed to ask my doctor for a deep discount and then brag about my new plasma television or fabulous cruise.

Sometimes, I just have to shake my head in wonder at some peoples’ idea of needs vs wants.