Healthcare workers are under tremendous stress, which has been made worse by the global COVID-19 pandemic. The pandemic has also brought to light the ugly underbelly of the (for profit) United States Healthcare system and how it fails the poor, POC, women, and the uninsured/underinsured. These are complex problems that will require equally complex solutions, some of which I’ll cover.

But first, I’d like to highlight a glaring example of the WRONG approach to these problems. This one is brought to you by ER physician, author, alleged man of faith (though he really needs to read what Jesus said about the poor), and blogger, Dr. Edwin Leap. It’s an older article, circa 2014, but the attitude toward poor folks seeking healthcare in the ER (because they can’t afford primary care, don’t have health insurance, can’t get off work, etc.) is one that I’ve heard from medical professionals in my circle and from the GOP. We have the opportunity to change the system in ways that will increase healthcare coverage, lower overall costs, and create a healthier population, but do we have the will? Do policy makers?

I believe we do, but if people like Dr. Holier-Than-Thou have their way, the system will continue to be draconian, one in which blaming poor people for their plight, making false assumptions about their frivolous spending on “luxury items” rather than prohibitively expensive healthcare plans, and belittling them for life choices and culture (that are often code for racist and sexist assumptions) are standard-of-care.

What does Dr. Edwin consider America’s “inverted priorities?” For starters, he has a big problem with tattoos, piercings, and Smartphones, particularly in the context of uninsured patients. Why would they spend money on frivolous things like ink, bling, and phones when they could use the money to pay for (overpriced) health insurance? Tattoos and piercings have grown in popularity, but apparently Dr. Edwin still thinks only bikers, gang members, drug addicts, unruly metal heads, or ex-cons get inked and pierced, a prejudice experienced by ordinary human beings who choose tattoos as a form of self-expression.

BTW, bikers aren’t bad people, nor are metal heads. Gang members, drug addicts, and ex-cons are often victims of circumstance. Yes, they made poor choices, but you won’t “turn their lives around” by refusing to attend to their medical needs.

According to Dr. Venita Mehta, this phenomenon, known as “controllable stigma,” is like “obesity, drug abuse, and lung cancer as a consequence of smoking. This is known as a ‘controllable stigma,’ and it includes tattoos, because they arise as a matter of choice.”

The stigma is worse for women. “Research reveals that women with this form of body art are perceived as more promiscuous, as being heavy drinkers, less attractive, less caring, less intelligent, and less honest.” Given Dr. Edwin’s assertion that, “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,” he’s likely judging his female patients more harshly based on ink as well as personal pubic grooming habits, since women are more likely to shave, pluck, wax, tweeze, and laser all parts of their mammalian bodies to satisfy the demands of the patriarchy.

Side note: what kind of doctor publicly obsesses over his patient’s pubic hair? That’s creepy. I’m pretty sure that violates the spirit of ethical standards if not the letter of the law. So gross, dude.

Of course, people with tattoos, piercings, and/or groomed pubic hair aren’t inherently awful leeches to the system who should spend less on their proclivities and more on health insurance. It’s a false equivalence. And even if these patients didn’t have tattoos, piercings, or Smartphones (which are a necessity these days for school and work), they wouldn’t automatically have the funds to pay for health insurance. Tattoos cost anywhere from $150-$800 (and up to $4,000), and body piercings run between $30-$85. Smartphones are priced at $550-$1,400 + carrier service, and are often essential for work or school (think of students in virtual school who can only access online classes by phone; think how many times you check work emails or answer work calls in the 24/7 economy; think gig workers who rely on phone Apps in ride share and food delivery). I’m sure Dr. Edwin, like my clinical colleagues, uses his smart phone to check messages, review patient records, communicate with colleagues, etc. How is that different from his “irresponsible patients?”

He’s a very busy and important doctor, and his patients are mere peasants who can’t manage their money or priorities?

Spoiler alert: That’s ^^bullshit.

For the sake of argument, even when you factor in additional costs of personal grooming (assume Brazilian wax at $50-$120 every month – $1,020/year). Add that to $400 for ink, $50 for piercing, $1,368/year for phone and service, you’re looking at $2,838. Private insurance for a HEALTHY person will cost around $5,580/year with up to a $4,000 deductible. Even if you took your took your “savings” of just under $3,000 and scrimped on other trivial things like food, clothing, and shelter (smell the sarcasm?) to come up with around $2,700 to cover your private insurance, you’d still be dealing with that steep deductible, high co-pays, procedures and preventative care that may or may not be covered, expensive prescription drugs that keep getting more expensive thanks to greedy assholes like Pharma Bro, and probably conditions related to malnutrition and homelessness since you can’t get health insurance AND pay your rent unless you’re privileged like, oh I don’t know, and medical doctor!

Would Dr. Judgy McJudgyton have a problem if the inked/pierced/groomed patient with a cell phone in question had insurance or could pay full price? Three guesses!

The answer, according to Dr. Self-righteous is priorities! It’s so simple. Modern definitions of poverty need to change, because heaven forbid poor people have things like an “expensive cell plan, new truck and big-screen TV with satellite” without putting up “a little money for their own health care.” Newsflash! $5,580/year isn’t a little money. It’s a year and a half’s worth of car payments (at $300). It’s 6 months’ worth of groceries (at $200/week). It’s 6 months’ worth of rent ($784/month).

Nearly 8 million people in the United States are impoverished. One in four workers are either unemployed or working at poverty level wages. Three of four are WORKING (as hard if not harder than doc here) for pittance. Are they less important? Do they matter less? Or, perhaps, are the bootstraps of the poor frayed, broken, and a WHOLE lot shorter than the doc’s?

The doc’s biggest flaw, as far as I’m concerned, is behaving as if he’s the rightful moral authority for his patients. He claims, “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 in the next paragraph, he bitches about, “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.” Well, thanks for clearing that up, Dr. God Complex! How dare the poor turn to “vices” like personal expression and phones necessary for work when they COULD be living right in your eyes by paying for healthcare while living in a box.

Oh, and he’s all about shaming smokers and opioid addicts, which is of course the best way to inspire lifestyle changes (NOT). Try that on veterans. I fucking dare you. I doubt you’d get funding or IRB approval for that study.

This sort of mindset is common among cis/het white males who are voluntarily blind to their privilege, so they preach “hard truths” to the downtrodden people without privilege while profiting from their misery. The real hard truth to face is owning your own privilege (as an educated, affluent, cis/het female, I’ve got plenty), understanding the advantages of a system that rewards you for no other reason than you’re a white human being and you’re a male. Do I doubt he’s had struggles? Not at all. But his race, gender, sexual orientation (he’s straight), religion, and self-professed conservative views haven’t been barriers to his success.

Speaking of being completely unaware, this is from his blog: “I’m also a conservative, so you’ll excuse me (I hope) if I also post things that reflect my political views. I promise not to be hateful, cruel or demeaning to anyone, because that would violate my allegiance to Christ, against which political leanings are merely dust in the winds of eternity.”

Because shaming the poor is totally what Jesus would do and isn’t totally hateful and cruel…

“Hate me if you want,” he writes. I don’t hate him. I pity him. But I pity his patients and colleagues and those he influences even more. You want to be a moralist? Leave medicine and enter philosophy or the clergy. You want to help people? Judge less and advocate for expanded access to healthcare, preventative care, and an end to poverty – there should be no such thing as the working poor. Do that, then I might be inclined to listen to you “speak the truth.”

Sincerely – me and my bald, irradiated arm pit ❤