The other day, while I was looking at my Twitter feed, I came across this amazing thread by Dr. Jennifer Cowart. I was so moved by this heartfelt plea to our elected officials that I asked her permission to post it here.

Female doctor with the stethoscope holding heart

I have never seen a patient who did not deserve healthcare.

I have seen people, rich and poor, who do not take care of themselves. Who drink too much, eat bad food, smoke, use drugs, drive recklessly, etc. If you smoke and get lung cancer, or if you didn’t smoke and get lung cancer, you deserve healthcare.

I have seen people, rich and poor, who believed themselves entitled to whatever care they wanted, at whatever cost, whether it was evidence-based or not. It didn’t change the fact that they deserved appropriate healthcare.

In fact, it is interesting that “entitled” is an epithet more often thrown at an “undeserving” poor person than a rich person with the same behavior and attitude.

I treat “good” and “bad” people. People I wouldn’t let in my house. It doesn’t matter. I’ve treated registered sex offenders. I don’t ask what they did. I take care of their pneumonias, their heart failure, their cirrhosis. They deserve healthcare. My care.

I took my (healthy, neurotypical) baby to a specialist the other day. We passed many children with (visible) special needs. A girl with a trach in a push chair. A teenager escorted by her father with CP. Children with various genetic syndromes. They deserve healthcare.

That could have been us. If not for the luck of genetics, my children could be those children. Blessings, but also requiring significant care, time, money, and resources. Those children are worth as much as mine and deserve their healthcare.

To me, the fact that it will cost a lot of money to ensure everyone has healthcare coverage is secondary to the fact that everyone deserves it. If we decide everyone deserves it, we will finance it. Expensive things can be worthwhile. Healthcare is one of those things.

I have seen cancer patients lose their insurance and not know where their care will come from. Chemo regimens interrupted. Radiation not given. “Lost to follow up.” I have been in those rooms, held those hands, wiped those bitter tears.

When you’ve worked your whole life, had private insurance, got cancer before you are old enough for Medicare, get too sick to work, lose job, lose insurance, have to wait for disability/Medicaid to kick in… this is pain like you haven’t seen. Those people deserve healthcare.

I know there’s the flipside. People who never worked. Maybe they really were truly lazy, or maybe they were caretakers and never worked outside the home (doing invisible work). Some of these folks are rich, some poor. I treat them all.

Illness doesn’t respect your work history. “Bad behavior” may increase risk of bad outcomes, but we transplant a lot of livers into cirrhotics who drank. Cancer strikes a lot of folks who never smoked, who got HPV from their spouse, who did nothing “wrong.”

The only category I see that we consistently say as a country who doesn’t “deserve” their care are the poor. Sure, people judge alcoholics or people dependent on opioids, but we haven’t made huge moves to dump all of those folks off their healthcare programs.

Yet Congress tried to cut millions of people out of Medicaid. Give them the “freedom” to “choose” their care—which they can’t afford. They didn’t cut smokers off, or alcoholics, or diabetics who eat sugar, or heroin users. Just poor people, those “undeserving.”

We are still waiting for CHIP to be funded. Guess who’s children are covered under CHIP? Not the kids of smokers. Kids of working people who don’t make much, but earn too much for Medicaid. In other words, people who don’t have enough $ to “deserve.”

I reject the premise that money is what makes you worthy of my time and care. I understand that healthcare must be financed. My time is not free. I am not a volunteer. But if you have pneumonia, my worry is not how will you pay, but how to treat you.

So figure out how to pay for it, because everyone deserves to get treatment for their special needs child, their cancer, their pneumonia. To get that treatment, and not be bankrupted by it. Everyone deserves basic healthcare.

Jennifer B. Cowart, MD works as a hospitalist in Jacksonville, Florida.  She is a graduate of the The University of Texas Health Science Center at Houston and trained in Internal Medicine at Baylor College of Medicine followed by a fellowship in Clinical Pharmacology and Hypertension.  She then served as the Chief Resident in the Quality and Patient Safety (CRQS) program at the Michael E. Debakey Veterans Affairs Medical Center.