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April 14, 1993

What Are We Teaching About Indigent Patients?

JAMA. 1993;269(14):1789. doi:10.1001/jama.1993.03500140040022

To the Editor.  —I do not share Miles' pessimism that there is a decrease in charity care by physicians and that physicians "put their own advantaged financial interests ahead of their patient's immediate needs." That this occasionally happens is true, but it is certainly not universal. Miles' case in point was a patient with an arm fracture who was refused care by an orthopedic surgeon, allegedly because Medicaid did not pay enough.Charity is giving care because you want to—not because you have to. Medicaid and Medicare health care reforms were introduced to help the elderly, the young, and those without means. But to make the programs work, physicians, hospitals, and conventional medical insurance are expected to subsidize them. Doing so is not a charitable act, but a response to coercion. Let's not get the two mixed up.I recently received a letter from our Medicare intermediary stating that it