All of us have long known that poverty in America isn't like poverty anywhere else in the world. There really isn't anything here comparable to the poverty in Haiti, or Calcutta, or large swathes of Africa. Even poor people have televisions and phones. And it's apparent that a surprising number of people who are living on the thin edge economically still find money, not just for basic cell phones, but for fancy ones with lots of service; and are able to buy, not just basic clothes, but status conscious name brands. Even when one is poor, one still makes choices.

Linda Halderman writes about some of the choices her patients made when she practiced in a low income clinic. Either because they didn't care, or because they knew or assumed that our system, which never turns people away at the ER, provides a safety net, many of them chose not to buy insurance but, instead, to invest in things that would affect the immediate quality of their lives: high end transportation, fancy communication devices, cosmetic surgery, etc. Being young and healthy, and having to make choices, they invested in their present, not their future. The question Linda asks is, as to these people, the ones who can and do make choices, why should be, the taxpayers, be forced to provide them with essentially free insurance?

Individuals in this country have a right to decide how -- and how not -- to spend their money.

But that right does not include accepting entitlements without sharing responsibility. Doing so contributes to the high cost of care that burdens every unsubsidized patient.

If individuals prefer to buy luxury items rather than pay for their healthcare needs, that preference should not be rewarded while taxpayers struggle to foot their own bills.