As I sat in a frozen yogurt store a couple of years back, I watched as two young men pulled up in an expensive vehicle. They were wearing athletic attire from a private faith-affiliated university in the neighborhood. Both grabbed sample cups and cup-by-cup consumed about ten dollars-worth of yogurt each before jestfully yelling “Gracias” to the Latin store employee and walking out the door without paying for anything. Then I saw the same thing happen with another group a few minutes later. While this may have been the most “entitled” I think I have ever seen anyone act, it occurred to me how commonplace this term has become in recent public discourse.

At some point in the past ten years, we began speaking publicly about government-sponsored health insurance and retirement plans as “entitlement” programs. The term is accurate. Veterans are entitled to VA benefits. They sacrificed their lives for the security of our nation. Senior citizens are entitled to Social Security when they retire. Their payments are commensurate with what they paid in over their careers. Since health insurance in the United States is employer-driven, Medicare is needed to provide a safety net for those beyond retirement age. Our values hold that children are entitled to healthcare even if their parents can’t provide it. That is where Medicaid comes in.

I can’t help to think that we started using the label “entitlement programs” in somewhat of a pejorative sense meaning that maybe the entitled people shouldn’t really be entitled to the government programs voted into place by the leaders we elected. Just like the affluent college students above, I have to say that the most “entitled” people I have met since becoming a physician have not been the poor or infirmed.

At a graduation party for my medical school at a nightclub, one of my classmates (the son of a physician) felt as though the bartender wasn’t serving him fast enough, so he reached behind the bar and helped himself to a bottle of liquor. During residency, one of my fellow residents (the daughter of a physician) parked in a handicap slot because she was late for work.

One of the attending physicians at my residency program who was compensated entirely by a private practice radiology group once complained about “entitled” patients over-utilizing the emergency room. In the meanwhile, this attending enjoyed never having to work overnight as well as the financial reward of having residents generate hundreds of thousands of dollars in revenue for her practice. You may think that the radiology practice that was sending the medical bills to the patients was paying the radiology residents who were doing much of their work for them. Nope. Just like most other medical residents in the United States, the residents were paid by the federal government through the hospital. Private radiology practices are entitled to having the government buy them call coverage overnight in exchange for offering an educational program that meets minimal standards, regardless of whether more radiologists are needed or not.

Maybe government health insurance isn’t the first “entitlement” program that needs to be modified.

Cory Michael is a radiologist.

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