I am tired of hearing about Universal Healthcare. Its all about what the Gov't MUST do for the individual but nothing about what the individual must do to help control costs. Recently I ran across an article about a woman that lived in Texas that went to the E.D. over 600 times in 2 or 3 years. Always by ambulance and if memory serves she was a Medicare patient. When someone has access to totally free healthcare you can expect this kind of abuse and it is abuse plain and simple. I think she was a COPD'er but Im guessing that maybe she had some other comorbidities that went along with it. How many times have you seen a COPD'er that still smokes, is grossly overweight , is a type 2 diabetic and virtually non-compliant with a medication regimine. If you have never seen it then you havent been in this profession all that long.Where is the personal accountability in this scenario? When things are free most people will go to the trough at the first  ache or pain since they dont have to pay for it. Human nature plain and simple. Additionally 65% of medicare dollars are spent during the patients last year of life. There is no return on investment in this scenario. I worked with a patient with advanced Alzheimers that was almost 90 years old. The family INSISTED that she get a CT or MRI (cant remember which) of the brain to see if there was anything that could be done. To the DR's credit he fought against it as long as he could til they threatened to sue unless their wishes were honored. End result the lady had the test. Was there anything that could be done, no, but some dippy family member, who probably got their information from WEB MD, was placated but it was done at a great cost with no net result. Why waste  money on something like this? Was she going to recover? No but some family member, probably with a guilty conscience for having MOM in a home, was able to rest better at night. That cost the taxpayers of this country big money esp when you knew going into the test their was no hope. If we are going to have universal healthcare then when the DR says no to a test then thats the answer. Period. If the family insists then tell them that they will have to pay for it out of pocket. That will put a stop to thiose types of things  in a hurry. If we are going to have universal care then everyone should get a coupon book for 4 PCP visits year and if you want more than that then ............you pay. E.D. visits of a non-emergency nature should be back billed to the patient. How many times in the E.D. have you heard:" Oh it started bothering me about 3 weeks ago but I waited until 3am today to come in and have it looked at". Unacceptable,,,,,,,,,,,,here's you bill. One last thing, you always hear seniors talk about having no money for meds but when I watch my local nightly news and they have a story in about the casino guess who you primarily see sitting there playing the slots..............you guessed it granny and grampa. Im for universal health care but if we demand nothing form people then we get nothing and shame on us for not requiring personal accountability in the big picture.  I found this great article regarding these frequent fliers check out :  Man calls the Emergency Room Home- los Angeles Times   web adress- articles.latimes.com/2001/sep/23/local/me-48992  Personally I feel we as a healthcare community have no reason whatsoever to play this guys game. Its cost the taxpayers over 900K to treat this moron  and that was up til 2001. Waste of our money.....................