When the System Breaks Our Hearts and Blames Us At The Same Time

This weekend has been especially hard for those of us in emergency medicine. We show up everyday, trying to the best for every patient we see. Yet, this week, we find ourselves gaslit by an administration that suggests we are responsible for the long wait times and overcrowding plaguing our nation’s emergency departments because we care for people regardless of their ability to pay.

Let’s be clear: these waits result from massive systemic failures, not the fact that we refuse to turn anyone away. Yet somehow, caring for people who are uninsured, undocumented, or excluded from state and federal assistance programs has become the scapegoat for an unsustainable healthcare system that those in power seem hellbent on making worse.

And as if that weren’t enough, our community is also reeling from the heartbreaking story of a 20-year-old who died after two visits to a NY area emergency department. This tragedy has deeply affected us all and is now dissected in the press and the courts.

We’re expected to care for everyone, miss nothing, work within a system that dismisses our needs, and then show up again the next day with a clear mind and an open heart.

For those of us who are not only emergency physicians but also mothers, daughters, and family members of immigrants, many of us immigrants ourselves, the weight of these moments feels unbearable, because it is.

Let’s start with the truth: it’s not just EMTALA, the Emergency Medical Treatment and Labor Act, that requires us to care for anyone who enters our doors. It’s our ethos.

We don’t look into someone’s eyes and decide whether they deserve care based on their citizenship, skin color, gender identity, or ability to pay a bill. Emergency medicine exists to be the open door when all others are closed. That’s what we signed up for. It is fundamental to who we are.

So when this administration claims that people without insurance are driving up costs or “clogging” the system, it’s not just cruel, it’s also economically absurd.

We know that providing preventive care, insurance coverage, and access to primary care reduces emergency department utilization and overall health system costs. If policymakers wanted to save money, they’d expand access to care, not restrict it.

And let’s not forget: undocumented immigrants pay into our system every day. They contribute billions in taxes to programs they’re excluded from using. The idea that they are a “drain” on the healthcare system is not only false, it’s offensive. Caring for everyone isn’t what’s breaking our system. Refusing to build a system that cares for everyone is.

Then there’s the story of Sam, a young man (who shares a name with my own son), who unexpectedly died after two ER visits. His death has shaken our community to its core, especially here in New York City. The expansive article touched on many daily issues we face: nursing shortages, overcrowded departments, and patients who need care beyond what our administrators and payors will support. Even after reading the story multiple times, many of us still don’t know exactly what happened or what we could have done differently.

We accept the immense responsibility of this job and hold ourselves to the highest standards. After an unexpected outcome, we ask: What can we learn? How can we do better? And how much of those corrections are in our control versus those who employ us or run our government?

Both of these current events, the demonization of caring for the uninsured and the tragic death of a young patient, are symptoms of the same disease. Our healthcare system is collapsing under the weight of political neglect, financial austerity, and administrative denial.

We are in the middle of a government shutdown, health coverage expansions are being dismantled, and tax credits are expiring, driving up premiums for millions of Americans. Despite its recognition on shows like The Pitt, emergency medicine is at a breaking point. We’re managing more patients, complexity, and suffering, with less support than ever.

Lisa Miller’s New York Times article captured the overcrowding, staffing shortages, and unbearable boarding conditions we face. But it couldn’t fully convey the ongoing moral injury of showing up every day, expected to do the impossible, doing the absolute best we can and then knowing, somewhere down the line, someone may say, “You were the problem.”

We are not the problem. We are the last safety net when everything else fails. We deserve a system that values that, employers that support us, and a government that tries to make it easier for us to do our jobs. Until then, we will hold ourselves together with the duct tape and glue we have used for far too long, knowing that the whole system may collapse one day, and we will likely be inside.