A couple of weeks ago I visited my internist for the annual physical to which she subjects me in order to confirm that my various organs are still operating according to specifications. As she poked and prodded, I asked how her practice was going. This question elicited a resigned sigh and a brief but poignant discourse on the necessity of “firing” her Medicaid patients. Medicaid, the government program that ostensibly provides health coverage for the poor, imposes so much red tape and pays so parsimoniously that she simply cannot afford to treat these patients if she wishes to avoid bankruptcy.