During my last night's shift in the ER, I had the pleasure of evaluating a patient with a shiny new gold tooth, multiple elaborate tattoos, a very expensive brand of tennis shoes and a new cellular telephone equipped with her favorite R & B tune for a ringtone. Glancing over the chart, one could not help noticing her payer status: Medicaid. She smokes more than one costly pack of cigarettes every day and, somehow, still has money to buy beer. And our president expects me to pay for this woman's health care? Our nation's health care crisis is not a shortage of quality hospitals, doctors or nurses. It is a crisis of culture — a culture in which it is perfectly acceptable to spend money on vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. A culture that thinks, "I can do whatever I want to because someone else will always take care of me." Life is really not that hard…. Most of us reap what we sow.