Unfortunately, no. $40000 per year sounds expensive, but I pay half that much in Switzerland, and my medical experiences are much worse than described.
In fact, if somebody would just freed me from any worries about hospital bills, negotiations, late fees, appointments etc, I would consider paying $40000 flat yearly rate to get everything covered (if for the whole family). Unfortunately, it looks impossible in Switzerland. There are concierge services, but they just add their own bill on top of hospital bills.
From the article:
"The annual fee covers the cost of visits, all tests and procedures in the office, house calls and just about anything else other than hospitalization"
Hospital _stay_ -- no. Hospital visits -- yes. Most of my medical expenses to date were unrelated to hospital stay (though it is the hospital who issued the bulk of the bills). All in all, I have payed around $100k for medical expenses since 2011.
I.e. I am OK with the terms. I would prefer to pay a little less, $40k is outside of my affordable range ($24k is more like it). However, if absolutely unnegotiable, I might put it on wishlist for the next 3-4 years.
Although the article doesn't specify the details of the program, but a typical visit to a hospital emergency room in the US is billed differently than a regular office visit with much higher mandatory co pays. By the example given in the article, it seems like their private "concierge" doctor shows up at the hospital, but what about the other costs associated with the visit? nursing costs, xray, ambulance, labs, other doctors? all of those are billed separately and patient's responsibility, and they are not cheap. If that 40k covers those additional costs at 100% as well, then it actually sounds like great value, but somehow i doubt it. But anyway, the folks on the $40k/yr plan probably are not concerned about the additional cost they just want fast private service.
According to the article, $40k is the flat rate for everything except hospital stay, which makes a lot of economical sense.
If it is $40k _on top_ of existing medical expenses (which I doubt), it is just another toy for the wealthy, and will not gain significant traction. "Regular" concierge service is usually much less expensive.
No. It's really as simple as that. only the US allow for this.
Edit: To all the down-voters. The article isn't about private healthcare which in the US is more the rule than the exception. It's about a layer on top of private healthcare.
Of course private healthcare exist in other countries. But this concierge layer for "normal" rich people you will be hard pressed to find many other places I ma pretty sure off (but could be wrong of course). Unless you are a politician or royal or something.
While there may be some countries that disallow private healthcare entirely, the international situation is far more nuanced than your comment implies. For example, I lived in Spain, where most people use the highly functional public health system but there is a parallel private healthcare industry that is also very effective (and still reasonably priced, compared to private healthcare in the US).
Yes private healthcare systems of course they exist in other countries. But the article is as far as I understand it about something else. It's about a layer on top of the already existing private healthcare system in the US.
Many countries have parallel private medical care. The egregious thing is that the US doesn't even have an affordable public option for the rest of the population.
Completely agree. I didn't mean to say only the US has private healthcare. I was reading the article as an extra layer on top of the already existing private healthcare with even better access than ex my Aethna all access bla bla thing.
Well, probably not this level of pampering, but clearly money always helps, and that is allowed pretty much everywhere. And, I'm willing to bet, in those places where it's not allowed it's done off the record anyway.
My own data point: back when I had a job that provided private insurance in Spain, making an appointment for my daughter with a specialist required waiting for weeks. The shortcut? A paid, private appointment, outside this private insurance. The specialist saw her in a matter of days.
I could have paid for that visit without having private insurance. If anybody allows this it is the state, and as far as I know it was all allowed and legal. With regard to this extra layer on top, I doubt it wouldn't be allowed in Spain. There just isn't a market for it, in all likelihood.
Thats not the point. You can't just get right in front of the best doctor if you choose to pay out of your own pocket. The whole point is that this layer provides you with extra access and extra care.
I disagree. Given enough money you'll get a top-tier doctor in any specialty pretty soon, pretty much anywhere. Again, my point is that probably few places disallow this service, as you indicated. Maybe you meant to say that even the wealthiest in countries with outstanding health systems don't bother looking for such a service? That may very well be the case.
Some countries with public health care disallows private medicine practice. Where I live health care is neither the worst nor the best in the world. If you're dying then you'll be taken cared of with low out of pocket expenses (mostly drugs). On the other hand if what you have isn't life-or-death, it can take months or years before it'll be taken of.
More recently, they started allowing private practice but there are rules for how much time a doctor can work vs in the public system. Tbh I'm not sure I how stand on it, it's a complex problem with many variables. The only thing I'm sure of is your wealth shouldn't affect your chance of living or dying, and for that we're better off with a public system. Should a private system also exist in parallel? Time will tell I guess.
As far as I know, most of Europe has effective public healthcare. And those same doctors have a parallel private practice which gives you the same treatment but faster. For a pittance.
For example. To see a dentist in Slovenia there is a 6 month waiting list. But if you pay 20eur, you go to their private practice and see them in 2 weeks.
Optometrists are a several month as well. But you can go private, see them in 1 week, and they waive the fee if you buy glasses from them.
Bigger procedures get a little more expensive and there are things that don't exist in private (surgery can never be private because the country only has N surgery rooms and they are booked up with public stuff), but in general it's the same doctors and the same service in private and public health care. Private lessens your waiting times and the doctor is a bit nicer to you.
Now that I'm in the US I'm essentially terrified of needing a doctor even with insurance because of the crazy copay and deductible and in-network out-network system. Been here 3 years, never needed a doctor thank god.
I wonder to what degree the waits in Slovenia are exacerbated by the people that pay to jump the queue.
If you only have one pool of doctors to draw from then those who are seem faster by paying are slowing down the remainder. If its a small enough difference that a significant portion pay the slow down could be substantial.
My concern is that this sort of approach to medicine is going to result is the "top specialist" tier of doctors spending more time treating complaints that don't really require their particular level of expertise. You probably don't need to see the world's best cardiologist if you just have high blood pressure, but if you are paying 40k a year for a concierge medical service they might feel that the need to get you in front of him or her in order to justify their fee. Otherwise what are you paying for? Consequently this amazing heart doctor spends an hour telling you to eat better and exercise rather than evaluating someone's complicated and life threatening condition.
In theory though, the market should address that right? e.g. a version of this that's $10k a year but can handle 10x the volume because you triage patients with competent nurses and PAs and save the expert's time for the cases where they can actually make a difference.
Yeah, I had the same thoughts when I was writing that. The key difference is that the current system is so convoluted that there is almost no meaningful market for consumers on the actual care side of things.
why is this market failure automatically attributed to too much regulation instead of the wrong kind of regulation. Wealthy elites paying 40k to set a broken bone shows exactly why deregulating would be disastrous, medical decisions are rarely made rationally. There is a quote from the article that implies that these elites would pay anything.
"But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?"
Unregulated markets do not work for this type of irrational actor. Please stop spreading lies about how to fix this problem. Instead maybe look at countries that regulate it correctly(Spain).
I like how the article says Private Medical "does not advertise", then immediately follows that with some glossy, staged press shots. They don't advertise, except for the advertisement they just ran in the New York Times.
The NYT, with advertisement slogans like "Truth. It has no alternatives." (When I first saw it, I had to double-check whether I am reading some English translation of one of the "Pravda" issues in the USSR -- no, it was still NYT), -- well, despite such bold claims, they often act as the principal venue for top-level PR firms. Increasingly so in the last few years -- I understand that newspaper business is in deep trouble, and I understand their envy to Facebook and Twitter, but this sounds just a teeny tiny bit unethical to me.
I think a fair question is whether all that additional expense results in better outcomes. I certainly understand the experience is better for patients, and there is little or no wait time, but is there evidence that health outcomes are actually better?
I wonder if it's like the difference between taking coach vs. a private jet. The private jet is more convenient and comfortable, but safety ratings are considerably better on major airlines.
I wonder if it's like the difference between taking coach vs. a private jet. The private jet is more convenient and comfortable, but safety ratings are considerably better on major airlines.
That's probably what it is, accidents are more likely in general aviation but still rare, however if you must fly commercial you get to face the TSA perverts every single time you go through security.
I think another way to look at this is minimizing risk/resulting guilt. The broken leg example seems to support that - the father is paying for the best possible care for his son, even if the outcome is the same (leg heals properly) as the ER doctor, the father has obsolved himself of the risk that he didn't do enough and allowed the leg not to heal properly.
In other words, the (I'm guessing) relatively slim chance there is a complication with the broken leg is not worth it to the wealthy father to take.
> In other words, the (I'm guessing) relatively slim chance there is a complication with the broken leg is not worth it to the wealthy father to take.
In medicine, though, there have been a lot of recent studies recently that have shown that too much care can be harmful (especially in the orthopedic realm). Sometimes the best thing to do really is nothing, but when you're paying 40k a year, my guess is you, and more importantly your doctors, would rarely take that point of view.
Buses are probably safer than cars, but many people still prefer cars, and willing to take the risks (and these risks are not insignificant). I have survived a near-fatal car crash (as a passenger), but I still drive a car, because in my Bayesian model of reality, convenience just outweighs the risk.
The same goes for private jets (which I can't yet afford), or private medicine.
This is a really important point, having seen both public and private systems I think it's quite valid.
In this case I probably would not want a head of orthopaedics to treat a relatively straightforward leg break- I would want a practitioner who has a significant amount of recent experience in this area. The ER doctor likely sees hundreds of these a year, so may actually be the best person. Of course if my case is particularly challenging, I want a consultant with a significant amount of experience- but it doesn't seem right for that person to pushing their skills to the highest bidder, regardless of patient need.
I also don't want a steak with my meal, nor do I care for a fancy waiting room, as they aren't going to fix my leg.
It's unclear what the point of this article is supposed to be other than to stoke outrage at the 1% who get premium treatment while the rest of us proles suffer 'normal' healthcare. It's almost as if all of a sudden having money buys you nicer things, as it always has for all of history, including in the healthcare systems of every other nation.
In developing countries like China, Russia, India, Saudi Arabia, there are entire parallel healthcare systems for the wealthy and connected to get high quality care and when such care isn't available, they travel to richer countries or hospitals that cater to foreigners in Bangkok, Seoul, Cleveland, Medellin, and any number of medical tourism destinations that have popped up. I've been to several of these hospitals and they are nice. In Seoul, at the Samsung Medical Center, hospital rooms for foreigners have one bed each, as opposed to four beds each for Korean nationals. Why? Koreans are paying less via subsidies and rich foreigners with weaker currencies are paying full fare.
In universal healthcare countries with market economies like the UK and Canada, private clinics are the only way patients with money who want to avoid the limitations imposed by rationed care can get access. In Canada, instead of waiting an average 9.5 months(!) to replace a painful knee, you can go to Duval Orthopedic Clinic in Montreal to get a knee replacement for under $14,000 USD (compared to $49,000 in the US). In Hungary--this is a fun one--you can go to a terrible state doctor for free or pony up $50 US for a private doctor. Most Hungarians who can afford it pay the cash, because they know they will get the quality for it. Even in the so-called universal medical system of Cuba, the political elite and their relatives have their own private hospital, whereas the rest of the population suffer substandard equipment, years-long wait lists, lack of medication and outdated facilities, and worst of all, doctors who spend half their time working side jobs as taxi drivers to pay the bills.
The point is, markets will always step in to fill needs that aren't being met by state-run care--it's as predictable as the sun coming up. Often, the gap between rich and poor is worse in systems that try to do the most to eliminate it--Cuba being a prime example.
What I found most interesting about this article--most likely unintentionally-was the hypocrisy of the Bay Area, the liberal mecca of the country, that would vote for universal healthcare in a landslide, also being the main drivers of demand in premium private service, widening the gap between the rich and the poor such a healthcare policy is bound to exasperate.
If you think all that extra money rich people habe is deserved, things are okay.
But many people think this is not the case.
And if it's not the case it's important to show the world what you get for (undeserverd) extras for that money, like a longer and healthier life, for example.
In Canada, instead of waiting an average 9.5 months(!) to replace a painful knee, you can go to Duval Orthopedic Clinic in Montreal to get a knee replacement for under $14,000 USD (compared to $49,000 in the US).
In the US, your charge is likely to be $49,000, but I think many insurers have agreements to only pay 20-40% of that.
You can always get better faster service if you pay more.
Disney World, health care, cars, political favors, nutrition, hospice, climbing Everest, prosthetics, cleaning staff, coaches, going to outer space, etc.
I wouldn't expect Health Care for the proletariat to be somehow different from the rest of our brief mortal existence. Somehow, it has seemed recently to gain a special status all to itself.
"You can always get better faster service if you pay more." - Just because that's how things are now doesn't mean its ideal or the only way.
Benjamin Franklin while an unrepentant capitalist, tempered that with protestant values and a sense of civic duty. Allowing money to control how critical social functions work: elections, medicine, education directly undermines them.
Maybe you could pick one of those things from your list and try to find ways to make it better both for the individual and the common good.
This is the sort of thing that ends up with rich people swinging from lamp posts.
Not the fact that you can hire a private doctor. Taking one doctor out of circulation, more or less, doesn't enrage people.
No, the offensive thing is that John Battelle's kid's broken leg is too important to be seen by a mere ER doctor, and instead the very senior orthopedics doctor is summoned away from dealing with serious problems to deal with a broken leg.
How does the head of orthopedics live with himself? I'm sure he comforts himself with money.
Battelle made his money by doing things, and hardly anyone begrudges him that. But his son now knows that his broken leg is more important than some grandmother's shattered hip, and is likely to keep that attitude as he rises to adulthood.
>This is the sort of thing that ends up with rich people swinging from lamp posts.
i don't understand why smart-ish people keep repeating this. there will never be another revolution in a first-world (western) nation. it's just not happening.
A lot of reasons, but one solid one is that there is a pretty strong anti-pattern in that the ones that desire wealth redistribution the most are the most likely to support gun control and/or the banning of private ownership of weapons.
Wealth inequality is not the only reason for revolutions. There are also dictatorships, human rights abuse, corruption, disregard of laws for the elite, and other fine things that might warrant the direct action.
While true, those values are highly correlated - at least in Americans, and most of the developed world - with people desiring lower access to guns for the private citizenship. Low access to force multipliers makes it much harder to spark and win a revolution against the state.
Looking at the Roman Republic, there was exactly one revolution in 500 years, led by the Elder Gracchus, and that wasn't successful. The Secession of the Plebeians came close (but is semi-legendary), greater success in the Conflict of Orders was had through working within the political system and all of this (Twelve Tables, opening of high office to plebeians) happened in the early republic.
I'd say that Caesar was a very successful warlord, but there were others before him, Sulla and Marius come to mind. The real revolutionary figure was Augustus, he made conscious choices not to reestablish decisionmaking in the senate.
Our sickness is that we have it good enough now. Most people live through sugar watered days of evolutionary affluensa stopping any chance of future revolutions.
At most we show our apathy in disapproval.
The only way we will improve from now on is through technology which rips apart old structures.
This is my hope for blockchain tech. I know it's becoming a meaningless buzzword but I do hope that it challenges traditional financial/state institutions in a way that gives the average participant more power than they currently hold.
I am on the other side of the discourse (hopefully, not of the lamp post -- just yet), but I politely disagree. Why do you think the revolution (or even a civil war) is impossible these days?
Never say never. I'm sure Marie Antoinette felt much the same and we all know how that ended, France was very much a first-world nation when it did.
What's interesting about revolutions is that it doesn't necessarily take much to trigger one, all it takes is a large enough initial event and you're off to the races. Just like chemical reactions require activation energy so do revolutions.
We already know that shooting black kids in the back doesn't seem to be enough, and there are plenty of other things that have been tried by now that apparently are not enough to trigger a major escalation.
But I really would not rule it out from ever happening again. Rather the opposite, it is a miracle that we've held out this long without one, which translates into a lot of latent pressure building up.
> we've held out this long without one, which translates into a lot of latent pressure building up
I agree with the rest of your comment, but I would like to point out that absence of evidence of a revolution can't be evidence for an impending revolution (since you can't have it both ways).
If you had said that there would never be another successful revolution in a first-world western nation, you may have been correct.
From the point of view of the person playing pendulum on the lamp post, though, it doesn't matter if the revolution is successful or not. All that matters is that the revolution attempt, no matter how ill conceived and doomed, started where that person happened to be.
It doesn't even need to be an attempt at revolution. It just needs to be a sufficient build up of anger in a local region. We KNOW this can happen in a first-world western nation because we've seen it happen several times.
are you talking about the october revolution or all of the fall of the soviet union or the revolutions in the soviet friendly states? because none of those fit first-world (literally) or western.
I was specifically thinking of the collapse of the Soviet Union.
Point being, however you scope it nations and empires fall. There's no magic that says the the United Kingdom or France will be here 200 years from now. Given current events, it isn't a sure thing that a map of the U.K. wont be very different in a few decades time.
Some examples of modern incidents in first-world western nations where anger has built up sufficiently in a local area or region for crowds to violently go after people:
Los Angeles riot, 1992.
Paris, May 1, 2017 riot. (May day protests also turned into riots in several other cities that day).
a woker at Upenn fell off a building and shattered the bones in his arm and hand. Upon arriving to Upenn hospital (a great one) they told him he would never have functional use of his hand again (bad for someone in this line of work).
somehow he knew senior orthopedics doctor that did most of his work with Pitchers for the Phillies, and he refused treatment until this doctor arrived. Somehow not receiving medication for the pain was all part of this, but he endured.
now he has nearly full use of his arm and hand, and the orthopedics doctor told him if he let the ER docs touch him, he never would have used that hand again.
Yes, it makes a difference.
Furthermore, and if you dont like it, advocate for more doctors and accountability for sub par care.
I think that's just the difference between ER docs - who are, by their nature, generalists - and specialists.
The main problem is that a specialist isn't being consulted during the ER visit for cases that are outside the scope of the ER docs' knowledge. I think if the ER docs are at the point of saying "yes, we can 'kind' of fix it but not back the way it was" that should trigger an automatic specialist referral.
What is interesting is that anecdotally in my experience and those I talked to the VIP patients in VIP rooms tend to have worse outcomes.
It may be because there is a tendency for VIP to demand that something be done and it not be uncomfortable. So they may go through more tests and procedures for every little complaint and maybe get more pain meds which ends up contributing to worse outcomes.
In addition, the doctor may be reluctant to say "no". For the ultimate example of this, see Michael Jackson.
Finally, teaching hospitals provide some of the best care in the country. So because of that, a VIP may go there. However, many of them don't want to be seen by residents and medical students and residents. They want to be seen by the famous department chair. Well, in many cases the department chair may be good at research and politics and fundraising, but may not be the best actual doctor. In addition, they may be years removed from actual day to day patient management, relying on the residents to manage the details. You can imagine how things can go wrong.
I don't personally have a problem with people paying extra to receive what they perceive to better care.
But I think if you look at outcomes, I doubt you will find that they have received better care by paying the extra 40k or whatever it is a year. It's great that the kid in the story was able to be seen by a established orthopedist in a city hospital - but most general orthopedists know how to set a kids leg, and I doubt the outcome would have been much different if they had gone to the originally intended ER.
It's certainly a good gig for the family practitioner, but I think the following quote at the end of the article:
"“The traditional model of having a good internist is dying,” said Mr. Traina, a scion of a prominent family here that arrived with the California Gold Rush.
will apply to the concierge doc in the longer run as well. If you are reasonably healthy, checking your blood work once a year and your blood pressure every so often, you don't have much need for a family doc. If catastrophe strikes, then you will probably need a specialist - and if you're willing to spend the money, it's best to save it for these times - yes your cash will get you in as easily as a concierge doctor can - rather than dishing out 40k annually.
I recently chose a medical clinic that's part of a university system for my own healthcare, as opposed to a family doc who charges $1400 for an initial exam and $400 for follow ups. Do they spend as much time with me? No, I'm in quick and out quick. I get my shots and blood work and I'm out the door. Since I'm pretty healthy, that's the way I want it.
It is the most rational model. Unfortunately, like mentioned in other threads here, fully private, cash-to-hands medical practice is prohibited in many countries.
I have to travel to Spain for my medical tourism needs. However, it is mighty inconvenient.
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[ 2.8 ms ] story [ 136 ms ] threadIn fact, if somebody would just freed me from any worries about hospital bills, negotiations, late fees, appointments etc, I would consider paying $40000 flat yearly rate to get everything covered (if for the whole family). Unfortunately, it looks impossible in Switzerland. There are concierge services, but they just add their own bill on top of hospital bills.
From the article: "The annual fee covers the cost of visits, all tests and procedures in the office, house calls and just about anything else other than hospitalization"
I.e. I am OK with the terms. I would prefer to pay a little less, $40k is outside of my affordable range ($24k is more like it). However, if absolutely unnegotiable, I might put it on wishlist for the next 3-4 years.
If it is $40k _on top_ of existing medical expenses (which I doubt), it is just another toy for the wealthy, and will not gain significant traction. "Regular" concierge service is usually much less expensive.
Edit: To all the down-voters. The article isn't about private healthcare which in the US is more the rule than the exception. It's about a layer on top of private healthcare.
Of course private healthcare exist in other countries. But this concierge layer for "normal" rich people you will be hard pressed to find many other places I ma pretty sure off (but could be wrong of course). Unless you are a politician or royal or something.
My own data point: back when I had a job that provided private insurance in Spain, making an appointment for my daughter with a specialist required waiting for weeks. The shortcut? A paid, private appointment, outside this private insurance. The specialist saw her in a matter of days.
All your private insurance allowed you to do is do what the US system allow you to do through a better healthcare insurance.
The article as far as I understand it is another extra layer on top.
More recently, they started allowing private practice but there are rules for how much time a doctor can work vs in the public system. Tbh I'm not sure I how stand on it, it's a complex problem with many variables. The only thing I'm sure of is your wealth shouldn't affect your chance of living or dying, and for that we're better off with a public system. Should a private system also exist in parallel? Time will tell I guess.
These countries help underwrite the thriving medical tourism markets in places like Thailand and India.
For example. To see a dentist in Slovenia there is a 6 month waiting list. But if you pay 20eur, you go to their private practice and see them in 2 weeks.
Optometrists are a several month as well. But you can go private, see them in 1 week, and they waive the fee if you buy glasses from them.
Bigger procedures get a little more expensive and there are things that don't exist in private (surgery can never be private because the country only has N surgery rooms and they are booked up with public stuff), but in general it's the same doctors and the same service in private and public health care. Private lessens your waiting times and the doctor is a bit nicer to you.
Now that I'm in the US I'm essentially terrified of needing a doctor even with insurance because of the crazy copay and deductible and in-network out-network system. Been here 3 years, never needed a doctor thank god.
If you only have one pool of doctors to draw from then those who are seem faster by paying are slowing down the remainder. If its a small enough difference that a significant portion pay the slow down could be substantial.
"But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?"
Unregulated markets do not work for this type of irrational actor. Please stop spreading lies about how to fix this problem. Instead maybe look at countries that regulate it correctly(Spain).
I wonder if it's like the difference between taking coach vs. a private jet. The private jet is more convenient and comfortable, but safety ratings are considerably better on major airlines.
That's probably what it is, accidents are more likely in general aviation but still rare, however if you must fly commercial you get to face the TSA perverts every single time you go through security.
In other words, the (I'm guessing) relatively slim chance there is a complication with the broken leg is not worth it to the wealthy father to take.
In medicine, though, there have been a lot of recent studies recently that have shown that too much care can be harmful (especially in the orthopedic realm). Sometimes the best thing to do really is nothing, but when you're paying 40k a year, my guess is you, and more importantly your doctors, would rarely take that point of view.
The same goes for private jets (which I can't yet afford), or private medicine.
In this case I probably would not want a head of orthopaedics to treat a relatively straightforward leg break- I would want a practitioner who has a significant amount of recent experience in this area. The ER doctor likely sees hundreds of these a year, so may actually be the best person. Of course if my case is particularly challenging, I want a consultant with a significant amount of experience- but it doesn't seem right for that person to pushing their skills to the highest bidder, regardless of patient need.
I also don't want a steak with my meal, nor do I care for a fancy waiting room, as they aren't going to fix my leg.
In developing countries like China, Russia, India, Saudi Arabia, there are entire parallel healthcare systems for the wealthy and connected to get high quality care and when such care isn't available, they travel to richer countries or hospitals that cater to foreigners in Bangkok, Seoul, Cleveland, Medellin, and any number of medical tourism destinations that have popped up. I've been to several of these hospitals and they are nice. In Seoul, at the Samsung Medical Center, hospital rooms for foreigners have one bed each, as opposed to four beds each for Korean nationals. Why? Koreans are paying less via subsidies and rich foreigners with weaker currencies are paying full fare.
In universal healthcare countries with market economies like the UK and Canada, private clinics are the only way patients with money who want to avoid the limitations imposed by rationed care can get access. In Canada, instead of waiting an average 9.5 months(!) to replace a painful knee, you can go to Duval Orthopedic Clinic in Montreal to get a knee replacement for under $14,000 USD (compared to $49,000 in the US). In Hungary--this is a fun one--you can go to a terrible state doctor for free or pony up $50 US for a private doctor. Most Hungarians who can afford it pay the cash, because they know they will get the quality for it. Even in the so-called universal medical system of Cuba, the political elite and their relatives have their own private hospital, whereas the rest of the population suffer substandard equipment, years-long wait lists, lack of medication and outdated facilities, and worst of all, doctors who spend half their time working side jobs as taxi drivers to pay the bills.
The point is, markets will always step in to fill needs that aren't being met by state-run care--it's as predictable as the sun coming up. Often, the gap between rich and poor is worse in systems that try to do the most to eliminate it--Cuba being a prime example.
What I found most interesting about this article--most likely unintentionally-was the hypocrisy of the Bay Area, the liberal mecca of the country, that would vote for universal healthcare in a landslide, also being the main drivers of demand in premium private service, widening the gap between the rich and the poor such a healthcare policy is bound to exasperate.
If you think all that extra money rich people habe is deserved, things are okay.
But many people think this is not the case.
And if it's not the case it's important to show the world what you get for (undeserverd) extras for that money, like a longer and healthier life, for example.
In the US, your charge is likely to be $49,000, but I think many insurers have agreements to only pay 20-40% of that.
Woe to you if uninsured in the US, though: they'll expect the full $49K. See David Belk's http://truecostofhealthcare.net/
You can always get better faster service if you pay more.
Disney World, health care, cars, political favors, nutrition, hospice, climbing Everest, prosthetics, cleaning staff, coaches, going to outer space, etc.
I wouldn't expect Health Care for the proletariat to be somehow different from the rest of our brief mortal existence. Somehow, it has seemed recently to gain a special status all to itself.
---
"Wish not so much to live long as to live well."
- Benjamin Franklin
Benjamin Franklin while an unrepentant capitalist, tempered that with protestant values and a sense of civic duty. Allowing money to control how critical social functions work: elections, medicine, education directly undermines them.
Maybe you could pick one of those things from your list and try to find ways to make it better both for the individual and the common good.
Not the fact that you can hire a private doctor. Taking one doctor out of circulation, more or less, doesn't enrage people.
No, the offensive thing is that John Battelle's kid's broken leg is too important to be seen by a mere ER doctor, and instead the very senior orthopedics doctor is summoned away from dealing with serious problems to deal with a broken leg.
How does the head of orthopedics live with himself? I'm sure he comforts himself with money.
Battelle made his money by doing things, and hardly anyone begrudges him that. But his son now knows that his broken leg is more important than some grandmother's shattered hip, and is likely to keep that attitude as he rises to adulthood.
i don't understand why smart-ish people keep repeating this. there will never be another revolution in a first-world (western) nation. it's just not happening.
The only way we will improve from now on is through technology which rips apart old structures.
What's interesting about revolutions is that it doesn't necessarily take much to trigger one, all it takes is a large enough initial event and you're off to the races. Just like chemical reactions require activation energy so do revolutions.
We already know that shooting black kids in the back doesn't seem to be enough, and there are plenty of other things that have been tried by now that apparently are not enough to trigger a major escalation.
But I really would not rule it out from ever happening again. Rather the opposite, it is a miracle that we've held out this long without one, which translates into a lot of latent pressure building up.
I agree with the rest of your comment, but I would like to point out that absence of evidence of a revolution can't be evidence for an impending revolution (since you can't have it both ways).
Relevant article: http://lesswrong.com/lw/ih/absence_of_evidence_is_evidence_o...
From the point of view of the person playing pendulum on the lamp post, though, it doesn't matter if the revolution is successful or not. All that matters is that the revolution attempt, no matter how ill conceived and doomed, started where that person happened to be.
It doesn't even need to be an attempt at revolution. It just needs to be a sufficient build up of anger in a local region. We KNOW this can happen in a first-world western nation because we've seen it happen several times.
oh? do tell?
Point being, however you scope it nations and empires fall. There's no magic that says the the United Kingdom or France will be here 200 years from now. Given current events, it isn't a sure thing that a map of the U.K. wont be very different in a few decades time.
Los Angeles riot, 1992.
Paris, May 1, 2017 riot. (May day protests also turned into riots in several other cities that day).
December, 2015, Corsican riots.
August, 2016 riot in Kalgoorlie, Australia.
Revolutions aren't about armies.
somehow he knew senior orthopedics doctor that did most of his work with Pitchers for the Phillies, and he refused treatment until this doctor arrived. Somehow not receiving medication for the pain was all part of this, but he endured.
now he has nearly full use of his arm and hand, and the orthopedics doctor told him if he let the ER docs touch him, he never would have used that hand again.
Yes, it makes a difference.
Furthermore, and if you dont like it, advocate for more doctors and accountability for sub par care.
The main problem is that a specialist isn't being consulted during the ER visit for cases that are outside the scope of the ER docs' knowledge. I think if the ER docs are at the point of saying "yes, we can 'kind' of fix it but not back the way it was" that should trigger an automatic specialist referral.
It may be because there is a tendency for VIP to demand that something be done and it not be uncomfortable. So they may go through more tests and procedures for every little complaint and maybe get more pain meds which ends up contributing to worse outcomes.
In addition, the doctor may be reluctant to say "no". For the ultimate example of this, see Michael Jackson.
Finally, teaching hospitals provide some of the best care in the country. So because of that, a VIP may go there. However, many of them don't want to be seen by residents and medical students and residents. They want to be seen by the famous department chair. Well, in many cases the department chair may be good at research and politics and fundraising, but may not be the best actual doctor. In addition, they may be years removed from actual day to day patient management, relying on the residents to manage the details. You can imagine how things can go wrong.
It's certainly a good gig for the family practitioner, but I think the following quote at the end of the article:
"“The traditional model of having a good internist is dying,” said Mr. Traina, a scion of a prominent family here that arrived with the California Gold Rush.
will apply to the concierge doc in the longer run as well. If you are reasonably healthy, checking your blood work once a year and your blood pressure every so often, you don't have much need for a family doc. If catastrophe strikes, then you will probably need a specialist - and if you're willing to spend the money, it's best to save it for these times - yes your cash will get you in as easily as a concierge doctor can - rather than dishing out 40k annually.
I recently chose a medical clinic that's part of a university system for my own healthcare, as opposed to a family doc who charges $1400 for an initial exam and $400 for follow ups. Do they spend as much time with me? No, I'm in quick and out quick. I get my shots and blood work and I'm out the door. Since I'm pretty healthy, that's the way I want it.
I have to travel to Spain for my medical tourism needs. However, it is mighty inconvenient.
It's reasonably affordable without being velvet rope wealthy and gives you a much more streamlined care experience.