Five star health care inequality

As the Senate barrels forward with an attempt to cut our health care so rich people can get a tax cut, a new health care issue got my blood boiling this weekend: uber concierge medicine. This article, on the cover of the Sunday business section, enlightened me on a new inequality fronteir.  The story profiles the rising prevalence of private health care managers in the Bay Area.  These health firms for the ultra-wealthy command $40-80,000 a year in fees and ensure their clients have five-star health care experiences (i.e. shorter wait times for specialists, better referrals, coordinated services).

Can’t help but wonder when this story originated, but reading it at a time when Congress wants to take away health care from 23 million Americans (or, if they’re lucky, just increase their premiums by 800%), was extremely unsettling.

While I’ve always been concerned about wealth and income inequality, the move to Stockton makes me hyper-aware of the growing disconnect between the wealthy and poor.  (I can’t include the middle class in that sentence, because sadly, it seems as though the middle class disappearing. It terrifies me to say that, but living in the Central Valley and working in the Bay Area, I primarily observe examples of poverty and wealth–no real signs of a growing middle class in Northern California).  Anyway, one area of hope for equity, thanks to the Affordable Care Act, was health care.

With the ACA, in states that expanded Medicaid, the health benefits protection helped many more people get access to essential coverage.  As a Kaiser member, observing patients of all socio-economic levels accessing health services always gave me a bit of hope for the future.  In the last two years, between David’s pneumonia hospitalization, my miscarriage, pregnancy and delivery, I’ve spent time in Kaiser health centers in Oakland, Modesto, Walnut Creek and Stockton. These cities vary significantly in economic, education and health outcomes.  And yet, while economic disparity grows stronger between the coastal and inland cities, the ACA’s massive coverage improvements provided hope for a narrowing health outcome gap.  In my purely anecdotal experience, the quality of care and dignity of service in Walnut Creek was the same as Stockton, or any of the other cities. I can find few other public services examples where that is the case, and I attribute that to the ACA’s role in lifting standards and quality for all.

Apparently, feeling hopeful after observing waiting rooms of diverse patients is not a universal reaction.  From the article:

“Whenever I bump into a bleeding-heart liberal, which I am, I mention that schools, housing and food are all tiered systems,” he said. “But health care is an island of socialism in a system of tiered capitalism? Tell me how that works.”

Dr. Howard Maron, who founded MD Squared, is similarly candid about the new reality of ultra-elite medical care.

“In my old waiting room in Seattle, the C.E.O. of a company might be sitting next to a custodian from that company,” he recalled. “While I admired that egalitarian aspect of medicine, it started to appear somewhat odd.”

As we “bleeding-heart liberals” lament growing political and ideological polarization, we have to acknowledge it will only get worse if health care becomes even more tiered. (Should clarify, for all the ACA’s promise and potential, we are still far, far from an equitable health system. But the law was a step in the right direction).  The tiered system in public schools, neighborhoods, parks, transit, and more ensure the company CEO never brushes up against the company custodian.  And when that CEO never interacts with the custodian, what does she know of his experience? How will she ever favor policies that help him if she never sees him? It’s the classic Crash opening quote conundrum.

I recognize that viewing a hospital waiting room as a de facto town square, a public center where people of all backgrounds interact, is a deeply depressing statement. But in reality, what else is left? And if wealthy liberals want to take that away (to be clear, the article profiled wealthy Northern Californians; it’s not Texas oil tycoons normalizing this type of income separation, but our “liberal” neighbors) how can we possibly be surprised when Congress wants to barter away health care protections to gain tax cuts?

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Filed under Observations, Seniors

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