
How Hospitals Coddle the Rich - pavornyoh
http://www.nytimes.com/2015/10/26/opinion/hospitals-red-blanket-problem.html?_r=1
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hnamazon123
Sounds like this is actually a pretty reasonable practice. You know that the
NY Times would be hammering any sort of unethical results of this practice but
this is the worst that the author can come up with:

> [Rich patient to author:] "Doctor, I’d feel more comfortable if we stayed
> [at the hospital] another night, just to be safe.”

> Although there was no medical reason for him to stay, I smiled politely and
> said, “Yes, that’s absolutely fine.”

Interesting story overall. I get the sense that the NY Times desperately wants
there to be a class warfare angle here but seems pretty well handled by the
doctors and the hospital.

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nugget
You can see this trend even outside the hospital, for example in primary care,
with some doctors choosing to open concierge practices. In return for a few
hundred dollar annual fee, you have a doctor responsible for perhaps 1/3rd the
total number of patients. Meaning he or she can spend 3 times more time with
you. For every MD/DO who reduces their patient panel, it's likely that a mid-
level provider (nurse, np, or pa) picks up the slack. I would expect this
trend to continue in the future.

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sologoub
You start describing a very positive situation where a Dr. is able to spend
more time with a patient, but then immediately turn it into a zero sum
situation where people have to be relegated to lesser care.

How about having more doctors in general and overall better standards of care?
I'd gladly pay a few hundred a year to be able to get the care my family
needs. Following the changes from affordable care act (aka obamacare), the
main medical group in our city turned into something akin to cattle processing
facility. Doctors are encourage to spend less than 15 minutes per patient!
When we needed an urgent appointment for something that wasn't bad enough for
a 911 call, but certainly had the potential to turn in to one if neglected for
a few days, all we were offered was a slot 2 MONTHS from the date of the call!

I eventually escalated and escalated, but it turns out the supervisor I talked
with simply double-booked our doctor...

If we can add money to the system that allows for better doctor/patient ratio,
why is it a bad thing? Sure, the economics have to make sense and the real
price of this "luxury" should be charged.

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nugget
It's zero sum in that there are a fixed number of doctors today. We could
train more, but the focus in health care is on decreasing costs, not
increasing them. I can also tell you from experience that unless you are
called to primary care in a near spiritual way, it's just not a very appealing
job (work hours, environment, and compensation after many years in school).

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aeharding
Interesting. Health care is a problem in capitalism, and this is another
variable.

I wonder if there should be a distinction between how the hospital is funded,
just like how public schools cannot have a religious affiliation. But I don't
know enough about hospital/health care funding to form an opinion here.

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nugget
I think capitalism just reflects how the red blankets are allocated in this
case but the underlying story is about subtle inequalities that have always
existed since the big bang. Presumably there would be red blankets in every
system, e.g. in Cuba or Soviet Russia the party members had red blankets too.
If you make the hospital completely independent of any outside influences and
mandate no favoritism of any kind, there are still 'friends and family' of
employees and so forth. Ultimately our best hope for narrowing inequality
seems to come from technology and technology enabled processes that are simply
unable to discriminate. If a future MRI machine is invented that can read its
own scans as well as a top 10% radiologist, then every patient benefits and
the subtle discriminatory tendencies inherent in human nature are rendered
obsolete.

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bko
Not sure why anyone would be surprised by this. Providing health care costs
money and is run by human beings. I don't see why health care would somehow be
immune to basic economics and incentives. People who pay more get better
service, no matter how distasteful that may be. Trying to make administration
of health-care more "fair" often just means making private health care
illegal, which doesn't really benefit anyone.

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Ch_livecodingtv
Hospitals are trying to make good business. I see some of them are building
hotel like structures for the rich, really great interior, luxurious and
patients are treated a total VIP. Money Matters.

