John Goodman did a nice job yesterday in his blog on health care. Here is an excerpt:
Suppose the Cleveland Clinic announced an opening for surgery tomorrow morning at 8:00 a.m. (prepping begins at 6:00 a.m.). I have a better chance of getting there if I own a private plane. Even if commercial air travel allows, I must be able to pay for airfare, a hotel room the night before, and a hotel room for the period of recovery. The higher my income, the more affordable these options are. More generally, travel requirements and the need to be flexible on time favor the affluent.
This may be one reason why there is a major racial gap (and one presumes a socio-economic status gap) with respect to organ transplants in the U.S. -- even when the federal government is footing the bill (as in the case of kidneys) and even when there is a legal prohibition against buying organs.
The whole thing is worth reading. Here's a particularly good comment after his post:
When I was an MD in government service, (drafted) we were told RHIP, Rank Has Its Privileges. Can you imagine a public figure or "important person" waiting for an unimportant person? Other systems developed within the politically equal system, a covert barter system. The underclass found chips to bargain with at government expense.
This commenter goes further than Goodman, pointing out that in a socialized system, you will have, in essence, a nomenklatura. I'm not sure what his last sentence means, although it seems to undercut the commenter's first point.
One thing I often enjoy about Goodman's blog is the tone. Goodman will often criticize Princeton health economist Uwe Reinhardt, for instance, and Reinhardt will sometimes come on and comment. Although they twit each other a little, the disagreement is often good-humored.