From the New York Times:
“The concierges act like butlers,” said John Frehse, 37, who was visiting his ailing father, Robert M. Frehse, 86, the retired chief executive of the Hearst Foundations. He and his mother, Dale Frehse, paused in their praise of the care to recall the fate of a family friend stuck for three days in the NewYork-Presbyterian emergency room for lack of a hospital bed last winter. At the time, they recalled, the Saudi king had been granted the whole 14th floor for his entourage.
The younger Mr. Frehse contrasted the unit’s mouth-watering menu with the “inedible food” his father faced when he was treated on the non-elite second floor. “Here he has mushroom risotto with heirloom tomatoes,” he said.
The hospital said in a statement: “NewYork-Presbyterian is dedicated to providing a single standard of high quality care to all of our patients.”
Recent reports of the way the one percenters are treated at American hospitals make me think about Mitt Romney's protests about "class warfare." Whenever the Democrats start talking about taxing people like him differently, to be sure the percentage of their income paid in taxes matches that of their secretaries, Mitt speaks to his base and to Joe Sixpack and starts screaming "class warfare."
Then you look at the way the average Joe is treated American hospitals and compare that to the way the very rich are treated and you see real class warfare, or at least real class distinctions. It is warfare, you must admit, when it means the average Joe gets kept in the emergency room for three days because there are no beds available upstairs, when in fact those beds are being slept in by members of a large Saudi family accompanying their rich relative who is a patient occupying one bed on an entire ward, while the rest of his family occupies all the others.
As we have structured our health care system, hospitals are in business to make money, whether they call themselves non profit or for profit, they have to turn a profit enough to pay salaries and buy equipment and they are all for profit in a way no English hospital is for profit. And so, if more money can be made by keeping the hoi polloi shifting on their gurneys in the Emergency Room and renting out beds to rich Saudi oil barons upstairs, well, at this hotel money talks.
The hospital in this report is now called The New York Presbyterian Hospital of the Cornell Weill Medical Center, real mouthful. The name is so ponderous because of money. Part of the name was sold to Sanford Weill, an unappetizing scoundrel of a financier who was looking for respectability by given $150 million to Cornell University Medical College, which was willing to sell its good name for that sum. As benefactors to universities go, that was a pretty paltry sum. But when you get to whoring, whether it's a big sum or a small sum, as the story goes, we have already established what you are; we are just now haggling about the price. As for the "Presbyterian" part of the name, well that comes from Columbia Presbyterian hospital, the erstwhile cross town rival of Cornell. The two institutions amalgamated in order to achieve more clout in negotiations with insurance companies, somehow avoiding laws which forbid efforts to monopolize, but that's what they paid expensive lawyers for.
When I roamed its halls, it was called simply, The New York Hospital, with an arrogance suggesting it was The only hospital in New York, or, at the very least, the only really important hospital in New York City.
There was an arrogance in those halls in those days, born of a sense of superiority of rigor, effort and intellect. The chiefs of the various divisions within the department of internal medicine had written the classic textbooks in gastroenterology, infectious disease, cardiology and rheumatology. They were all eventually lured away to be chiefs of departments of medicine at other medical schools. Frank Glenn, a towering figure in surgery was head of surgery and following him, in succeeding generations were other surgeons. Fred Plum and Jerome Posner, authors of a classic textbook in neurology, and chiefs of neurology at The New York Hospital and Memorial Sloan Kettering, also part of the same center, were just as famous in the medical world.
Out of the interns and residents in medicine came Tony Fauci, who became head of the National Institutes of Allergy and Infectious Disease and the head of the AIDS task force. There was Henry Masur who wrote the original article in the New England Journal of Medicine describing the disease AIDS. He was able to do his work because, he had available to him in the same institution Suzanne Cunningham-Rundles, a PhD in immunology, who took the samples of blood Masur brought her from these mysterious patients dying of this bizarre disease and she ran the blood through her assays and called him back and said, "Whatever this is, it has caused the immune system more than just damage--it's a meltdown." And a few floors upstairs, was Kathleen Foley, a star in the world of pain management who also came from this farm system, which linked medical school to internship to residency to faculty status.
And the thing about each of these luminaries was they made rounds with the lowliest medical students and with interns and residents every day and they went to the bedside of the patient, who might be a bowery bum or a captain of industry, but the patients were all "Mr" or "Mrs" or "Miss" and they were all treated with elaborate respect. The patients seemed to sense they were important because they were all playing a role in the training of the next generation of students, and they frequently got into their roles. Many was the time I heard a patient say, "Well, being ill has been a blow, but at least I'm helping someone by being here, learn something, to help the next guy." If you could be sick and frightened and proud at the same time, they were.
But all that is gone now, buried under the weight of money, and the ethics of profit and none of these values mean anything to the suits with MBA's who hire and fire doctors at these institutions.
Okay, I'm a grumpy old man, living in an imagined past of neverwas--so I'll just go back and watch another episode of Doc Martin, set in an English Cornwall town, depicting a system of medical care which is not driven by money or profit, but by pride and the desire to serve. That's probably an illusion, too.
But no, it's not an illusion. I traveled to the real England forty years ago, spent two months as an American medical student, a stranger in a strange land, where the natives spoke a language I could understand, but they were not just Americans who sounded funny. They were very different from us. I asked the English patients, admitted to hospital when their own doctor was going to come in to see them, and they replied, astonished, "You mean my GP? Whatever would he come here for?" The English didn't expect their GP to see them in hospital. That's what the hospitalists were for. The hospital doctors would care for them and when they returned home, the GP would have a full report. I was appalled. Now, forty years later, it is the system American medicine has discovered and installed. The English were way ahead of us then and they still are, with midwives delivering most babies and a system of home health care, visiting nurses, which is much less expensive than what we do and which is no financial burden to the individual and which provides a sort of care the patients really appreciate, at home.
But here in America, politicians keep saying things like, "Well, here in America, we have the best health care system in the world. Let's not ruin that." We would not want to ruin it, if it were truly the best. The problem is, it is not. It's just the most expensive.
If you are ever wondering about who we are as Americans, you have to look no further than the difference between the American "system" of medical care and that of the English. There the clothes are stripped off and you see the naked truth about values and the character of a people.
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