27 January 2012

Lobster tails for hospital patients

Health-care related posts seems to elicit the most vigorous and conflicting comments on this blog, so here's a little grist for the mill, from a column in the New York Times:
The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, “I’ll be your butler.” 

It was Greenberg 14 South, the elite wing on the new penthouse floor of NewYork-Presbyterian/Weill Cornell hospital. Pampering and décor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such “amenities units,” often hidden behind closed doors at New York’s premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable American medical system..

A waterfall, a grand piano and the image of a giant orchid grace the soaring ninth floor atrium of McKeen, leading to refurbished rooms that, like those in the hospital’s East 68th Street penthouse, cost patients $1,000 to $1,500 a day, and can be combined. That fee is on top of whatever base rate insurance pays to the hospital, or the roughly $4,500 a day that foreigners are charged, according to the hospital’s international services department...

In Eleven West’s library on a recent Friday, Nancy Hemenway, a senior financial services executive, was reading the paper in a spa-style bathrobe. “I was supposed to be in Buenos Aires last week taking tango lessons, but unfortunately I hurt my back, so I’m here with my concierge,” she said. 

“I’m perfectly at home here — totally private, totally catered,” she added. “I have a primary-care physician who also acts as ringmaster for all my other doctors. And I see no people in training — only the best of the best.”
That last comment reminds me that some years ago a midwestern university hospital (which I will leave unnamed) had an upper floor reserved for wealthy patients, with posh accommodations, special food, and innumerable amenities.  When physicians were on morning rounds, the students and housestaff would stay behind while the attendings went to see their private patients.

However, at night if there was an emergency and the attending was in a distant suburb, the housestaff and fellows were called and had to correct problems with electrolyte imbalance, improve inappropriate ventilator settings, or detect missed diagnoses.  Many of the attending physicians were less procedurally competent (and frankly less practically knowledgeable) than the "physicians in training," who joked (among themselves) that the only good thing for the patients in the top floor suite was that the location was "close to a hospital."

One final salient comment from the Times story:
“These kinds of patients, they’re paying cash — they’re the best kind of patient to have,” she added. “Theoretically, it trickles down.” 
This is all very complicated, re the finances, re the medical implications, re the ethics etc.  I'll defer any additional commentary; there's much more in the Times and in a related story in Salon.

Photo: Marilynn K. Yee/The New York Times


  1. From Down and Out in Paris and London, describing behind-the-scenes at fancy hotel restaurants:

    "Apart from the dirt, the PATRON swindled the customers wholeheartedly. For the most part the materials of the food were very bad, though the cooks knew how to serve it up in style. The meat was at best ordinary, and as to the vegetables, no good housekeeper would have looked at them in the market. The cream, by a standing order, was diluted with milk. The tea and coffee were of inferior sorts, and the jam was synthetic stuff out of vast, unlabelled tins. All the cheaper wines, according to Boris, were corked VIN ORDINAIRE. There was a rule that employees must pay for anything they
    spoiled, and in consequence damaged things were seldom thrown away. Once the waiter on the third floor dropped a roast chicken down the shaft of our service lift, where it fell into a litter of broken bread, torn paper and so forth at the bottom. We simply wiped it with a cloth and sent it up again. Upstairs there were dirty tales of once-used sheets not being washed, but simply damped, ironed and put back on the beds. The PATRON was as mean to us as to the customers. Throughout the vast hotel there was not, for instance, such a thing as a brush and pan; one had to manage with a broom and a piece of cardboard. And the staff lavatory was worthy of Central Asia, and there was no place to wash one's hands, except the sinks used for washing crockery."

  2. I would like research into the HAI ratio of the swank vs the care of the commoners. I am guessing it's the same. (Hospital Acquired Infection - almost killed my wife...).

  3. Meh - I don't see the big deal. If rich folk want to pay a bunch of money into the hospital system to have a butler and a waterfall, let 'em pay. Someone has to make up for all of the people in the emergency room with non-emergency conditions that they'll never pay for, anyway.

    1. Well...That would be alright if it wasn't all paid for by the money the rich stole, conned or hoodwinked from the poor.

    2. I see your point and I mostly agree with it as I am opening my eyes to this idea more each day: If we were not at war, people would have less need for weapons and vices.
      "When in a gold rush, the real money is in selling maps and shovels." <- I'm ok with this millionaire.
      "When in a war, the real money is in selling both the bullets and the bandages" <- I could almost stomach this one, if it ended at 'million' but today we see that patriotism plays no roll in this transaction and so 'million' (modest margin) becomes 'billion' as 'they' sell to both friend and foe.
      ...Then we reward them with the best healthcare on earth. Great

  4. Ehh, rich people have always had something similar. We just sometimes get to see it now. As long as people are willing to pay for it, someone will fill the need.

    Minnesotastan, check this out: http://www.npr.org/2012/01/27/145950485/business-news

  5. Having worked in two different hospitals offering luxury accomodations, I'd say that at the end of the day, the medical care is not much different between regular rooms and private suites. I'm sure that on some level, the doctors and nurses may be marginally more attentive, but I think that the medical services rendered are very comparable between the two settings.

    The people who choose (and can afford) to pay for fancy hospital suites are largely paying for the amenities. As the article points out, insurance companies are billed identically for "wealthy" and "regular" patients. The extra expense per night is a service charge that gets billed directly to the patient and undoubtedly nets a profit for the hospital above and beyond the costs associated with the amenities provided.

    Unfortunately, it's impossible to escape the business side of medicine. Hospitals must meet their budgets to employ their staff and maintain their facilities. While it's tempting to vilify hospitals and doctors for catering to the wealthy, the fact is that with rare exception, none are turning their backs on middle class or destitute patients. Although some hospitals are set up to primarily care for the indigent, most hospitals do offer some degree of discounted or charity care to indigent or poorer patients. From a financial standpoint, this would not be possible without extra money coming in from elsewhere. These private hospital units for the wealthy are one way for the hospitals to offset some of those expenses to keep their doors open to all patients regardless of finances.

    As an aside, I've heard of patients from regular hospital rooms being selected to stay (for no extra expense) in the luxury units on occasion. I'm not sure what the reasons for these upgrades are, but it's a nice gesture for the patients.

    1. 'As an aside, I've heard of patients from regular hospital rooms being selected to stay (for no extra expense) in the luxury units on occasion. I'm not sure what the reasons for these upgrades are, but it's a nice gesture for the patients.'

      I'd wager there IS a reason but the reason(extended family, maid, etc.) of somebody with pull in the hospital) is left a secret.

  6. TRUE story. My friend went in for yet another surgery on her bad foot. (A boat ran over it.) Aquired a staph infection in her GOOD foot, resulting in amputation. Now she only has one foot and it's the bad one.
    Very sad tale, but my guess is she was simply too resistant to any antibiotic available after years of fighting with the injured foot.
    Before the amputation I suggest maggot therapy. She thought that was a disgusting idea;/

    And as I type my own dentist is facing an amputation after having simply checked in for minor knee surgery.

    1. Maggots are quite efficacious in debriding decayed flesh. I don't think they're as disgusting as the smell of Pseudomonas in a wound.

  7. Is it irony that I get sick looking at stuff like this?

    This kind of waste makes me ill. That people can afford these amenities while others cannot afford basic health care is disgusting.

    It reminds me of an ad I saw recently for a cruise line that promised to "indulge your every whim moments before you thought of it" (or similar words to that effect). All I could think of were the working stiffs who will be paid minimum wage so that others can be pampered beyond belief, the slave labor that makes all their amenities, the incredible amounts of food that will be wasted, and the fuel that will be expended so these spoiled, over-paid, self-serving EBs can go in circles for a few days.

    Gah! Makes me want to vomit.


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