First Class vs. Economy

With the issue of health care reform looming over us, I wonder what we can do to change the system. I'd like to mention an idea I had, even though I am not really satisfied with it. I thought of it in the context of the airline industry. Everyone who buys a plane ticket gets a basic level of service: a safe trip from one location to another. Yet a passenger can pay more to get more perks; business class might net some more leg room and first class may come with a gourmet meal. Yet the basic service is the same, travel from one place to another. In the case of an emergency, there's no preference given to passengers of one class over another.

In the same way, everyone deserves a basic level of health care. Under President Obama's plan, this may require everyone to carry some sort of insurance. This minimal level of insurance needs to encompass things like primary care visits, management of chronic diseases, preventative care like vaccinations, obstetric and gynecologic care, psychiatric services, hospital services during acute illness, etc. However, in order to promote competition between insurance companies, plans may offer perks above and beyond the basics. Of course, insurance plans already do this: they come with or without dental or eye care or prescription medications.

But what if this was extended to a hospital stay. Importantly - and this is most important in my eyes - the medical services do not differ. A doctor should not know whether a patient has an economy insurance plan or a first class one. Any physician or nursing services offered to one patient must be offered to another. But there can still be perks - perhaps the patient with "better" insurance has higher priority for single rooms or larger TVs with more channels or valet parking for visitors or flowers on admission. Perhaps they can get childcare or make long distance phone calls or have another bed in the room for the spouse or partner. Even though the medical care cannot differ, there might be a lot of other variables that "VIPs" could qualify for.

Will patients or companies pay more for "deluxe" treatment at hospitals? Will insurance companies use this as a means of enticing different customers or differentiating themselves? I don't know. I'm not sure I even like this idea since medicine ought to be a form of social justice. But given President Obama's desire for an affordable marketplace for health care, perhaps throwing more options into the mix will stimulate the market.