Read: The coronavirus’s real and immediate threat to democracy
For a professional sports organization to receive so many tests—which are being rationed across the country—in such short order is a jarring disparity, but it’s not unexpected. When I spoke with Wendell Potter, a former communications director at the insurance giant Cigna, on Thursday, he had a succinct explanation: The health-care system in the United States is built for the elite.
“We hear politicians say all the time that we have the best health-care system in the world,” Potter, now a leading advocate for Medicare for All, told me. “We have fabulous doctors and health-care facilities, but they’re off-limits to a lot of people because of the cost.”
But what is off-limits to some is readily available to others—namely the wealthy, powerful, and connected—through a combination of front, side, and back doors.
There are the obvious reasons: Wealthy people tend to have better health-care plans and are more able to pay out-of-pocket expenses than poor people are. And then there are the ethically dubious reasons: The powerful—such as politicians—can leverage their position of influence, and the wealthy can donate their way into faster treatment.
Nearly a decade ago, when Shoa L. Clarke, a cardiology fellow at Stanford University, was a medical student, he noticed something odd. There was a patient who had a red blanket on their bed. He didn’t think much of it at first, but the significance of the blanket quickly became clear. “It was a marker of status,” Clarke wrote in The New York Times in 2015. “At that hospital, patient relations gave them to some C.E.O.s, celebrities and trustees’ friends.”
I spoke with Clarke yesterday to see if anything was different in our current environment, and though he allowed that some hospitals had started limiting the practices he had described, these patterns still occur. “Most of the major hospitals in the country have some strategy now to not just recruit patients in general, but to particularly recruit patients who are relatively well insured,” he told me. “Often, hospitals are specifically recruiting international patients to fly over and pay out of pocket.”
There are some practical reasons for hospitals to do this, he said. Several hospitals have closed in recent years, and by bringing in patients who can pay more—and by giving them luxurious treatment to keep them—hospitals can keep the lights on. But as Clarke emphasized five years ago, that’s “vaguely unethical.”
The ethics of preferential treatment are even more acute as the country stares down a pandemic. “What we’re facing right now is unlike anything that I’ve ever experienced in medicine,” Clarke told me. “Our motivations should be driven by public health … and for folks who are coming in potentially with COVID-19, it doesn’t matter if they’re a CEO of the big tech company or a homeless person off the street—they need to be appropriately cared for.”