A wide disparity of health outcomes accompanies wealth disparity in the United States, and ability to pay often determines the level and quality of care available.
Who Has Access to High-quality Health Care in the US?
US patients get care along a continuum. At one end, those with means benefit from supplemental services such as concierge physicians, health clubs, personal training, and massage.
At the other extreme, housing and food insecure Americans also have limited access to care.
Concierge Medicine
I’m not saying that it’s unethical to use boutiques, but they shouldn’t be necessary.
And of course there are enormous health benefits from quick access, thorough attention, and vigorous follow through! It’s a winning model which demonstrably reduces disease and increases vitality.
Furthermore, concierge primary care doctors, themselves infuriated by the system, can instead pay close attention to a limited number of subscribed patients, and help them stay healthy — the reason they went to medical school.
The fees range from $2K to $5K per year. Subscribers must also carry full insurance coverage.
Concierge practices provide on-call, personal health care advocacy and achieve statistically better health outcomes for their subscribers. And they are popular, increasing in number by 83% between 2018-2023.
Who gets denied?
Those with no insurance or ability to pay. By law, Emergency Departments must stabilize patients if possible, regardless of their finances. As a result, safety-net hospital EDs frequently have wait times over 6 hours. Many health care organizations provide free care, but public funding is limited.
Case Study: A For-profit Health Care Disaster
Steward Health Care (see PBS Report) went bankrupt after enriching it’s executives and investors. I always struggle with this: What could possibly justify systematically enriching yourself on the suffering of others? And yet, it’s everywhere. Please let me know if you have answers.
Primary Care Providers
When the current health system was designed over 50 years ago, doctors provided two primary services which are no longer available without subsidy:
Preventive care and
Diagnosis & treatment of injury and disease.
Instead…
Health care professionals face limited resources, very sick patients, and personal risk. Mistakes become inevitable. Nursing shortages, for example, routinely cause death due to structural negligence. Like patients, they are caught up in a system that’s broken for everyone except the wealthy.
Primary, preventive care is vital to thriving individuals who, in turn, keep overall health costs down. Yet the field is shrinking compared to other medical specialties. In March 2024 there was a shortage of almost 7,500 primary care providers in the US. There are currently 300 such jobs posted in New Hampshire.
Providers must also manage computerized health records, insurance, prior approvals, prescriptions, etc. All take time and are not generally compensated. Policy and reimbursement changes could reverse this critical problem.
Family Medicine doctors earn around $250-300K, neurosurgeons $750K. The CEO of Mass General Brigham earned $8.4M in 2025.
Systemic Failures
While health care system failures are a symptom of deeper social and economic disparity woes, the current system is wasteful, expensive, and focused on the wealthy.
All the unnecessary suffering aside, this state is unsustainable: those lacking health care rapidly become expensively and increasingly unable to care for themselves.
Often, because it’s the only point of access, they cycle at great pain and expense through the ER.
Meanwhile, funding and access to free care programs is shrinking, for example, Boston’s award-winning program Health Care for the Homeless is laying off employees.
Possible Solutions
The US uninsured population went from 16.5% in 2010 to 8% currently (mostly due to the ACA). The practice of coverage denial for “pre-existing conditions” has ended. But we need new ideas, energy, and the political will to fix these entrenched problems.
Other countries (Japan, Australia, Canada) deliver far better outcomes at far lower cost per capita… And we already have Medicare, which could be morphed into a (much disparaged) “Medicare for All” plan.
There will always be boutique practices and private doctors. When their popularity wanes we will know that US healthcare is working better.
Read More
- Should I Feel Bad About Joining a Concierge Medical Practice? By Kwame Anthony Appiah, Ethicist for the New York Times
- Rise of ‘concierge medicine’ has benefits, drawbacks By T.H. Chan, Harvard School of Public Health
- Investigation reveals how investors made millions as Steward Health Care system collapsed from PBS News, 9/12/24
- Nearly Half of Americans Can’t Access or Afford Quality Health Care by Luke Schultheis for ONS Voice, 5/26/25
- The Pitt (trailer) — series from HBO Max
- Universal health care by country from Wikipedia
- Mass General’s growth comes at expense of affordable health care by Robert Kuttner in the Boston Globe, 1/11/25