Theresa Brown, RN, writes a periodic NY Times blog  that gives us a glimpse into the beautiful and awful stories that occur on a hospital oncology floor. This week, she wrote about privilege, money and health care reform: her story was of a VIP patient on the cancer floor receiving china-and-linen meal settings wheeled in on a cart for him and his family, while others received the usual institutional food:

The nurses on Brown's floor were disgusted at the VIP's special treatment, familiar with the monetary woes of their less-prominent patients.  She recalls one patient whose wife could neither afford to buy, nor receive for free, her meals at the hospital while her husband underwent cancer treatment.  While hospital administrators were busy kowtowing to VIPs, nurses sympathized with people like the insured woman who had to pay $600 up front each time she got chemo. 

Commenters on Brown's blog noted that disparities will always exist, and  health care reform legislation will never wipe them out.  I tend to agree. Others opine that disparaties in health care should not be eliminated; those are the free marketers who believe the health care market can somehow resemble a Milton Friedman ideal.  

I was once conversing with a surgical resident about health care costs. He offered that people should get what they pay for, and if that means some get better care than others, so be it.  I countered that health care is not like a new car; if you go to a car dealership, they aren't obligated to meet your needs. Health care providers are obligated, legally and ethically, to provide care, and therefore we must strive for equality.  The market is not free in health care, and pretending it is only compounds health disparities.

Commenter Lisa got it right: VIPs don't pay extra for special meals and such, but still they expect them. The well-insured, in fact, may actually pay less for a hospital stay than the uninsured because of deals hospitals make with insurance companies. There was a settlement in a class action lawsuit not long ago against a Seattle-based health system for precisely this. 

Like me, Nurse Brown is not perturbed that the rich are able to pay for fancier meals or even for extra nursing attention. (If  possible; hospitals usually do not permit patients to hire private nurses.) We nurses are troubled when rewards, like more and better food, are given to those who donate money, know someone, or hold an influential position in the community. And worse yet, when someone demands such perks because of their status.

Working in a surgical ICU in Cleveland many years ago, I was told by a VIP patient “I am special, you know.” I replied, “So is the 75-year-old woman who is alone and very ill in the next room. I am caring for both of you.” He didn’t like my retort, but he changed his attitude.

That VIP didn't know that nurses value equality very highly. We use the same sterile technique regardless of one’s social status. We listen to your troubles no matter who you are. We know that some people can pay for more expensive treatment, and we have to live with that while attempting to impart some small measure of justice to an unjust system.