Silvio Berlusconi, Italy's richest man and its former Prime Minister, recently flew to a hospital in Cleveland to have a pacemaker installed. Such journeys are not uncommon for the world's elite jet-setters and are often seen as indicative of the stature and preeminence of a particular hospital or facility in the world community. Absent concerns of cost or finance, only the best facilities will do for the wealthiest patients in the world.
Undoubtedly the Cleveland Clinic, the facility chosen by Mr. Berlusconi, is among the best in the world for the surgery he required. The 150 foot yacht "Excellent", San Siro Stadium, and AC Milan - his boat, stadium, and soccer (football) team respectively - are also among the best the world. When cost is no object, there is little point in making a purchasing decision on anything but surpassing quality. As Mr. Berlusconi's fabulous wealth, yacht, and even sporting team demonstrate, his purchasing patterns have little in common with those of his fellow countrymen or indeed the average American.
Mr. Berlusconi may choose to fly across the Atlantic to undergo surgery at an elite clinic where the world's best doctors can command the high prices that might draw them from other facilities in other corners of the globe. With an net worth in excess of $13 Billion he is certainly able to foot the bill. Such extravagance is beyond the reach of most Italians, however and as such few of Italy's middle class undertake expensive treatment at US clinics.
That, in and of itself, is an interesting observation given the primacy of health concerns in the Western World. Certainly if the treatments available at the Cleveland Clinic were substantially better than those available in the partially socialized medical systems of Italy, Germany, or Britain the middle classes in these countries would make frequent trans-Atlantic flights if only for major procedures. With the Euro stronger than the dollar and gaining ground by the day, American hospitals should be flooded with a veritable tide of middle class Europeans seeking treatment for all manner of medical issues common to an aging population.
And yet these plane-loads of patients have largely failed to arrive.
Is health unimportant to all but the most wealthy of Europeans or is there perhaps some other explanation for the strange discontinuity between Mr. Berlusconi's surgery and those of millions of other Europeans seeking medical treatment?
Perhaps a more honest look at the European medical system would reveal it to have its shortcomings - yes - but show it to be overall the equal of and in many ways superior to the American system, certainly for those that fall short of the multi-billionaire mark. Mr Berlusconi has chosen to buy a 150 foot custom yacht, and while "Excellent" in more ways than one, his decision does not mean that 150 foot custom yachts are the best financial decision for middle class Italians or Americans.
Extrapolating the medical decisions of billionaires as an argument for the US private healthcare system ignores not just the elasticity of demand in comparable goods1 but also the macroscopic purpose of healthcare on the national level. Certainly the best care available at the Cleveland Clinic and many other American hospitals may exceed the quality of the best care to be found in Europe's premier facilities; but if that care requires a billionaire's expense account, what does it matter?
Is the merit of a system of healthcare to be judged in the quality of the best care it can provide at its highest price-point or the health of the population it serves? Is it to be measured in the extravagance of one individual's therapy or the ability of a society as a whole to receive medical attention where necessary?
Though Lamborghini may make a superior product in almost every respect to Toyota, few would venture to say that a Diablo would be a better transportation purchase for the average American family than a Carola. Why, in healthcare, should we assume such extravagance to be the best prescription?
1. A bit of economics jargon. Essentially the notion that two goods which serve approximately the same purpose compete against each other for consumers based upon a number of factors including quality and price-point.