An ethics professor takes an interesting look at how elitist the US health care system is becoming. On one hand, we have concierge practices:

Now, one might wonder why it is necessary to pay a bounty to get a doctor to call you back, especially if you are already paying through the nose to belong to a managed care plan. The answer is that under the watchful eye of managed care and insurance companies, the quality of care has gotten so awful that doctors sneeringly refer to it as “hamster care.” Only those patients who pay more are going to get treated by the “concierge” doctors who get off the daily treadmill and practice good medicine, providing the sort of attention and service that our parents and grandparents took for granted.

On the other, we have what’s happening to the Medicaid program Tennessee:

Historically, decisions about what drugs or treatments a patient received were chosen by a standard of care known as “medical necessity.” Doctors determined what was medically necessary based on local standards of medical practice, and if they did not practice according to this standard they could be found guilty of malpractice. TennCare does away with the established standard and replaces it with a new one – “adequate care.” If a bureaucrat in the Tennessee department of health thinks a low-cost drug or treatment, or even no treatment at all, is “adequate,” then that is what TennCare will provide.