There is some hypocrisy to be noted about legislators who shoot down health care for children while keeping themselves well insured and with special and preferred access, or the shameful treatment of our soldiers in dilapidated facilities within walking distance of their own luxurious digs.
But on the other hand, maybe we should review our assumptions. How much does it cost to maintain facilities in condition to provide immediate and convenient service? Probably quite a bit, since we don't want expensive facilities and professionals sitting around without work to do, without providing billable services and simply waiting for the next client.
An inexpensive efficient system would keep all the professionals busy and keep the patients waiting. Some services are urgent, so the least urgent would have to wait proportionately longer for non-urgent services. This is like a patient in a car-crash bumping a routine hernia repair from a previously scheduled OR slot.
Would you pay extra to have your procedure at a facility in which your OR time was guaranteed? Perhaps it is acceptable to allow those individuals who can to pay for luxurious surroundings and improved convenience. There are some public health implications of access, but perhaps equal access is not desirable, merely sufficient access to achieve public health goals. After all, the interests of capital would prefer the ability to pay for better health care, much as our senators and congressmen claim as a perk of power. It seems the majority or Americans find it repugnant to allow some people to die because they could not gain access to a needed procedure or treatment due to differences in social class or insurance status. However, it is the way of the world to provide better quality for those who can afford it.
There is data emerging from the Health Disparities Collaboratives that community health centers provide a better level of quality than private facilities. CHC's do better in delivering necessary monitoring and treatment for diabetics, asthmatics and people with depression than private facilities. The facility I help run does a better job than my own physician's group.
On the other hand, we have long waits for new patients, old (but clean) facilities and a temperamental phone system. My physician answers calls personally and squeezes me in according to my needs and I have watched him do so for other (wealthy) non-physicians.
Capital may define quality in a different manner than public health does. This is an important observation to build a health care system we can all live with. It should not cost much to provide a basic and defined set of health services for low-income people. But it should be a system with sufficient drawbacks that people perceive an advantage to paying more for something better. That "something better" could involve greater coverage for procedures and treatments that do not yet have an overwhelming scientific advantage and to provide those services at a much greater level of convenience and luxury.