Lamborghini Healthcare: Why Billionaires Shouldn't Determine Health Policy

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?