Those lucky enough to have a job with health care benefits had access to a significantly higher level and broader range of services. Actually, within this class of service, one could distinguish the run-of-the-mill client from another level: the well-connected, wealthier client who had a personal network enabling them to find out who the best specialty physicians in the country were, get these physicians to take them on as clients, and pay for the airfare and hotel costs while getting the care they needed. Finally, at the very top of the heap, are clients for whom money is no object and who pay a very expensive cash fee to a renowned internist who has only a few clients, is available to them 24/7, and refers them instantly to the finest physicians in the world. This last class of clients, like the first class, does not bother with insurance.

Clearly, we have a health care system that is not only finely stratified by the client's wealth, but is also highly inefficient -- and these two facts are related. It is well-known that when the total cost of the American health care system is divided by the size of our population, we have one of the most expensive health care systems in the world. Some say it is also one of the best, but that turns out to be true only for those within the higher ranges of the system. The outcomes for the average client are just average in an international context, and the outcomes for those clients with scarce financial resources are comparable to the health outcomes for the citizens of third world countries.

One reason this grossly unfair and highly inefficient system is so hard to change is because health insurance companies whose revenues depend on it have enormous financial and political clout. But the clients who benefit most from this system also have enormous financial and political clout. There are, by definition, only so many top-notch hospitals and doctors, and this system enables those with the most money to have virtually exclusive access to them. They will not give that privilege up without a ferocious fight. That holds true not only for the super-rich--those with concierge medical services--but also for many in the next level down, the professionals and managers who work for the better firms with generous health care plans.

EDUCATION'S 1% CRISIS



Now consider our public education system. What our health care system accomplishes through its insurance system aligns with what our public education system accomplishes through the property tax used to finance our public schools. The result is the same: a highly stratified system of services differentiated by the income of the clients.

Yet funding for our public education system works differently. To a degree unmatched by any other industrialized country, the amount of money our schools receive is a function of the value of the homes in the community. This means that wealthy people can form their own school taxing district that is accessible only to people who paid a great deal of money for their home. It's an exceptionally good deal: because the community is so wealthy, their required tax rate is very low while the tax yield is very high. At the other end of the scale are the communities where people can only afford to pay very little for their homes, but ironically pay a very high tax rate for schools that have only a small fraction of the budgets available to schools in wealthier communities.