Dr. Michael Breen

My Twitter Site

admin — Wed, 10 Mar 2010 16:24:09 +0000

Medical marketing speeds along on a daily cycle. Just like journalism.

Every morning we take in the day’s news agenda, imagine the media’s needs that day, and find a way to make our clients’ stories fit those needs. (A new heart stent may be hard to sell….but not on the day Dick Cheney returns to the hospital with chest pain.)

Any occassional insights are brief and have a shelf-life measured in hours.

For those reasons, I’ve been writing more on Twitter, often several times a day.

If you need to know every morning, what the medical media’s thinking…and what it’s seeking, please visit my daily posts at

https://twitter.com/tvdoc

Thanks.

Leveraging Your TV and Print Exposure

admin — Fri, 30 Oct 2009 18:27:31 +0000

In medical marketing content isn’t always king.

I recently placed a newspaper story that said our client, a large multi-specialty group, represented the next generation of primary care. Electronic medical records, data outcomes, and other tools had effectively made them like “Marcus Welby on steroids.”

The content was certainly positive, but I wasn’t prepared for my client’s euphoria.

Read more… or Read more right here… »

I’d only read the story on the web. I didn’t know the paper itself has our story page one with a doctor photo under the fold…or that the jump page had other photos of the clinic’s doctors and patients.

The placement was far more important than the content. Page one not only raises exposure, it also raises impact; it implicitly suggests the story is major news.

The problem is the next day there’s always a new page one. So (to turn a corner) how do you prolong your organization’s moment in the sun?

There are several ways:

Put The News Clip On Your Web Site

Do it immediately.

Banner the story (”as seen on ___”) on your home page for a few weeks then move it to your “In The News” section (which of course your organization has.)

Also send a mass emailing your patients and potential patients that links to yourstory.

Let me them know that the media (which, of course, only seeks out the best), has once again sought you out.

Use The Clip During Events Marketing

One or more news pieces when introducing your practice immediately raises its credibility and prestige with audiences

Display News Clips In Your Waiting Room

We just finished editing a half-hour collection of news clips for a chain ofaudiology clinics.

Every waiting room will see the clinic’s doctors interviewed on TV, they’ll see stories about the clinic’s groundbreaking advances.

One plastic surgeon client even shows his appearance on “Oprah.” (Needless to say, patients are sold before they ever enter his office.)

Upload Your Clips To You Tube

It’s easy to do and practically free.

What’s more, taking some simple steps can increase the odds, your story will show up on Google searches

Display Articles On Your Web Site As PDFs

The bottom line is the internet has made all news “immortal” (The pundits call it the “long-tail” effect.) The attention from a story diminishes, but it goes on forever.

Don’t settle for fifteen minutes of fame. Leverage that media attention and you’ll be amazed at how long you stay in the spotlight.

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The Swine Flu Virus….Your Media Opportunity!!

admin — Fri, 30 Oct 2009 18:09:33 +0000

Today I pitched plenty of client stories to the media: a multi-specialty clinic is designated a “medical home,” a plastic surgeon has a better way of doing facelifts, a medical device company releases a better stimulator for chronic pain, an audiology clinic sees a spike in hearing-impaired women, a dentist happily hands out “healthy” Halloween candy, and more.

But medical reporters and producers don’t care.

For the moment (as one put it) it’s “all swine flu all the time.”

Fortunately, that challenge is also an opportunity. Medical reporters are desperate for new angles on a continuing story. We’ve found some angles and gotten some coverage.

Here are different approaches that worked for us..and provided publicity for clients sometimes far afield of Swine Flu:

Read more… or Read more right here… »

1) Using A Computer To Automatically Alert High-Risk Vaccine Patients

The Swine Flu vaccine’s uncertain arrival time, number of doses, and recommended use created a nightmare for large primary care clinics. Which patients should they alert to come in for the vaccine…and when?

One of our clients solved the problem with its state-of-the-art electronic medical records. The digitized records are constantly scanned by a system that then automatically phones and sends out emails alerting patients to come in.

Much like a military campaign, a task force met weekly to assess new developments. They then sent the computer new guidelines for choosing the patients most in need.

We described the clinic’s approach as an example of “the next generation of primary care” ..and the media liked it.

2) Preventing Older People From Seeking Swine Flu

Another client made special efforts to prevent its senior patients from seeking the vaccine and feeling rebuffed. The client created very separate Swine Flu and Seasonal Flu Clinics that were held in different places on different days. It also printed leaflets explaining that older people had less need for the limited vaccine.

We also broadened the story to ask: Why in this case are older patients better protected from this virus than younger ones? (Answer: exposure to some similar form of Swine flu in the past.)

Medical reporters have found this a very topical angle because these days so many senior citizens worry they’re being denied care.

3) Many Heart Patients May Have Extra Protection From Swine Flu

A recent study suggests patients taking cholesterol-lowering statins are also getting some protection from Swine Flu. Researchers found the medication appeared to limit the complications on seasonal flu and many experts believe the benefit may apply to Swine Flu as well. (Apparently because of the drug’s anti-inflammatory effects.)

The media liked the story because it combined two very broad audiences (statin-takers and those concerned about Swine Flu).

4) When Does Your Child Need Tamiflu?

We jumped early on this controversial issue (frankly the recommendations on when to use Tamiflu are all over the map.)

Our hospital’s ER was holding off on Tamiflu until tests confirmed the diagnosis. The staff felt this was the best way to use the limited amounts available to children.

5) Patients Who Feel Grateful For The Swine Flu Outbreak

They’re the patients of a well-known plastic surgeon. His nose reconstruction patients have to stay in town for a week post-op. During that time they wear a surgical mask to cover bruising.

The angle here is now they don’t have to be self-conscious about wearing a mask because everyone just assumes they’re protecting themselves from Swine flu. (I know it’s soft, but the story’s visual and for some reason appeals to me.)

I’m sure these stories are just the tip of the iceberg. You’d probably be surprised at some of the ways the Swine Flu mania is impacting your practice or hospital.

And that mania applies to medical reporters just as much as patients. Don’t pitch them the same old angles. Be creative…those reporters will thank you for it.

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Are Doctors Risk-Takers?

admin — Wed, 23 Sep 2009 18:00:35 +0000

Physicians are very complicated.

Take our attitude toward risk. On one hand we’re risk-takers. We were trained to routinely make life and death decisions. The practicing doctor thinks clearly in the most stressful situations. We tell ourselves of course we’re risk-takers. (Never, ever tell an orthopedic surgeon that he’s afraid of risk.)

Yet physicians are also self-selected to be risk-averse. As a rule we chose a conventional career path for the guarantee of a lucrative lifetime income. And we excelled in an educational and medical culture that rewarded unquestioning obedience and conformity.

Yesterday I dealt with three doctors who personified all these attitudes toward risk.

Read more… or Read more right here… »

The first was an ophthalmologist friend. Over coffee he complained about his shifting profession. The general ophthalmologist turned to refractive surgery when Lasik became hot. At first he made a lot of money but now a recession, rising royalties, and more competition have cleaned him out. Ten years later he’s back to general practice.

“It wasn’t supposed to be like this,” he complained. “Nobody told me this was a business. Nobody told me I might fail.”

I hear this frequently. After all, society has broken an implicit contract with the best students of our generation. That contract said do well, get into med school, spend hundreds of thousands on your education, devote years of your life to training and when you emerge, we’ll guarantee you respect, security, and a high-income for the rest of your life. Failure will never again be an option.

But now medicine is a business, failure is an option, and many physicians can’t handle it. Once again in the name of security they’ve conformed…this time by becoming the employees or pawns of ever more heavy-handed insurers and government payers. Unfortunately, we see these doctors everywhere. They look embittered and betrayed: life wasn’t supposed to turn out this way.

That afternoon, though, I met a younger client who embraces risk. He’s a 30-something cosmetic dentist in suburban Chicago. We met at his office for a TV news appearance my firm had placed. (It was on the use of Lumineers in teens as a replacement for braces.)

After his TV interview he came over to me. “This is going to change dentistry,” he said. “That’s what I told her on TV and that’s what I believe. The other dentists won’t like me saying that but you know what? Who cares? This isn’t the old days. My colleagues are my competition! I’m doing this procedure now, it’s safe and effective, and I want everyone to know what I’m doing.”

Spoken like a real risk-taker (and his practice is exploding.) This attitude, I suspect, is the wave of the future.

Finally yesterday I spoke on the phone to a doctor in transition. He’d done terrifically as a student then joined a group practice a decade ago. But in recent years he felt he’d been taken advantage of: he was breaking off to form his own practice.

We talked about the marketing help he’d need: a new web site, print ads, direct mailings to current patients, appearances in print and TV

This was not an easy phone call for him to make. I could hear his excitement and his apprehension. He was a little fearful…..controlling your own destiny will do that.

I can’t wait to help him.

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The Media and Swine Flu

admin — Tue, 01 Sep 2009 21:30:05 +0000

I don’t know just how serious the coming swine flu season will be. It’s obvious no one does (even the WHO and CDC can’t agree on a message.) But I do know this:

The media and the government will try to scare your patients to death.

I know this because (like the raging LA wildfires) the government will provide the heat, and the media will provide the spark to ignite a seeming disaster (real or not)

I know this for two reasons:

First because TV news and newspapers are going through their last spastic death throes. At this point they’ll do anything to get your attention. And nothing works like stoking up a panic. Of course, the media will claim to be “responsible” about it’s coverage. But “responsible” is a very relative term. For instance, last week the WHO’s estimate of 90K deaths was page one in most papers. Later that week, the CDC’s less alarmist outlook was on page 32.

No. The MSM is desperate and with jobs at stake, ethics have become expendable.

But the media’s not the only party interested in stoking the flames. The Swine Flu “pandemic” is a godsend for the Obama administration. In the midst of the health care reform fiasco, Swine Flu creates universal fear and lets the government come to the rescue. The government gets to show it really can deliver healthcare and that voters really can’t get by without a government solution.

Most important, the greater the fear, the greater the calamity the government can claim to have prevented.

So over the next few weeks look for a one-two punch. First the government will issue dire warnings…then media will scream them to the sky. And ultimately, when the outbreak is minimal, the government will credit its own aggressive intervention. It’s just good politics.

Who knows? Those future warnings might turn out to be accurate. But I suspect the Swine Flu story isn’t about a disease…but about a timely cure for the powers-that-be.

Using Twitter To Get Major Exposure

admin — Wed, 26 Aug 2009 14:24:58 +0000

Yesterday I met with the honchos of a suburban hospital. They want to compete with the “big boys” ie the city’s academic medical centers. That means generating some citywide coverage.

I told the staff that I could do that, but only with their help. They had to question their staff to help find the great stories that are all around them.

At which point the hospital’s CEO said, “Frankly I’ve given up on the media. We just got a national award for our diabetic care. Not a single station or newspaper showed any interest.”

Of course not. That story is dead on arrival.

To understand what the media wants, you first have to understand how it works.

Read more… or Read more right here… »

Every day the news isn’t observed, it’s created. At 9AM each morning TV producers and newspaper editors reconstruct the day’s wire stories and other “news” into a flowing half-hour screenplay. Their goal is to make “the news” mimic fiction. To make “reality “just as entertaining and involving as any novel or TV drama.

If there’s a fire, reporters must “Find me the dog who saved the family’s life or the smoke alarm that failed for lack of a 50 cent battery.”

If interest rates are down, they’re railed at “Find me the young couple that can finally buy their own home. I want emotion!”

Reporters then spend the rest of the day making their boss’ screenplay real. They’ll bring home the imagined story their bosses want (whether it’s accurate for not.).

That’s how it works. So how does this knowledge benefit your practice or hospital?

Well, simply put if you can anticipate, you can participate. If you know what stories the media is likely chasing, you can quickly offer up your own expert, make the reporter’s job easier, and get the attention you want.

It’s not hard; the stories the media picks up are usually quite predictable.

In general they:

§ Have Emotion

§ Apply To A Broad Audience

§ Are Visual In Nature

§ Lend Themselves To A One-Sentence “Tease” (For Promotional Reasons)

For over ten years those are the stories I sought out every morning. I went to 20 internet news and medical sites and singled out those I knew met these criteria and would get broad coverage by the end of the day.

Frankly I loved the process. It was like panning for gold nuggets. I enjoyed it so much that, even though I’m no longer in TV, I still do it almost every morning. For instance, last week buried in dozens of medical stories was one about how “obesity shrinks your brain” and another about a new “Viagra soda.” Gold. (I didn’t say substantive, or even worthwhile. I said gold.) By the end of the day those stories were everywhere.

Now, though, I don’t put these nuggets on CBS, I put them on Twitter.

My goal is to give practices and hospital marketing departments an edge. If you know in real time what a paper or TV news show is working on, you can be part of the process.

For reporters struggling to actualize their producers’ daily screenplay, logistics is everything! The clock starts ticking the moment they get their assignments. I’d get daily migraines waiting for PR departments to get me the expert I wanted. If you had proactively offered me that expert, I’d have been so grateful I would have been that much more flattering about your organization!

Every morning I put 3-4 of these upcoming stories on my Twitter page. Some stories won’t apply to your organizations, but some will.

And when you call that assignment desk or reporter and you’re already in their heads, they’ll be impressed. What’s more, the next time they need somebody for their news piece or article, they’ll call you first.

Our Twitter id page is “tvdoc.” Please consider it…because everybody wants to have an edge.

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You Have A Story!

admin — Tue, 25 Aug 2009 21:26:55 +0000

This morning I mentioned to a physician client that my son just entered USC’s “Business of Cinema” program.

He said, “You have to be young to be in movies these days. Video is changing so fast it’s overwhelming.”

“No joke,” I said. “When I was in TV news my goal was to make pictures look like reality. I’d walk out of one frame and into the next…obey the rules of continuity. Now TV news stories are a kaleidoscope…just random jump cuts. Some stories even have music and special effects. There’s not even the pretense of faking reality.”

“What happened?”

Read more… or Read more right here… »

“The younger generation’s figured out TV’s illusion of reality is just that…an illusion. They watch Fox and MSNBC conjure up two different “realities” from the same facts. On Google news they read different newspapers do the same thing. I’m happy younger people see through it all, but that just made it hard for older TV types like me.”

“Why’s that?”

“Because my power came from the myth that my retelling of an event was the only retelling. In fact, I could make the same set of facts support almost any conclusion I wanted. It was all very heady. I used to smile when I drove past our broadcast tower thinking all that technology was built just to spread my reality.”

“So what do younger viewers watch now?”

“Jon Stewart. They figure if any single version of reality is bullshit, they might as well choose the one that gives them a few laughs.

Anyway, why am I sharing this conversation? Because to truly believe your practice or hospital belongs on TV, you first have to understand just how arbitrary the “news” is. The “news” is not etched in granite; it’s a manufactured product designed to make money. Every station stakes out its own version of “reality” hoping that version will sell. That reality might be conservative or liberal, black or white, optimistic or pessimistic, masculine or feminine, terrifying or empowering. Whatever “reality” a news station or newspaper selects, it will find the facts (or approach) to support it.

The bottom line is there are a million events every day that are “newsworthy” (which is why last night I saw a feature on a local steakhouse.) News managers simply select out those events they feel are most consistent with the “reality” they want to present.

There’s no threshold of importance for getting on the news. That’s nonsense. If you have a compelling story your practice or hospital has as much right to be on the news or in the paper as anything else.

In fact you might tailor a story’s pitch to the station or paper who’s “reality” it best represents. For instance, I’m pitching a story about a treatment that helps Iraq veterans. The station I’m working hardest on? Fox. If I were pitching a “poignant” individual story, I’d go with CNN.

Don’t diminish yourself. Worthwhile “newsworthy” stories are all around you. You just have to find them…and determine whose ends they serve.

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Getting National Attention

admin — Mon, 27 Jul 2009 18:40:32 +0000

I have a very clever client.

He’s just published the first heart disease prevention book ever for preschoolers. I wrote a press release, made some calls, and got him some local exposure. But, frankly, not as much coverage as I hoped.

His solution? He demanded I press the national media.

And there, we got lots of response….from USA Today, CBS Morning News, Fox News Network, and other national outlets. It’s counterintuitive but a poor local story can make a great national story (and vice-versa).

You can get national media attention…with the right story. Here’s what the networks, national magazines, and newspapers of record are looking for:

Read more… or Read more right here… »

Ridiculously Broad

National outlets have to appeal to audiences of all ages and ethnicities. The illness or condition you pitch has to appeal to them all. For all practical purposes that means stories about obesity, sexuality, stress, exercise, nutrition, heart disease and perhaps a few other very broad topics. Besides the heart disease book, other personal example that worked would be “off label prescription drugs that help you lose weight,” and “how Botox can help your complexion.”

Very Strong Human Interest Component

You have to be able to offer a compelling patient for the story. National producers on daily schedules don’t have time to find these patients themselves. You have to provide them and they have to be telegenic. Eg I put a reproductive doc on CBS AM News (about a new form of IVF) but the producer did the story only because the couple involved was so attractive and articulate

Skews Young

For the record, this is something I hate but it’s a fact of life. The national media is now obsessed with attracting younger viewers. They’re the only ones advertisers will pay for. (NBC for example couldn’t care less Leno is losing to Letterman; he kills Letterman in younger viewers.)

The bottom line is the first question I’m always asked at the national level is: “How old are the patients this affects?” If the story skews over 65, it’s often a non-starter. No matter how good, or deserving, the story is.

Very Topical

National media loves health angles on larger stories e.g. the ridiculous health tie-ins to the Michael Jackson story. The networks did endless stories on vitiligo, scalp burns, prescription drug abuse, plastic surgery addiction, racial identity, anything that let them keep talking about Jackson. Another example would be national attention we got for a dentist who treated a Hurricane Katrina victim for free. If you can pitch a creative angle to a national story as it happens, you’ll receive countrywide attention.

If you have a story that meets some of these requirements. here are some tips when you contact the national media:

Avoid Any Local References

For example, that producer in New York doesn’t care if your orthopedic surgeon just became the first in Chicago to use a new hip implant. Save that line for your local paper.

Focus on the universal importance of that new implant to everyone, no matter where they live.

Practice Your First Sentence

Once you get that jaded twenty-something “Today Show” (or other) producer on the phone, you have a single sentence to get their attention. Make it count. That sentence has to make that producer go “huh?” Examples are “I have news about a diet that can make you pregnant,” “A new study shows Botox can actually be used to treat someone’s acne!” or “Many dentists are now treating gum disease to prevent obesity!” In general that first sentence should be the banner you put on your Press Release. Only then, when that producer knows she may have story, should you identify who you are and who you represent.

Know Your Shows

Different national shows like different stories eg Oprah is all female problems and all about emotion. You have to have an emotional patient. The “Today” show prides itself on being topical. That’s a great place to pitch if you can tie-in to a national breaking story (same with the New York Times.) Fox News (unfortunately) is all about sex and medical oddities. They also like patriotic stories (eg I sold Fox a PTSD treatment story).

Don’t Forget The Internet!

Recently I placed a story that’s been translated into five languages, seen nationwide, and was the lead story on a medical news show. And all without any coverage by the national mainstream media. The story simply became viral on the internet. If you Googled it you’d see dozens of references this story. What’s more to my client, a plastic surgeon, this coverage is even more important than mainstream coverage. Why? Because almost all his patients do their homework. They Google his name when they’re looking for a provider…and they learn that he gets worldwide attention.

This level of exposure has been a real learning experience for me personally. I’m (perhaps belatedly) discovering I can help my clients without getting them on traditional media. Public relations has become a whole new ballgame.

Be Patient

You may not hear from a network show for weeks. It’s just the way national media works these days. Everything is by committee and all ideas have to percolate to the top for approval. It’s a slow process but once the story is green-lighted, you’d think the Space Shuttle had exploded. They have to do the story immediately. There’s an almost comic sense of urgency. You just have to smile and go with it.

You may disagree with the results, but there is certain logic to what the national media covers. Better to understand it…because you’re not likely to be the exception.

Pardon this but: Choose the right “pitch” and you’re far more likely to hit a media “home run”

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Health Care Reform: Why Doctors Personalities May Never Be The Same

admin — Fri, 24 Jul 2009 22:53:36 +0000

A high price buys the best….unless you’re looking for medical care. In that case cost and quality are on separate planets.

We hear that message a lot from the supporters of health care reform. They praise the Mayo Clinic, Cleveland Clinic, and other models of efficiency.

But if those models become the norm, we’ll be seeing a different breed of physician…for better and worse.

I’ve seen that breed for myself. I first visited the Mayo Clinic twenty years ago when, as a medical reporter in the Twin Cities, I travelled to nearby Rochester. Everyone knew it was the best hospital in America: I wanted viewers to know it was also among the cheapest. (Some difference I made! This is still news to almost everyone.)

By the way, do you know just why the Mayo Clinic is one of the country’s least expensive hospitals? The answer has nothing to do with good medicine.

Read more… or Read more right here… »

The answer has to do with climate. During Minnesota’s long winters Mayo’s rich international clientele wanted to spend as little time in frigid desolate Rochester as possible. So Mayo doctors became expert at getting their patients’ work-ups done as quickly as possible. Those patients also dislike hospitals, so Mayo’s staff became unparalleled at treating complex patients on an outpatient basis. (You may not be aware the Mayo Clinic is just that…a clinic. Admitted patients end up at nearby St. Mary’s Hospital.)

The result is the ultimate well-oiled machine. Our camera crew followed an out-of-town patient who had a neurological problem. In a single day he saw three world-renowned specialists and received a battery of tests. The tests were done first, instantly transcribed, whooshed through a labyrinthine underground network of suction tubes, and delivered to the experts within minutes. Similarly within minutes of each doctor visit, that doctor’s notes had become part of the patient’s chart (so the next doctor could benefit from them.)

By the end of the day the three separate but collaborating doctors had reached a diagnosis and treatment plan. The patient was informed that day, his referring doctor received a summary of the day’s test results and diagnosis a few days later.

But to me the Mayo physician who practices in that environment is rather unique. He/she is among the best at what they do. They could command their own price anywhere they practiced yet they choose to live on a modest salary in Rochester, Minnesota. They make that choice partly to escape a “fee-for-service” environment that spurs overtreatment, partly to avoid insurers and paperwork, and mostly to be a small part of the best medical care in the world.

But while there are exceptions, the docs who make that choice aren’t always the most exciting individuals. They’re hardly “characters;” they’re quite content being subsumed by an institution. You have to experience the Mayo Clinic to appreciate the institution is almost a living entity; its God-like aura is everywhere. (The doctors’ acquiescence sometimes reminded of the “borgs” on Star Trek.) Mayo’s docs could care less about money, and certainly weren’t entrepreneurs. They didn’t make sparkling dinner guests, but if you needed someone to save your life they were the world’s best. That was their reason for being.

Now Dr. Denis Cortese, the Mayo Clinic’s CEO, says all doctors should be more like Mayo’s doctors.

Surprisingly Cortese is a main opponent of the House health care reform bill. His argument is that the essence of reform is to reward all doctors the way the Mayo Clinic rewards it’s own staff, not for their volume of procedures but for their patient results. To accomplish this Dr. Cortese thinks doctors should be closely monitored using with outcome based data. All of which is a hop, skip, and jump away from receiving a salary.

I suspect the result would lead to a new breed of doctors much like those I met at the Mayo Clinic. They’ll be more altruistic, less concerned about money, and more concerned about patient welfare. But they’ll also be less independent, less autonomous, and more willing to be subsumed by the institutions they work for. They won’t necessarily be the risk-takers…or perhaps the best students.

Maybe it’s for the best. Maybe practicing medicine doesn’t require the best students. And certainly health care is broken and needs reform.

But why then does it all leave me feeling a little wistful?

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How The Health Care System Contributed To Michael Jackson’s Death

admin — Fri, 26 Jun 2009 17:08:20 +0000

“The Rich Are Different From You And Me.”

F. Scott Fitgerald

That’s true when it comes to health care. And not always for the better.

Just look at Michael Jackson . Jackson was rich…and because of it he received inappropriate care that ultimately killed him.

We’re now learning the pop star received daily doses of Demerol from his personal live-in doctor. Family members say yesterday that doctor “injected too much” and Jackson collapsed. (The LAPD is now on a manhunt for that doctor as I write.)

Everything about the pop star’s treatment was wrong and unethical. The mutilating plastic surgeries, the refusal to confront his apparent pedophilia, the overprescribing for “stress” and other ailments.

It’s fair to say that Jackson’s “medical” care helped kill him. All because fawning, parasitic physicians were willing to give the unbalanced star any treatment he desired.

I once knew a famous transplant surgeon who treated former Senator Hubert Humphrey and other national celebrities. He always claimed “Celebrities get the worst medical care of all.” His argument was that fearful doctors treated celebrities “by committee.” The problem was (like Aesop’s fox with too many plans of escape) the docs wasted precious time nervously debating the best course of treatment while the patient just continued to deteriorate.

I know. This is the exception. Rich people live longer and a main reason they do is because they have access to better health care. The rich are “different” there as well.

Just look at Steve Jobs. He effectively bought his liver transplant. The national transplant registry encourages patients to get on transplant lists in as many regions of the country as possible. But that’s just not practical for most of us: insurers will only pay for the extensive pre-transplant work-up at a single hospital. So in reality most hopeful recipients are on a single waiting list in the region where they live.

Not Steve Jobs. He spent the money for work-ups at hospitals nationwide and ultimately got a transplant at Methodist University Hospital in Memphis. This loophole for the rich is typical, perfectly legal…and totally unethical.

Which reminds me of Ernest Hemingway’s rejoinder to Fitzgerald’s observation about the rich. “Yes,” said Hemingway, “They have more money.” And as Mark Twain said, “When it comes to money, more is better.”

Unless you’re Michael Jackson. Then you get the worst health care of all.