The Population Health Blog's travels have included San Francisco. That's where it got to learn about the "Google Bus" imbroglio.  As the PHB understands it, some Silicon Valley companies have arranged for private buses to transport their high-wage techies to and from work.  Long-term city locals, upset at the rising rents of gentrification, see the luxury buses as emblematic of an upstart class of professionals who are "too good" to take public transportation.

"Welcome to the future of health care!" says the PHB.

As public financing with private insurance subsidies (Obamacare) and government insurance (Medicare and Medicaid) expand, public budgets will sooner or later be insufficient to support their good intentions.  Examples outside of healthcare include education (Chicago), national defense (Pentagon) and infrastructure maintenance (bridges).

While it's no expert on public transportation, it believes the system has been generally starved for funds. Unable to adapt to shifting demand with new routes and new buses, the private sector in San Francisco has stepped up with its own solution.

The same could happen with health care.  While we are headed toward a future where everyone has health insurance, similar underfunding (leading to catastrophes like this) could lead to significant service shortfalls.  Persons - with access to the money it takes to pay their own way - will cut their own deals with private-pay providers and high end hospitals.

They'll ride in luxury and the rest of us will resent it.

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