America is rapidly becoming, if you have the money and you want responsive medical care, the land of concierge doctors and nurses.

The number one hospital for orthopedic surgery, HSS, where I had my left knee replaced almost 600 days ago, boasts on huge banners all over its grounds that it has been the top hospital for orthopedics fourteen years in a row. That doesn’t mean they provide aftercare, and they don’t claim to. If you have a problem, pain, stiffness, difficulty walking, sleeping, whatever, when the x-rays show a perfect mechanical result, it’s not their problem, since the operation was 100% successful, even if you can’t walk more than a block 18 months after surgery.

They don’t claim to be the number one hospital for follow-up care, as you learn when they provide zero aftercare, can’t get you in to see their physical therapists for post-surgical evaluation and offer no solution (other than another operation, a 50/50 coinflip) to a not uncommon, foreseeable but difficult to fix chronic disability they did not help you avoid.

Corporate medicine increasingly works this way in the United States. Health care is an enormously profitable sector and vampire entrepreneurs are increasingly getting in on this lucrative growth industry. More and more doctors work for corporations that take care of all the business aspects of medical care. The bottom line is probably better for all of them and it’s easier to be a doctor in our country if you don’t have to compete with giant medical corporations that have the wealth and infrastructure to put you out of business.

The only casualty is the patient, sometimes. In the event of a good result, there’s no problem. In the event of a problem, complication, need for follow-up, corporate medicine has an answer — concierge follow up, done by telephone, billed as a regular doctor visit, sometimes 100% paid by insurance, or in the case of someone over 65, if you have purchased supplemental insurance for your 20% Medicare copay.

I had a call from my new urologist’s office the other day. These folks are hard to reach or get a return call from on a good day and I’m not optimistic about reaching anyone there if something goes wrong with my upcoming procedure. The caller, a likable guy named Tony, called to offer me a direct number to call and talk to a dedicated nurse any time after my upcoming surgical procedure.

We wound up speaking for a while and it emerged he was not affiliated, nor did he know, the medical practice he was calling from. Somehow, through corporate wizardry, his call appeared to be coming from the difficult to reach office with an offer to give me a direct after care line. Tony worked for a third party selling concierge assurance to rightfully nervous patients.

He agreed it was crazy that he couldn’t tell me the price I’d have to pay for one of these follow up calls billed as a doctor visit. He was with me when I pointed out the madness of healthcare being the only store in America where they can’t tell you the price of anything before you buy it. The standard line is that the doctor has to wait for insurance to bill them before they can tell you the price. My standard reply is to ask if I’m the first patient who ever came to them with this insurance that they take every day. Their standard reply is some kind of smile reflecting an attempt to be civil. None of these folks have any control of anything, and it’s pointless to antagonize them with questions there are no reasonable answers to. Tony and I parted as friends, our call recorded, and by midway through he was no longer trying to sell me a service he could not tell me the price of, but one I’d definitely be on the hook to pay 20% of.

America the beautiful. Exceptional. About to become even more exceptional. I’m keeping my fingers crossed it won’t become too much more exceptional. It’s already much more exceptional than is healthy for almost every American.