Skip to comments.Coming: A Two-Tiered Health Care System
Posted on 05/25/2013 7:55:06 AM PDT by Kaslin
I believe we are moving toward two different health systems. Which tier do you think you will be in?
In one system, patients will be able to see doctors promptly. They will talk to physicians by phone and email. They will have no difficulty scheduling needed surgery. If they have to go into a hospital, a "hospitalist" (who reports to them and not to the hospital administration) will be there to make sure their interests are looked after. They may even have an independent agency that reviews their medical records, goes with them when they meet with specialists and gives them advice on every aspect of their care.
In the other system, waiting times will grow for almost everything ? to get appointments with physicians, to get tests, to obtain elective surgery, etc. Patients may find that they don't have access to the best doctors or the best hospitals. They may find that the facility where they are treated does not have the latest technology. In terms of waiting times and bureaucratic hassles, health care for these patients may come to resemble the Canadian system. It may become even worse than the Canadian system.
The evolution toward a two-tiered system was already under way before Barack Obama became president. But ironically, the Affordable Care Act (Obamacare) is accelerating the pace of change. It is doing so in four ways.
First, Obamacare is supposed to insure 32 million additional people by this time next year. If the economic studies are correct, these newly insured will try to consume twice as much medical care as they have been. In addition, most of the rest of us will be forced to have more generous coverage than we previously had. There will be a long list of preventive services that all plans will be required to cover ? with no deductible and no copayment ? and commercial insurance will be required to cover a great many services previously avoided (including, everyone must know by now, contraception). These two changes alone will boost the demand for care considerably.
On the supply side, there is really no provision under Obamacare to create more doctors. In fact, the supply of doctor services is likely to decrease because of two more features of health reform. Doctors, who are already weary from third-party interference in the practice of medicine, will step up their retirement dates as they contemplate the prospects of even more bureaucracy. Also, hospitals are acquiring doctors as employees at a rapid rate. Indeed, more than half of all doctors are now working for hospitals. When doctors quit their private practices and start working for hospitals, they reduce the number of hours they work. (Forty hour work weeks and golf on the weekends replaces 50 and 60 hour work weeks.) Since they have a guaranteed income, they also become less productive.
These four changes add up to one big problem: we are about to see a huge increase in the demand for care and a major decrease in the supply. In any other market, that would cause prices to soar. But government plans to control costs (even more so than in the past) by vigorously suppressing provider fees and the private insurers are likely to resist fee increases as well. That means we are going to have a rationing problem. Just as in Canada or Britain, we are going to experience rationing by waiting.
Consider how much waiting there already is in the U.S. health care system. On the average, patients must wait three weeks to see a new doctor. In Boston, where we are told they have universal coverage, the average wait time is two months to see a new family doctor. Amazingly, one in five patients who enters a hospital emergency room leaves without ever seeing a doctor ? presumably because they get tired of waiting.
All this is about to get worse. Waiting times are going to be especially lengthy for anyone in a health insurance plan that pays providers below-market fees. The elderly and the disabled on Medicare, low income families on Medicaid, and (if the Massachusetts precedent is followed) people who acquire health insurance in the new health insurance exchanges will find they are financially less desirable to providers than other patients. That means they will be pushed to the end of the waiting lines.
Those who can afford to will find a way to get to the head of the line. For a little less than $2,000 a year, for example, seniors on Medicare can contract with a concierge doctor. These doctors promise prompt access to care and usually talk with their patients by telephone and email. They serve as an advocate for their patients, in much the same way as an attorney is an advocate for his client.
But every time a doctor becomes a concierge doctor, he (or she) leaves an old practice serving about 2,500 patients and takes only about 500 patients into the concierge practice. (More attention means fewer patients.) That means about 2,000 patients now must find a new physician.
Because the two tiers of health care will compete with each other for resources, the growth of the first tier will make rationing by waiting even more pronounced in the second tier. As a result, waiting times in the second tier could easily exceed those in Canada.
I also believe all this is going to happen much more rapidly than anybody suspects.
It’s the communist way, comrade
the party elite never had to wait in line or suffer without medication
just wait until someone over 70 tries to get some IRS clerk to approve hip replacement or chemo, especially if their personal records are flagged with any conservative affiliation
1. Wait in line, wait several months, wait for the bureaucrats to decide your fate, crappy, one size fits all, costly and very wasteful, government run, taxpayer paid service care.
2. Out of pocket service care that only the rich can afford. If you really need that surgery, then pay up!
Logically, the author’s projections make sense, and would be the normal economic response. However, we in the US have a hangup with this thing called “fairness.” It wouldn’t surprise me to see legislation forbidding this type of behavior, because it “unfairly” advantages people who have more money.
How could such legislation proceed? I’m not sure—but one way would be to forbid doctors accepting insurance payments from having any sort of side contract for additional service.
Of course, people of means will eventually find a way to pay for better service. There are already the beginnings of medical tourism for elective surgery. My crystal ball says that offshore medical clinic ships will become a reality. Medical care on those ships will be like gambling on a cruise ship, where the slots are turned on and the wheel starts to spin once the boat is 12 miles offshore.
They will outlaw tier 2.
For those who remember the old Soviet Union, it was a grim place at least for average citizens. But not so for those in government. Contrary to the official ideals of equality and a classless society that the ruling communist regime espoused, the USSR created a privileged class of party members inside government the nomenklatura.
This semipermanent bureaucracy earned higher incomes, got better health care, ate better food and had greater job security than average Russians, the much-despised proletarians. Today, our bloated government seems, in significant ways, to be creating this same dynamic.
I will, of course, be on the lower tier, but that doesn’t mean my doctor won’t call me. He loves to talk over the phone. He’s never met my wife, but they can talk for an hour when he calls. I haven’t given him my email or cell phone number.
That thought out of the way, the leftnuts wanted Obamacare because they thought it would mean free healthcare for everyone, no more discrimination between rich and poor, and all that crap. When everyone discovers they are paying more, a lot more, and getting less at twice the hassle, people are going to want something else. The rich will still have quality healthcare, but the poor will be reduced to lab rats being tortured by bureaucrats.
“These doctors promise prompt access to care and usually talk with their patients by telephone and email. They serve as an advocate for their patients, in much the same way as an attorney is an advocate for his client.”
Unfortunately, those doctors will be on the obamacare hit list and not be able to have hospital privileges.(The you will assimilate clause)
No One Knew Anything; Sound Familiar??
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The common riff-raff like you and I will be screwed.
Eventually to be outlawed for the proles, only the politburo elite will be allowed.
Leave for medical care and IRS will confiscate all your accessible wealth, inaccessible wealth now makes you a criminal.
You can leave but you can never check out.
Medical tourism will become a big business.
I foresee a rise is out of country vacations for surgeries.
Actually, I believe the GOP-controlled House of Representatives has on multiple occasions voted to repeal OdumboCare. Reid and the dems just sit on it in the Senate and, of course, even if the Senate did pass the repeal, the Won would just veto it.
Work on getting good conservatives elected to the Senate next year; donate if there are not races in your state. I think that the scandals currently erupting in Washington, combined with what I expect will be near-universal revulsion with what OdumboCare is going to do to our health care system and health insurance premiums, could easily lead to a electoral tsunami in November 2014. It's even conceivable (though not likely) that we, the good guys, could have an almost veto-proof majority.
Unless, of course, the eGOP once more snatches defeat from the jaws of victory.
Just two tiers? I don’t think so... Many tiers... With healthcare for the poor being at the bottom, the subsidized middle class in the middle, and those able and willing to pay the most being at higher tiers.
It amuses me when otherwise conservative people think that “equality” can and should be mandated for some services that we pay for and consume, while other goods and services should have their prices set by the market. Government intervention strikes again by “we the people” and the puppet masters we elect...
“Sorry sir, but our records indicate that you are a conservative and own a firearm, therefore your daughter is not covered under the current healthcare system. So I regret to inform you that she cannot have the needed medical care she requires and will no doubt expire sometime later today.”
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