Are We Headed For A Two-Tier System?
Monday, June 28, 2010
Is two-tier health care inevitable as a result of the federal overhaul, with some doctors catering to the rich with concierge practices that don't accept Medicare and Medicaid patients while overwhelmed clinics are struggling to serve the less-well-off with government insurance? Is there still a role for physicians who serve all segments of the public?
June 28, 2010 11:51 AM
Two-tier health care is nothing new
By Uwe Reinhardt
James Madison Professor of Political Economy, Professor of Economics and Public Affairs
I have written and said for years that the U.S. is headed for a two- or multi-tiered health system. In fact, we have long had it, although never quite as blatantly as we have it in education and in the administration of “justice” (google, for example, Tulia, Texas).
Do we really believe that the health care experience of America’s millions of uninsured has been quite like that enjoyed by insured Americans? And is not rationing health care by price and ability to pay just as much “rationing” as is rationing by the queue?
The main driving force here is not health reform per se, but the widening income distribution in the United States, coupled with the inexorably rising health-care cost per capita. In fact, concierge medicine is hardly a new phenomenon. It started a decade ago, not at all to my surprise.
According to the Milliman Medical Index, the average cost of health care of a privately insured American family of four (excluding people over 65 years of age) is now $18,000. It ha...
I have written and said for years that the U.S. is headed for a two- or multi-tiered health system. In fact, we have long had it, although never quite as blatantly as we have it in education and in the administration of “justice” (google, for example, Tulia, Texas).
Do we really believe that the health care experience of America’s millions of uninsured has been quite like that enjoyed by insured Americans? And is not rationing health care by price and ability to pay just as much “rationing” as is rationing by the queue?
The main driving force here is not health reform per se, but the widening income distribution in the United States, coupled with the inexorably rising health-care cost per capita. In fact, concierge medicine is hardly a new phenomenon. It started a decade ago, not at all to my surprise.
According to the Milliman Medical Index, the average cost of health care of a privately insured American family of four (excluding people over 65 years of age) is now $18,000. It has been rising at an average compound rate of about 8 percent over the past decade.
The lower middle class, with family incomes below $50,000 or so, will not be able to finance traditional, high-cost health care with its own resources.
At the same time, I doubt that Americans in, say, the upper third of the income distribution will be willing to help finance with taxes for the lower middle class quite the exquisite health care the upper-middle class and the wealthy demand for themselves.
Therein lies the tension that is likely to drive us ever more to a multi-tiered health system.
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June 28, 2010 10:50 AM
Absolutely
By John C. Goodman
President and CEO, National Center for Policy Analysis, and Kellye Wright Fellow
Except it will not be a two-tier system. It will be a multi-tier system. We already ration by waiting in this country and the rationing (access to care) problems are about to get much worse. If the CBO forecast is accurate, there will be 32 million newly insured people. If the economic studies are correct, these 32 million will try to double their consumption of medical care. But since the health reform law makes no provision for any new medical personnel, access to care will be worse than ever.
My advice: try to avoid any health plan that pays doctors below market rates.