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Two-Tiered U.S. Healthcare System Looming

Philip Betbeze, for HealthLeaders Media, October 21, 2011

I've been hosting more than my fair share of "roundtable" style discussions among healthcare leaders lately. I like doing it. The discussions in these groups are meant for dissemination. The participants know this, yet are often remarkably candid about the challenges they face as healthcare gets turned upside down in the general upheaval we call healthcare reform.

Though these leaders are generally frustrated with the details, it's interesting that none would argue that upheaval isn't necessary. For many, it's the way change is happening that represents the problem. And it's an access problem.

In quiet moments during breaks at the roundtable events, and sometimes during the discussions, executives will cautiously bring up a controversial opinion. Usually they'll make a remark in passing, poking me to follow up on the trend or theory. Sometimes I do; sometimes I don't.

Lately, I've been hearing whispered opinions that basically go like this: Enactment of the Patient Protection and Affordable Care Act started a metaphorical snowball rolling downhill toward a two-tiered health system. 

Essentially, the argument goes, increased access to healthcare that comes along with PPACA, coupled with the government's miserable payer record (in terms of cost of care, not promptness), practically guarantees a healthcare system in which the publicly subsidized insurance theoretically covers all, but to such a pitiful degree that a massive industry in the secondary healthcare market is enabled. Perhaps not even the politicians who crafted it could have seen coming.

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7 comments on "Two-Tiered U.S. Healthcare System Looming"


Anna Cox (10/25/2011 at 3:25 PM)
"...worse doctors, and poorer quality institutions..." What a biased and poorly informed statement. I've spent most of my career as a NP working in community outpatient clinics, providing care to those without insurance, or with public health insurance. No, this is not a recipe for getting wealthy, but to suggest that the providers who work to care for these patients are incompetent and offer poor quality care, is beyond the pale. You owe the hard-working men and women of community care a big apology.

Phyllis Kritek (10/25/2011 at 12:05 PM)
I am one of the persons arguing that we have a two-tiered system now, perhaps even more than two tiers. There are hundreds of studies that document that fact, particularly those that address inequity in health care services for the indigent and for some minority populations. It is disingenuous to posit otherwise. And equally disingenuous to posit that the PPACA is going to suddenly introduce inequity in care. Health care in the US has for some time now been better for you as a patient if you are wealthy and meet an array of other less overt criteria. PPACA may simply make that fact more transparent.

Tyco Brahe (10/24/2011 at 1:47 PM)
Of course we already have a two-tiered system: Those who have insurance and those who don't. The free market will never give us an answer as economists all agree that healthcare does not follow free market principles[INVALID]everyone will have to use healthcare sometime. There is no choice. Even Adam Smith, the father of the free market, believed that healthcare may be better served by the government. America will have to do what the rest of the developed world has already done: Universal healthcare, most effectively with a Medicare-for-all single payer system. Any other system just delays the inevitable.