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.