By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    health benefits of taking a vacation to reduce stress
    Relaxing European Destinations to Reduce Stress Risks to Health
    October 11, 2021
    pain management tips
    Managing Pain Differently: Alternative Pain Management Techniques
    January 12, 2022
    5 Ways to Promote Wellness in Your Home
    April 12, 2022
    Latest News
    First Aid Training Enhancing Workplace Health and Safety
    September 25, 2023
    Beyond the Clinic: Medical Surveys Are a Roadmap to Passive Income for Doctors
    September 23, 2023
    5 Self-Care Habits to Help You Live an A+ Life
    September 21, 2023
    Keep Employees Safe & Healthy By Reducing Warehouse Injuries
    September 20, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    What the Election Means for Health Care
    November 9, 2012
    public private partnerships
    Strengthening Global Healthcare Systems Through Public-Private Partnerships
    April 8, 2015
    jeopardy clue tile
    Jeopardy: “I’ll Take Medical Errors For $100,000, Alex!”
    December 25, 2012
    Latest News
    Job Seekers with Disabilities Should at Health Insurance Benefits
    September 12, 2023
    Reasons That Drug Prices Are Rising to Unsustainable Levels
    September 12, 2023
    How Revenue Lifecycle Management Helps Healthcare Providers to Optimize Business Operations
    September 6, 2023
    The Hidden Benefits of Practice Exams for Medical Professionals
    September 6, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Coming: A Two-Tiered Health Care System
Share
Sign In
Notification Show More
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Coming: A Two-Tiered Health Care System
Health ReformPolicy & LawPublic Health

Coming: A Two-Tiered Health Care System

JohnCGoodman
Last updated: 2013/05/31 at 8:11 AM
JohnCGoodman
Share
7 Min Read
obamacare
SHARE

I believe we are moving toward two different health systems.

I believe we are moving toward two different health systems.

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.

obamacareIn 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.

More Read

trust ligitation end of life

Understanding Trust Litigation When Dealing with Health Issues

The Journey to Healing: Navigating the Aftermath of Wrongful Death Claims 
Navigating Immigrant Police Encounters When Getting Healthcare
How Personal Injury Law Supports Your Wellbeing
7 Tips for Improving Reproducibility and Efficiency in the Lab

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.

(ACA: longer waits? / shutterstock)

TAGGED: ACA, obamacare

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
JohnCGoodman May 31, 2013
Share This Article
Facebook Twitter Copy Link Print
Share
Previous Article allergies and GMO GMO Part 3: Allergies
Next Article Communication and Engagement Helped Minn. Hospitals Cut Avoidable Readmissions

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

workplace first aid training
First Aid Training Enhancing Workplace Health and Safety
Health September 25, 2023
Anxiety Disorder
The Importance of Nutrition in Anxiety Disorder Treatment
Anxiety September 24, 2023
spinal health
How to Advocate For Your Spinal Health In A Healthcare Setting: Strategies From Dr. Brandon Claflin
News September 24, 2023
Medical Surveys
Beyond the Clinic: Medical Surveys Are a Roadmap to Passive Income for Doctors
Health September 23, 2023

You Might also Like

health insurance disability
Policy & Law

Job Seekers with Disabilities Should at Health Insurance Benefits

September 12, 2023
rising drug costs
Pharmaceuticals

Reasons That Drug Prices Are Rising to Unsustainable Levels

September 8, 2023
healthcare providers
Hospital Administration

How Revenue Lifecycle Management Helps Healthcare Providers to Optimize Business Operations

September 6, 2023
Medical Professionals exams
Medicare

The Hidden Benefits of Practice Exams for Medical Professionals

September 6, 2023
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US
© 2008-2023 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Lost your password?