Two Tiered Health Care System Will Evolve In The United States

Over the next decade I believe we are going to see a major transformation of American medicine.

It won’t be the kind of transformation that is normally discussed at health care conferences and at inside-the-Beltway briefings. Nor will it be the kind of change anticipated by the people who gave us the Affordable Care Act (ObamaCare).

Instead, what I envision is a large migration of patients and doctors, and facilities and services out of the third-party payer system.

That means a major increase in concierge doctors, concierge facilities and concierge-type services. More generally, it means the creation of new markets where providers are free to repackage and reprice their services without third-party payer approval; where transparency of price and quality becomes the norm for patients; and where suppliers of services compete for patients on price, quality and amenities. The single most important cause of this transformation will be the Affordable Care Act (ACA).

That is especially ironic in four ways.

First, the most important purpose of the act was to bring millions of people into the health insurance system, not to push millions of people (at least partially) out of it.

A second purpose of the ACA was to change the way medicine is practiced — using electronic medical records, financial incentives and regulatory powers to goad providers into providing lower cost, higher quality, more transparent care. Yet all of these goals will be achieved more quickly, more completely and more effectively outside the system.

A third goal of the ACA was to create a more egalitarian system in which all have access to the same care. Yet the world we are about to enter will be the exact opposite — a two-tiered system in which access to the best doctors and the best facilities will depend very much on your ability to pay.

A fourth goal of the ACA was to create universal access to care. Yet our more vulnerable populations — the poor, the disabled and the elderly — are likely to have less access to care under the new reforms than they have today.

John Goodman President and CEO Kellye Wright Fellow National Center for Policy Analysis ,12770 Coit Rd., Suite 800 Dallas, Texas 75251

Editor’s Note: This article is “right on.” We are already beginning to see some of our clients transitioning away from the third party payer system – a system whereby an employee can see a primary care doctor within 24 hours, with little or no waiting time, guaranteed quick referrals to specialists with little or no waiting time, and quick and easy access to selected health care facilities at little or no cost to the patient – quality medical care through a select grouping of medical care providers.