reason.com - the coming two-tiered system

[crock1255]

---

Members don't see this ad.

Interesting read on what the author believes will be the future of medicine.

http://reason.com/archives/2013/05/06/the-depressing-future-of-american-health

What do you guys think?

 

[John Lannister]

Interesting read on what the author believes will be the future of medicine.

http://reason.com/archives/2013/05/06/the-depressing-future-of-american-health

What do you guys think?

This is a laughable statement:

If Canada’s experience serves as any guide, one can expect the one-tiered system in the U.S.—where anyone, regardless of socioeconomic status gets the same quality health care by the same physicians in the same hospitals with the same promptness—will slowly evolve into a two-tiered system, whereby those who can afford it will get state-of-the-art, prompt, courteous, consumer driven health care, while everyone else waits on line.

Does anyone really believe that everyone in the U.S., regardless of socioeconomic status, gets the same quality of care? Not even close to true.

 

[Textbookversion]

Interesting read on what the author believes will be the future of medicine.

http://reason.com/archives/2013/05/06/the-depressing-future-of-american-health

What do you guys think?

I think the republican party, and the "intellectual" atmosphere around it has gone so far off the reservation it is laughable.

This healthcare reform bill was a conservative idea, and it's a conservative solution. What we need is an actual socialist plan to be implemented.

 

[notbobtrustme]

This is a laughable statement:



Does anyone really believe that everyone in the U.S., regardless of socioeconomic status, gets the same quality of care? Not even close to true.

all those people who don't have insurance don't count because they are poor and/or brown.

 

[Wilf]

all those people who don't have insurance don't count because they are poor and/or brown.

Liberals...

 

[John Lannister]

Liberals...

Facts...

 

[Wilf]

What does that have to do with your ridiculous statement that I quoted? And did you read the criticism section at the bottom of that wiki page or did you conveniently not notice it?

 

[Dave89]

I think the republican party, and the "intellectual" atmosphere around it has gone so far off the reservation it is laughable.

This healthcare reform bill was a conservative idea, and it's a conservative solution. What we need is an actual socialist plan to be implemented.

How is this relevant to the discusison?

What does that have to do with your ridiculous statement that I quoted? And did you read the criticism section at the bottom of that wiki page or did you conveniently not notice it?

I guess John Lannister eagerly laps up whatever the latest politically-skewed "research" propaganda is fed to him.

 

[calvnandhobbs68]

How is this relevant to the discusison?



I guess John Lannister eagerly laps up whatever the latest politically-skewed "research" propaganda is fed to him.

And how is that last statement relevant to the discussion either? Care to elaborate on "research propaganda"?

You either believe that there is already a "one-tiered" system in the US (which is hilariously untrue) or you don't.

 

[Dave89]

And how is that last statement relevant to the discussion either? Care to elaborate on "research propaganda"?

I'm not going to take the time at the moment to debunk all the WHO "findings" but I'll throw out 2 things for you to look up

1) They count healthcare "equality" or some such nonsense as a factor that goes into the ranking.

2) Look up the different definitions of what's considered live birth, and how this varies by country.

You either believe that there is already a "one-tiered" system in the US (which is hilariously untrue) or you don't.

Um, no, I was referring to Textbook's comment on Republicans, PPACA, how it's conservative, and socialist health care.

 

[Textbookversion]

I'm not going to take the time at the moment to debunk all the WHO "findings" but I'll throw out 2 things for you to look up

1) They count healthcare "equality" or some such nonsense as a factor that goes into the ranking.

2) Look up the different definitions of what's considered live birth, and how this varies by country.



Um, no, I was referring to Textbook's comment on Republicans, PPACA, how it's conservative, and socialist health care.

Look at the website, look at their political ideology, look at what they are advocating, then look at my comment.

 

[GUH]

all those people who don't have insurance don't count because they are poor and/or brown.

Yeah and under PPACA there will still be a lot of poor and/or brown people without insurance.

 

[Dave89]

Look at the website, look at their political ideology, look at what they are advocating, then look at my comment.

I know what Reason is. In a sense, the writer is correct, and it's a rather ominous trend for MDs. Midlevels are going to make significant inroads into primary care, and MDs will need to drastically drop prices to compete.

 

[Textbookversion]

I know what Reason is. In a sense, the writer is correct, and it's a rather ominous trend for MDs. Midlevels are going to make significant inroads into primary care, and MDs will need to drastically drop prices to compete.

No. Wrong.

 

[Dave89]

No. Wrong.

I guess you could argue that if midlevels' care is bad enough, patients will pay more for services from doctors. This depends on whether midlevel training improves commensurate with their increased responsibility. But in any event there will likely be multiple tiers of care.

 

[Textbookversion]

I guess you could argue that if midlevels' care is bad enough, patients will pay more for services from doctors. This depends on whether midlevel training improves commensurate with their increased responsibility. But in any event there will likely be multiple tiers of care.

Most midlevels don't want to work in primary care, very few of them go into it. Most PA's head to EM, surg, other sub specialties. The demand for primary care continues to rise, and the number of docs isn't rising to meet it, nor is the number of midlevels. You are so off base it's pointless to talk to you. You are absolutely clueless about what is going on.

 

[Dave89]

Most midlevels don't want to work in primary care, very few of them go into it. Most PA's head to EM, surg, other sub specialties. The demand for primary care continues to rise, and the number of docs isn't rising to meet it, nor is the number of midlevels. You are so off base it's pointless to talk to you. You are absolutely clueless about what is going on.

Well, I'm sure you know far more than the dean of admissions of my school, who told me exactly the same thing last week. 🙄

 

[John Lannister]

Well, I'm sure you know far more than the dean of admissions of my school, who told me exactly the same thing last week. 🙄

Very good chance he does.

People stuck in academics for 40 years can have no idea what's going on in the real world.

Oh and to the WHO comment, sorry - I didn't realize they are a sham organization. Thanks for informing me. Of course the United States has a one tier system, where a person who makes $14,000 per year has the same access to health care as Bill Gates. That's exactly what's going on right now.

I also know a lot of PAs. They want to make money like the rest of the med students. Hmm, get 50% raise and a "cooler" job or do primary care.

 

[Dave89]

Very good chance he does.

People stuck in academics for 40 years can have no idea what's going on in the real world.

Oh and to the WHO comment, sorry - I didn't realize they are a sham organization. Thanks for informing me. Of course the United States has a one tier system, where a person who makes $14,000 per year has the same access to health care as Bill Gates. That's exactly what's going on right now.

I also know a lot of PAs. They want to make money like the rest of the med students. Hmm, get 50% raise and a "cooler" job or do primary care.

The dean is a practicing IM attending.

 

[Textbookversion]

The dean is a practicing IM attending.

and s/he's clearly clueless, hardly unprecedented

 

[Dave89]

and s/he's clearly clueless, hardly unprecedented

Ah, so a practicing IM attending, who is charged with selecting a crop of future physicians (and as such might want to have some tiny clue of what's in store for them) is, presumably like me on this matter, "so off base it's pointless to talk to [him]. [He is] absolutely clueless about what is going on."

Thanks for playing, champ! 👎

 

[Textbookversion]

Ah, so a practicing IM attending, who is charged with selecting a crop of future physicians (and as such might want to have some tiny clue of what's in store for them) is, presumably like me on this matter, "so off base it's pointless to talk to [him]. [He is] absolutely clueless about what is going on."

Thanks for playing, champ! 👎

Yes? I don't see why you find this surprising. Most physicians are economically illiterate, and that doesn't discriminate on the basis of professional position. Being an expert in medicine != knowing anything about healthcare economics.

You wouldn't expect Greg Mankiw to know anything about treating a heart failure patient, I don't know why anyone expects a dean of a medical school to understand healthcare economics.

 

[John Lannister]

Ah, so a practicing IM attending, who is charged with selecting a crop of future physicians (and as such might want to have some tiny clue of what's in store for them) is, presumably like me on this matter, "so off base it's pointless to talk to [him]. [He is] absolutely clueless about what is going on."

Thanks for playing, champ! 👎

A guy who gets paid $500,000 to hobnob with donors and make speeches knows little about what's happening in small town America?

Yeah, I think that's true.

Anyone will tell you the problem with primary care is not having doctors in the rural areas (there's plenty in major cities). People in academics are usually more in tune with research, school politics, school vision (I'm sorry, but anyone who says their school vision is primary care is selling you a story - FM had the lowest US senior match rate around 44% US seniors - that number is dropping also. So if it's their mission, they are failing). Look @ your own school match list and see how many went into FM. IM isn't really primary care because many of those US seniors will go on to fellowships.

Being a dean @ a school has absolutely nothing to do with healthcare policy or allocation of services. That's like saying the CEO of Apple knows how to improve technology disparities in the lower socioeconomic areas.

 

[Dave89]

Just gonna leave this here. I think KevinMD is considered a more conservative site, so you can pick your poison from the links:

Midlevel Providers Fill Primary Care Doctors' Shoes

Primary care doctors at a competitive disadvantage to midlevels

Nurses, other 'mid-level' providers: Future of primary care already here in South LA

 

[John Lannister]

Just gonna leave this here. I think KevinMD is considered a more conservative site, so you can pick your poison from the links:

Midlevel Providers Fill Primary Care Doctors' Shoes

Primary care doctors at a competitive disadvantage to midlevels

Nurses, other 'mid-level' providers: Future of primary care already here in South LA

What happened to the one tier system argument? Did we win that one?

I don't mind the argument that midlevels will take over primary care. As soon as they get equal practice rights, they will earn more and then fill those roles. That's just legislation away from happening.

 

[Dave89]

What happened to the one tier system argument? Did we win that one?

I'm not saying we have a one-tier system now. But in the future the tiers will be increasingly divided into MDs/DOs vs midlevels.

 

[IlDestriero]

This is a laughable statement:



Does anyone really believe that everyone in the U.S., regardless of socioeconomic status, gets the same quality of care? Not even close to true.

Well, when they go, they see the same physicians, go on the same patient schedule, have the same operations and procedures in the same hospitals if they're Medicaid or super premium private insurance. If they don't go to the doctor at all, that's a different problem.
Soon, change will come. I expect a 2 tier system as well. The top ~5% have a lot of money, and they'll spend it on their health.

 

[notbobtrustme]

I'm not saying we have a one-tier system now. But in the future the tiers will be increasingly divided into MDs/DOs vs midlevels.

Well, when they go, they see the same physicians, go on the same patient schedule, have the same operations and procedures in the same hospitals if they're Medicaid or super premium private insurance. If they don't go to the doctor at all, that's a different problem.
Soon, change will come. I expect a 2 tier system as well. The top ~5% have a lot of money, and they'll spend it on their health.

This was already happening regardless of any healthcare reform. It's not like this trend just popped into existence in 2010 when the ACA was signed into law. We are seeing the results of a 20 year process.

 

[calvnandhobbs68]

Well, when they go, they see the same physicians, go on the same patient schedule, have the same operations and procedures in the same hospitals if they're Medicaid or super premium private insurance. If they don't go to the doctor at all, that's a different problem.
Soon, change will come. I expect a 2 tier system as well. The top ~5% have a lot of money, and they'll spend it on their health.

Uh unless of course their doctor/hospital doesn't accept Medicaid patients. Kind of forgetting that small detail.

 

[tco]

Does anyone really believe that everyone in the U.S., regardless of socioeconomic status, gets the same quality of care? Not even close to true.

It's too bad that we threw out that psych patient a couple of months ago that had no insurance/job and couldn't afford to pay her way through treatment.

Oh, no, wait...She stayed 63 days...

 

[notbobtrustme]

It's too bad that we threw out that psych patient a couple of months ago that had no insurance/job and couldn't afford to pay her way through treatment.

Oh, no, wait...She stayed 63 days...

anecdote =/= data

 

[Textbookversion]

anecdote =/= data

the data was already linked in this thread princess

 

[John Lannister]

It's too bad that we threw out that psych patient a couple of months ago that had no insurance/job and couldn't afford to pay her way through treatment.

Oh, no, wait...She stayed 63 days...

Wow, that means 100% of people in America get the same health care.

Oh, no, wait... no it doesn't.

You should offer your experience in a new piece of health care legislation. It would move mountains to show the equality in our nation. Keep fighting the good fight.

 

[John Lannister]

Well, when they go, they see the same physicians, go on the same patient schedule, have the same operations and procedures in the same hospitals if they're Medicaid or super premium private insurance. If they don't go to the doctor at all, that's a different problem.
Soon, change will come. I expect a 2 tier system as well. The top ~5% have a lot of money, and they'll spend it on their health.

So is your argument that a multi-millionaire has the same health care access as someone earning $14,000 per year at Walmart with no health insurance?

Btw, I know people who don't qualify for medicaid but can't afford health insurance.

If you don't qualify for medicaid, how do you pay ~$20,000 or so for a family of four?

http://www.jsonline.com/business/he...y-of-four-to-top-20000-d95e6f2-151550145.html
Health care costs are projected to reach $20728 this year for a family of four

We even rate or grade states with the ability for people to access healthcare. In a one-tier system, there would be no need to rate access.

 

[GUH]

So is your argument that a multi-millionaire has the same health care access as someone earning $14,000 per year at Walmart with no health insurance?

Btw, I know people who don't qualify for medicaid but can't afford health insurance.

If you don't qualify for medicaid, how do you pay ~$20,000 or so for a family of four?

We even rate or grade states with the ability for people to access healthcare. In a one-tier system, there would be no need to rate access.

The huge cost of the PPACA for individuals and families is going to force it to collapse in on itself. There is nothing "affordable" about it. A family of four that does not qualify for medicare or the premium subsidy will simply not be able pay $20,000+ for insurance. They will be forced to pay the tax penalty.
Healthy young single men will have it the worst since we're going to have to subsidize everyone else. If I wasn't required by medical school to have insurance, I would drop out of the whole scheme at 26 in a heartbeat.

And if you think you can improve everyone's care by converting to a single-payer system, you're wrong. Canada and the UK both have two-tiered systems as well.

 

[calvnandhobbs68]

The huge cost of the PPACA for individuals and families is going to force it to collapse in on itself. There is nothing "affordable" about it. A family of four that does not qualify for medicare or the premium subsidy will simply not be able pay $20,000+ for insurance. They will be forced to pay the tax penalty.
Healthy young single men will have it the worst since we're going to have to subsidize everyone else. If I wasn't required by medical school to have insurance, I would drop out of the whole scheme at 26 in a heartbeat.

And if you think you can improve everyone's care by converting to a single-payer system, you're wrong. Canada and the UK both have two-tiered systems as well.

Nobody mentioned the PPACA and the article wasn't even about the PPACA. Nice totally random comment.

The point being made in opposition to the article is that we already have a multiple-tiered health care system so it really isn't an argument to say that healthcare in the US is going to become two-tiered.

Edit: I should say that the article doesn't really have anything to do with the points you bring up although it does mention the PPACA. John Lannister's point was also not arguing that the PPACA was suddenly going to drop the price of insurance in that post, so you're basically arguing against nothing.

 

[GUH]

Nobody mentioned the PPACA and the article wasn't even about the PPACA. Nice totally random comment.

The point being made in opposition to the article is that we already have a multiple-tiered health care system so it really isn't an argument to say that healthcare in the US is going to become two-tiered.

yeah I misinterpreted the post I was responding to. My bad

 

[Geebeejay]

If medical care ever moves toward this nonsense "two-tiered system" separated by god-knows what criteria, it will be from this >2 multi-tiered system we have now. Medical care will never be equal regardless of socioeconomic status, and to think so would be laughable if it wasn't so disheartening that intelligent people actually believe this and try to base health care legislation and policy on this naive ideal...

 

[siliso]

If Canada’s experience serves as any guide, one can expect the one-tiered system in the U.S.—where anyone, regardless of socioeconomic status gets the same quality health care by the same physicians in the same hospitals with the same promptness—will slowly evolve into a two-tiered system, whereby those who can afford it will get state-of-the-art, prompt, courteous, consumer driven health care, while everyone else waits on line.

I want to know what US this author is living in. One-percentville? 😕.