health care-bottom line

Okay, so let me put in my two cents reagrding health care. The bottom line is the cost to provide prompt quality care to every American is too expensive. Although I believe this would be a reasonable way to spend our national treasure, to extend the lives of the people who generate the treasure, the cost would eat up a major portion of the GDP. To avail everybody of all the technological advances and heroic treatments available would be cost prohibitive. So what is the solution to provide universal care to all Americans? By the way, guaranteeing insurance to people does not guarantee care as there may not be a doctor who accepts your insurance.
The end game has to be a two tier system as exists in other countries. A public and a private system. Everybody will obtain a package of insurance that provides basic care. That insurance may be from an insurance company or more likely from the government. Most likely it will not be profitable enough for an insurance company to participate. The availabilty of that care will be depend on reimbursements to providers. If it acceptable then people will be seen and treated promptly. However, the more likely scenario is if payment to providers is poor then as in other countries access to a doctor, obtaining tests and receiving operations will be delayed and waiting lists will be the norm. Most doctors offices, radiological facilities, hospitals, are for profit businesses. If profit is no longer possible or too low then the availability of those services will decrease. This will generate a second tier of private medicine where a person can see a doctor or get a test promptly for direct payment. This second tier is profitable to the provider/owner and will be provided promptly. There may be an insurance policy for this second tier of healthcare.
I see a system where a doctor spends some time in a public clinic seeing patients in the basic tiered insurance and then has another private office where he sees his private patients. The public clinic could be located in the hospital because the doc will not be able to or want to pay rent to see poorly reimbursable patients. The office hours will be limited and the number of patients limited resulting in waiting lists.
To avoid runaway healthcare costs and keep the expense neutral the solution is either to maintain current reimbursements and volume of patients thus rationing care as more volume comes online (more patients in the system). Alternatively, to increase the volume at lower reimbursements resulting in waiting lists (as described above) which also rations care by default. In either case care will be rationed. By including everybody, by necessity, access will be reduced. Only those that can afford it will obtain immediate access to healthcare. Universal coverage is a noble goal, but don't expect the access to care which that coverage provides to remain what it is today.