Future of Healthcare, Two Tiers

This country has a major problem which is bankrupting government at all levels and is making our corporations uncompetitive. There is no solution in sight and nobody is talking about the choices that will need to be made to address the problem. The issue is health care and how we provide and finance medical services to the citizens of this country.

The Obama administration in its attempt at health care reform only exacerbated the problem. They have increased the number of people eligible for government care without addressing the cost factor (the so called bending of the curve). It seems to me that eventually we will end up with a specific system which is inevitable. It will take time to get there in this country because government by its nature is a slow process. Other countries have arrived at this healthcare model and it involves a basic medical plan for everybody covered by the government, the medicare for all plan. This care is likely to be low paying to the doctor, involves wait times for specialty care, surgery and testing. The doctor will have to work in a low overhead environment to make a profit which means less office staff and a less attractive office, ie. a clinic setting. This will be a downgrade for many people’s care that they now receive but is crucial if costs are to be contained.

If an individual wants to be seen immediately or have his/her test or surgery done immediately then they have the choice of seeing the doctor outside the government system at his private office. This office will be in a nicer setting with short wait times and more staff. The individual can pay out of his/her pocket for this private care or may carry an insurance policy covering private care. The doctor will have two offices. One for his private patients and one for the clinic patients. He will see the clinic patients during limited hours during the day only. The private patients can be seen in the other nicer office with expanded office hours (nights and weekends) for their convenience. Two tiers of care, the public one desired by the left and the private one desired by the right.

The problem exists now that if a doctor participates in medicare he/she is not allowed to charge any more than medicare fees, in essence eliminating the option of a service being provided outside the medicare fee schedule. Even if the doctor does not participate with medicare he/she can only charge 3% over medicare fees. So if the patient cannot opt for private care he is stuck in the slow government system. It is critical this be changed to allow patients the choice to be seen privately at their discretion. This will be demanded by the public as fees to doctors decrease resulting in more doctors not being willing to accept medicare patients, limiting access to the doctor in the public system. They will demand the option of being able to see the doctor by paying out of their pocket.

The other critical ingredient to this system is malpractice reform. A doctor will not see patients only to be able to afford his/her malpractice insurance and pay off the lawyers before he works for pennies.

A doctor must be allowed to work in both the public and private system simultaneously and not have to choose one or the other (currently not possible). The patient will have the choice of where and when to be seen.

This satisfies the right and left with private and public options. It accomplishes universal coverage. Cost will be contained by government limiting benefit packages and compensation. The only argument will be that it is unfair that the rich can afford the top tier of care and the poor cannot. There is no acceptable answer other than eliminating the private option completely or giving everybody top tier care are nonstarters.

This is the future of medicine in America, can we just get there already.