Is America Headed to Two Separate and Unequal Healthcare Systems?

Southern Dad

macrumors 68000
Original poster
May 23, 2010
1,532
547
Shady Dale, Georgia
Will concierge doctors bring about a two level medical system in the United States? I thought about this as I wrote out the annual check to my daughter’s pediatrician for membership. Is the future of medicine two levels of care? Concierge Medicine for those that can afford it and waiting rooms for those that are on subsidized plans?

There are a lot of misconceptions about concierge doctors. While most of them do not take medical insurance, you can usually submit the paid bills to your healthcare insurance company and be reimbursed at the out-of-network levels.

Concierge doctors don’t want you to be unhappy. They are in competition. There is a less expensive alternative. If you aren’t happy, you won’t continue to pay the annual retainer. These doctors know you on a personal level. It’s not an hour wait, followed by a five minute visit. Many of these will make house calls.

Are you willing to pay an annual fee to have more access to your doctor? Could this lead to a shortage of doctors taking the ACA?

Why concierge medicine will get bigger - Marketwatch

Is Concierge Medicine The Correct Choice For You? - Forbes
 

iBlazed

macrumors 68000
Feb 27, 2014
1,593
1,224
New Jersey, United States
Are you willing to pay an annual fee to have more access to your doctor? Could this lead to a shortage of doctors taking the ACA?
The ACA is not an insurance plan. There have always been people willing to pay cash for doctors that don't take insurance. Unfortunately for concierge doctors, it's a pretty small demographic. And it will continue to be small as long as the individual mandate is in place. Why would you pay a doctor when you're paying insurance premiums already anyway?
 

VulchR

macrumors 68020
Jun 8, 2009
2,329
10,249
Scotland
Socialised medicine is the way to go. Everybody gets care according to their need, not their wallet. If people pay taxes toward the socialised system, but then want to pay extra for private care then that is fine with me. However, if the rich lobby against the taxes needed to fund an adequate health care system (rather like they do for education), then that is not fine with me.

At any rate, America already has had a two-tier health care system for ages. Some were sufficiently well off to get insurance or provide for their own care, the rest lived with untreated illness and died ill.
 

Michael Goff

Suspended
Jul 5, 2012
13,262
7,298
Now there will be a two tiered instead of a three tiered. That's a step in the right direction in my book. ;)
 

Macky-Mac

macrumors 68030
May 18, 2004
2,589
1,142
we've already had two separate and unequal healthcare systems for some time.

But as for concierge doctors; sure some people who are well off will pay the extra money for the added attention and access, but this isn't something that's going to be affordable for most of the middle class. Concierge doctors will be a niche market, and while that niche will grow some, the potential market is limited.

Could this lead to a shortage of doctors taking the ACA?
No
 

Southern Dad

macrumors 68000
Original poster
May 23, 2010
1,532
547
Shady Dale, Georgia
The ACA is not an insurance plan. There have always been people willing to pay cash for doctors that don't take insurance. Unfortunately for concierge doctors, it's a pretty small demographic. And it will continue to be small as long as the individual mandate is in place. Why would you pay a doctor when you're paying insurance premiums already anyway?
You are correct, the ACA isn't a healthcare plan but it is a governance of healthcare plans. Many of which are subsidized by the government. My daughter's pediatrician is a concierge doctor. I joined the membership when I found out that 24/7, I would be able to reach him or someone from his office. A friend of mine, was a member, we are getting ready to start our third year of membership.

No. And I won't. I have health coverage. I am entitled to see my doctor as I see fit. Why would I need "more access"? What does "more access" even mean? My wait is only 5-10 minutes in the waiting room as it is...
The goal of the ACA is to increase the number of people using doctor's offices rather than emergency rooms. This could change that wait time as the doctors load increases. One thing the ACA doesn't do is increase the number of doctors.

More access, can mean house visits, 24 hour access via telephone.

----------

we've already had two separate and unequal healthcare systems for some time.

But as for concierge doctors; sure some people who are well off will pay the extra money for the added attention and access, but this isn't something that's going to be affordable for most of the middle class. Concierge doctors will be a niche market, and while that niche will grow some, the potential market is limited.

No
Why, do you think that it will be unaffordable? The ACA plans have deductibles. The Bronze Plan has a ridiculous deductible. The membership fees range from $1k to $5k. My daughter's pediatrician charges $1200. I don't have to pay anything for routine visits, sick visits or physicals. It's included in that price.
 

Happybunny

macrumors 68000
Sep 9, 2010
1,752
1,351
You are correct, the ACA isn't a healthcare plan but it is a governance of healthcare plans. Many of which are subsidized by the government. My daughter's pediatrician is a concierge doctor. I joined the membership when I found out that 24/7, I would be able to reach him or someone from his office. A friend of mine, was a member, we are getting ready to start our third year of membership.

Just a question don't you yourself have government subsidised health care?

If so what is your problem, that somebody else is getting a helping hand from the US government. :confused:
 

Southern Dad

macrumors 68000
Original poster
May 23, 2010
1,532
547
Shady Dale, Georgia
So $1,100 only for physician visits?
We can reach the doctor by Skype or phone pretty much any time. It works out. My insurance company will reimburse me at the out-of-network rate for some services. It isn't always the best choice but for some it may become a better alternative. My question is if this could lead to two different standards of healthcare in the USA? One for those willing to pay for it and one on socialized medicine (if we ever get there)
 

vrDrew

macrumors 65816
Jan 31, 2010
1,317
11,832
Midlife, Midwest
There have always been (at least) two standards of healthcare in the United States. Rich people, or at least those willing to pay more money, get access to better services and facilities.

Why this should be a cause for concern for anyone, least of all a conservative, is frankly beyond me. The ACA, despite Republican claims to the contrary, isn't some sort of plot to turn the USA into a Socialist People's Republic. So please don't act all surprised when it doesn't,
 

miloblithe

macrumors 68020
Nov 14, 2003
2,076
28
Washington, DC
I think this question is misleading because we already have far more than two separate and unequal healthcare systems based around who can afford to pay for what.

----------

The goal of the ACA is to increase the number of people using doctor's offices rather than emergency rooms.
Not exactly. That's a theory about what may happen if people have more access to healthcare. Unfortunately, that's not the result seen in the Oregon study:

http://www.nber.org/oregon/

Use of health care

Medicaid increased the likelihood of being admitted to the hospital by 30 percent, driven by hospital admissions not originating in the emergency department.
Medicaid increased the likelihood of using outpatient care by 35 percent, using prescription drugs by 15 percent, but did not seem to have an effect on use of emergency departments.


The Oregon Health Insurance Experiment is a landmark, randomized study of the effect of expanding public health insurance on the health care use, health outcomes, financial strain, and well-being of low-income adults. It represents the first use of a randomized controlled design to evaluate the impact of Medicaid in the United States. Although randomized controlled trials are the gold standard in medical and scientific studies, they are rarely possible in social policy research. In 2008, the state of Oregon drew names by lottery for its Medicaid program for low-income, uninsured adults, generating just such a randomized controlled design. This ongoing study represents a collaborative effort between researchers and the state of Oregon to use this opportunity to learn about the costs and benefits of this expansion of public health insurance.
The ACA is about increasing access to health care, improving population (and individual) health, and reducing financial risks of ill-health, not about reducing emergency room visits.
 

Macky-Mac

macrumors 68030
May 18, 2004
2,589
1,142
....

Why, do you think that it will be unaffordable? The ACA plans have deductibles. The Bronze Plan has a ridiculous deductible. The membership fees range from $1k to $5k. My daughter's pediatrician charges $1200. I don't have to pay anything for routine visits, sick visits or physicals. It's included in that price.
you've just told us about 75% Americans Living Paycheck-to-Paycheck so where do you think they're going to get the money for the additional cost.

Your daughter's pediatrician's plan, does it cover anybody in the family besides your daughter? You? Your wife? Does it pay her hospital room or just the doctor's visit? Lab costs? The cost of other doctors and specialists? Prescriptions? Or do you have to pay for those from something other than the pediatrician's plan?

And it sounds like your daughter is getting a bargain price as other concierge plans run up to $5000 or more. (My former doctor started a plan 12 years ago that cost a minimum of $6000 at the time, and typical of concierge practices it primarily provided convenient access to the doctor)

We can reach the doctor by Skype or phone pretty much any time. It works out. My insurance company will reimburse me at the out-of-network rate for some services....
So in figuring the cost for your daughter's healthcare, it isn't really just the cost of the pediatric doctor's plan. You also need to add in the cost of additional insurance.
 
Last edited:

Southern Dad

macrumors 68000
Original poster
May 23, 2010
1,532
547
Shady Dale, Georgia
you've just told us about 75% Americans Living Paycheck-to-Paycheck so where do you think they're going to get the money for the additional cost.

Your daughter's pediatrician's plan, does it cover anybody in the family besides your daughter? You? Your wife? Does it pay her hospital room or just the doctor's visit? Lab costs? The cost of other doctors and specialists? Prescriptions? Or do you have to pay for those from something other than the pediatrician's plan?

And it sounds like your daughter is getting a bargain price as other concierge plans run up to $5000 or more. (My former doctor started a plan 12 years ago that cost a minimum of $6000 at the time, and typical of concierge practices it primarily provided convenient access to the doctor)

So in figuring the cost for your daughter's healthcare, it isn't really just the cost of the pediatric doctor's plan. You also need to add in the cost of additional insurance.
If you take the ACA Bronze Plan, you have to come out of pocket for the $5k deductible and the 30% copay. If you take the Silver you've got $3k. Healthcare isn't free.
 

bradl

macrumors 601
Jun 16, 2008
4,006
11,823
If you take the ACA Bronze Plan, you have to come out of pocket for the $5k deductible and the 30% copay. If you take the Silver you've got $3k. Healthcare isn't free.
The bold is the problem. Especially, because we see how wonderful it works in other places around the world, and that people don't have to pay a bloody cent for it. The UK is doing great with theirs. Australia is as well.

We're one of the few countries that thinks that healthcare should be a business to make money off of, when without our health, we wouldn't be alive to make money at all. That is really sad.

But to answer the question in the title of the thread: I would say no, because the moment that happens, expect one healthcare system to sue the other because of segregation, citing Brown v. Board of Education as precedence. ;) :rolleyes:

BL.
 

Southern Dad

macrumors 68000
Original poster
May 23, 2010
1,532
547
Shady Dale, Georgia
The bold is the problem. Especially, because we see how wonderful it works in other places around the world, and that people don't have to pay a bloody cent for it. The UK is doing great with theirs. Australia is as well.

We're one of the few countries that thinks that healthcare should be a business to make money off of, when without our health, we wouldn't be alive to make money at all. That is really sad.

But to answer the question in the title of the thread: I would say no, because the moment that happens, expect one healthcare system to sue the other because of segregation, citing Brown v. Board of Education as precedence. ;) :rolleyes:

BL.
What are the tax rates in those countries? Does everyone pay? How is the healthcare? Canada has a wonderful plan from what I hear but Pennsylvania has more MRI machines than their whole country. Here is a side concern… In a single payer system who do the lawyers sue?
 

Macky-Mac

macrumors 68030
May 18, 2004
2,589
1,142
If you take the ACA Bronze Plan, you have to come out of pocket for the $5k deductible and the 30% copay. If you take the Silver you've got $3k. Healthcare isn't free.
yes but the ACA Bronze Plan also covers all those other costs that your child's pediatrician's concierge plan doesn't cover.

the average daily cost of a hospital stay for a child aged 1 to 17 was $8,200 in 2010.....your pediatrician's concierge plan only covers the cost of the pediatrician's visits, so you're going to be paying those deductibles and co-pays for all the rest as well.....or ALL of it if you don't also have insurance that covers it....as you say, healthcare isn't free.

The reality is that you're going to have to provide healthcare insurance coverage for your daughter anyway (even if the bulk of it is paid by your employer)
 

bradl

macrumors 601
Jun 16, 2008
4,006
11,823
What are the tax rates in those countries? Does everyone pay? How is the healthcare? Canada has a wonderful plan from what I hear but Pennsylvania has more MRI machines than their whole country. Here is a side concern… In a single payer system who do the lawyers sue?
http://en.wikipedia.org/wiki/Health_care_in_Australia

Medicare is the publicly funded universal health care scheme in Australia and was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% Medicare levy (with exceptions for low-income earners), with the balance being provided by government from general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that considerably subsidises a range of prescription medications.


Health care in Australia is universal. The federal government pays a large percentage of the cost of services in public hospitals. This percentage is calculated on:

Whether the government subsidises this service (based on the Medicare Benefits Schedule. Typically, 100% of in-hospital costs, 75% of General Practitioner and 85% of specialist services are covered.
Whether the patient is entitled to a concession or receives other benefits[10]
Whether the patient has crossed the threshold for further subsidised service (based on total health expenditure for the year)[10]

Where the government pays the large subsidy, the patient pays the remainder out of pocket, unless the provider of the service chooses to use bulk billing, charging only the scheduled fee, leaving the patient with no extra costs. In some countries, this is commonly referred to as a copayment. Where a particular service is not covered, such as dentistry, optometry, and ambulance transport,[11] the patient must pay the full amount (unless they hold a Low Income Earner card, which may entitle them to subsidised access).

Individuals can take out private health insurance to cover out-of-pocket costs, with either a plan that covers just selected services, to a full coverage plan. In practice, a person with private insurance may still be left with out-of-pocket payments, as services in private hospitals often cost more than the insurance payment.

The government encourages individuals with income above a set level to privately insure. This is done by charging these (higher income) individuals a surcharge of 1% to 1.5% of income if they do not take out private health insurance, and a means-tested rebate. This is to encourage individuals who are perceived as able to afford private insurance not to resort to the public health system.[12]

Insurance

Funding of the health system in Australia is a combination of government funding and private health insurance. Government funding is through the Medicare scheme, which subsidises out-of-hospital medical treatment and funds free universal access to hospital treatment. Medicare is funded by a 1.5% tax levy on taxpayers with incomes above a threshold amount, with an extra 1% levy on high income earners without private health insurance, and the balance being provided by the government from general revenue.[13]

Quality of care

In an international comparative study of the health care systems in six countries (Australia, Canada, Germany, New Zealand, the United Kingdom and the United States), found that "Australia ranks highest on healthy lives, scoring first or second on all of the indicators", although its overall ranking in the study was below the UK and Germany systems, tied with New Zealand's and above those of Canada and far above the U.S.[25][26]
So 1.5% tax on the people for free healthcare, and well above the US on quality of care, pre-ACA, post-ACA, or otherwise.

BL.
 

thekev

macrumors 604
Aug 5, 2010
6,667
1,738
The bold is the problem. Especially, because we see how wonderful it works in other places around the world, and that people don't have to pay a bloody cent for it. The UK is doing great with theirs. Australia is as well.

We're one of the few countries that thinks that healthcare should be a business to make money off of, when without our health, we wouldn't be alive to make money at all. That is really sad.

But to answer the question in the title of the thread: I would say no, because the moment that happens, expect one healthcare system to sue the other because of segregation, citing Brown v. Board of Education as precedence. ;) :rolleyes:

BL.
Australia's system is a bit more complex than that. They pay a fine if they don't purchase a basic level of private insurance over a certain age and make over a certain annual amount. Private insurance also cuts wait times on certain things, but it still works out better than what we have here.
 

miloblithe

macrumors 68020
Nov 14, 2003
2,076
28
Washington, DC
What are the tax rates in those countries? Does everyone pay? How is the healthcare? Canada has a wonderful plan from what I hear but Pennsylvania has more MRI machines than their whole country. Here is a side concern… In a single payer system who do the lawyers sue?
What's the optimum number of MRI scanners per capita? Canada has 4.6 per million people. The U.S. has 19.5. I'd wager the ideal number is somewhere in between (in terms of cost benefit compared to other things that money could be spent on).

http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States

The United States spends more on technology than Canada. In a 2004 study on medical imaging in Canada,[95] it was found that Canada had 4.6 MRI scanners per million population while the U.S. had 19.5 per million. Canada's 10.3 CT scanners per million also ranked behind the U.S., which had 29.5 per million.[96] The study did not attempt to assess whether the difference in the number of MRI and CT scanners had any effect on the medical outcomes or were a result of overcapacity but did observe that MRI scanners are used more intensively in Canada than either the U.S. or Great Britain.[97] This disparity in the availability of technology, some believe, results in longer wait times. In 1984 wait times of up to 22 months for an MRI were alleged in Saskatchewan.[98] However, according to more recent official statistics (2007), all emergency patients receive MRIs within 24 hours, those classified as urgent receive them in under 3 weeks and the maximum elective wait time is 19 weeks in Regina and 26 weeks in Saskatoon, the province's two largest metropolitan areas.[99]

According to the Health Council of Canada’s 2010 report "Decisions, Decisions: Family doctors as gatekeepers to prescription drugs and diagnostic imaging in Canada", the Canadian federal government invested $3 billion over 5 years (2000–2005) in relation to diagnostic imaging and agreed to invest a further $2 billion to reduce wait times. These investments led to an increase in the number of scanners across Canada as well as the number of exams being performed. The number of CT scanners increased from 198 to 465 and MRI scanners increased from 19 to 266 (more than tenfold) between 1990 and 2009. Similarly, the number of CT exams increased by 58% and MRI exams increased by 100% between 2003 and 2009. In comparison to other OECD countries, including the US, Canada’s rates of MRI and CT exams falls somewhere in the middle. Nevertheless, the Canadian Association of Radiologists claims that as many as 30% of diagnostic imaging scans are inappropriate and contribute no useful information.
That last line is key there. If 30% are unnecessary in Canada, what percentage do you think are unnecessary in the U.S?

MRIs and CT scans can be life saving if they provide useful information, but they are always expensive and CT scans result in effective radiation dose from 2 to 10 mSv.
 

FreemanW

macrumors 6502
Sep 10, 2012
472
87
The Real Northern California
SD, you truly are indefatigable when it comes to defending the indefensible.

Spectacular!

You are at once, the Black Knight standing on his own stumps, not a leg to stand on, while yelling, "it's only a silly squirrel rabbit!"

Thanks for the laughs. ;)
 
Last edited: