Borepatch writes:

Dr. J, 

In re; your excellent post about the likely outcome of Obamacare – a 2-tier health care system similar to the one in the UK where the Government system stinks and anyone who can uses the private one, we can extrapolate the reaction of the Left to the (entirely foreseeable) results of their societal engineering. When they see the poor and the elderly forced to wait while the “rich” waltz right in for service, they will become incandescent with rage. Expect harsh new regulations, perhaps even prohibiting private health care services entirely, “in the interest of fairness”. 

This is the same visceral rage that has resulted in every Communist state going feral, with death camps, gulags, and “re-education” for all the Hoarders and Wreckers who are the only reason the beautiful vision never ever ever ever ever worked. 

Borepatch 

Dear Borepatch,

Thank you kindly!

Dr. J. agrees with you. He has discussed in the past that Obamacare is designed to cause our current health care payment system to collapse by increasing the cost of private health insurance, leaving a government system becomes the easiest means to finance the cost.

What we have had in America is essentially a continuum of care where based on a number of factors there variable access to care of variable quality exists. Dr. J. knows the richest of the rich and the poorest of the poor who get care from the same doctors. He also knows of doctors and institutions who are careful about their payor mix to insure their ability to keep their doors open. He also knows people with various types of insurance and none, all of whom have doctors who try to deliver the best care tailored to their needs. The patient who goes to the VA, for example has a pretty comprehensive health care plan, while a patient who goes to the city hospital has challenges getting the medications they need paid for, but that city hospital has the access to those resources pretty well figured out, unlike other hospitals who can treat the heart attack of the uninsured patient very easily, but then don’t know where to start in planning for discharge of the uninsured patient to guarantee he has the medications he needs to insure his stent isn’t clotted off. Fortunately industry charitably lends a hand there to get the patient free samples.

There is no nation in the world that has socialized medicine, or government run health-care that does not have a second tier for the elites.

The issue then becomes how far does President Obama’s transformation of America go?

If he is looking to transform America into a European Welfare State™ then look no farther than the British National Health Service (NHS as its friends call it) for what to expect. Now Dr. J. will not pour vitriolic hate on NHS because he has friends and colleagues who trained and/or worked there. The doctors and nurses do the best they can with limited resources and as a consequence are tremendously skilled. That being said, they have limited resources handed to them from The State™. The fairest perspective on the British two-tiered system comes from David Asman from Fox News and Forbes Magazine. He wrote an article a long time ago in the Wall Street Journal regarding his wife’s stroke when they were in England and his perspective participating in both the public and private tiers. The link provided takes you to a re-print on the Fox News. It is as even handed a portrayal of what England has to offer, and as an American, you, like me, wouldn’t want it.

Indeed, even Chile, which as far as South American countries go, has its act together and has a very market based economy has a two tier system.

That being said, if President Obama is looking to transform America into China, Cuba, or dare he say it, North Korea, then there would still be a two tier system, but the bottom tier would be much bigger and disturbingly less desirable than the much smaller upper tier.

Dr. J. doesn’t believe that President Obama’s goal is to become Kim Jong Il, even with the awesome media room, fantastic chef and all those nifty parades. Dr. J. think’s he’d be happy with something a few notches left of France but still to the right of the Soviet Union.

Should Obamacare remain the law of the land, it will be interesting (in a bad way, but interesting nonetheless) to see how the two tiers shake out here and what shape and size they take.

Of course, Dr. J. hopes and prays that Obamacare is repealed and more rational market based solutions will be the order of the day. Only then will we see the cost curve bent down because individuals will be bending down for themselves.

Thanks for writing in.

Dr. J.