"And no one seems willing to call what is going on by its real name: class-based triage, or rationing, of medical care."
This American Interest post by Adam Garfinkle seems a bit befuddled to find that ObamaCare actually tightens health care triage based on class. Or income at any rate.
While Garfinkle's doctor retreats into a fee-based private practice model, he notes that ObamaCare plans will be structured to limit patient options.
And no one seems willing to call what is going on by its real name: class-based triage, or rationing, of medical care.
We can see this more clearly if we put these two data points together: We are slowly (or not-so-slowly) but surely moving toward a much more finely gradated class-based system of healthcare. Compared to where we were before Obamacare passed, the top is moving up and the bottom is moving down faster than ever, leaving a thinner middle where most Americans with employer-provided health insurance have typically been—somewhere in the murk between HMOs and PPOs of various descriptions. Now, those who can afford it will increasingly pay more and get more. Those who cannot afford it will pay less and get less.
Actually they will pay more and get less. When they do pay less, they will be paying more for less services. It may not be obvious to them, but the insurers will have done the math.
The problem is that triage of this sort is inevitable.
The market naturally rations products and services. There's no way to get around that. Even in a totalitarian state with a planned economy, national health care and price controls, professionals will just go to the most rewarding fields.
And there's always a class structure. Soviet academics lived much better than their colleagues lower down on the ladder. Meanwhile Soviet medicine was pretty terrible. The smart people were going into research and then not doing any research because the entire system was too far behind to catch up.
The more the system is tampered with, the more the middle, which is a product of the free market collapses, reverting everything back to the 99 percent and 1 percent model that the left pretends we have now. Except it's really more like a 67%, 9% and 24% model.
ObamaCare forces more doctors to become completely inaccessible to anyone other than the wealthy. The process began with HMOs, that original ingenious plan to solve the health care problem, which instead made it more expensive and less rewarding for doctors to do business. Costs kept going up and so did health care.
This is just one of the final steps on the rung before we end up with no middle ground. This won't just have an impact on the people in the middle, it will eventually destroy the quality of medicine in general.
There's only so much room at the top. If the only way to really make money is by treating the rich, that requires far fewer doctors and that means there's much less room in medicine.
Medical schools will turn out more mediocrities, Third World students who excel at rote memorization but have no interest in patient care, and the top tier of medicine will continue shrinking down. There will be some good people at the top, but their numbers will diminish with each generation.
And then American medicine will die. But you'll always be able to go and see a Nurse Practitioner for some obesity counseling.