Perhaps you're familiar with a two-tiered healthcare system. It's what they have in England, to name just one example. Under this model, the government provides a basic level of medically necessary healthcare, for which timeliness, and, some say, quality, are not guaranteed.
But back to whether two tiers are in our country's future. I don't know if I completely agree with the assessments I've been hearing from leadership. I have to admit, however, that given what we know about healthcare reform, and about disturbing trends among independent physicians, it looks like we're headed that way, unless there is a change in direction.
The penalty for not obtaining health insurance is currently insignificant and Medicare, at around 90% of costs, and Medicaid, at much less than that, are poor payers. The information I'm relying here is all anecdotal, but in Texas, many independent physicians have already closed their rolls to new Medicare patients, to say nothing of Medicaid. This is happening in other states as well.
Because just about everyone over 65 is on Medicare, and hospitals need that business, they're not likely to be in the vanguard of the new two-tiered health system, but smaller organizations will. How will you know it's happening? You'll know when more and more complex organizations, from physician practices to outpatient centers, begin to refuse to deal with government payers entirely.
On the balance, worse doctors, and poorer quality institutions, will want that business. That's not necessarily a bad thing for society. After all, the previously uninsured will have access to care that they theoretically didn't before (outside of the emergency room).