Will first and second tiers of service become tomorrow's healthcare in the U.S. - depending on one's income? Scott Sumner considered some possibilities recently, along with several of his commenters. While a two tiered result may still seem politically implausible, budget realities - let alone arbitrary limits in knowledge use applications - may eventually drive healthcare to this point. If class differentiation seemed likely before...
To be sure, basic forms of healthcare access are preferable to none at all, especially if someone can't pay. So why complain? There are more dimensions to healthcare issues than sometimes meet the eye. Today's extremely lousy excuse of a marketplace is not just about a lack of access, but also the ways in which healthcare services and remedies have become arbitrarily defined.
Battles for limitations in market definition took place in stages, and some battles in this regard have taken place only recently. While today's passive consumer has become part of the problem in terms of lifestyle and longevity constraints, the reality is that too many in healthcare exacerbated this set of circumstances. How so? By reducing the roles of more active and spontaneous components between providers and consumers, which were viewed as competition to traditional medicine.
While second tier levels of basic care would be valuable for emergencies, individuals who seek care often need to be a more active participant than the system acknowledges. Some care management comes across as patronizing, hence may even be a waste of time for the patient who is expected to "just follow directions". Low income default scenarios could worsen these aspects of limited choice, for passivity on the part of patients tends to magnify healthcare issues.
Unfortunately I'm in rant mode, because I'm now out of an herbal remedy which I've relied upon for over a decade, yet cannot procure locally! So when I hear "no choice" for lower income levels I tend to bristle, because the problem all along has often been that of the wrong choice sets at the doctor's office and in too many locations. If I were younger and still had reliable transportation, I wouldn't hesitate to order a whole range of alternative remedies, put a health library together, and once again set up shop locally. If only I could!
Readers of this blog, also know that lack of choice is far from the only concern I have about present day healthcare. In macroeconomic terms, the way healthcare has been structured in the U.S., has brought imbalance and needless complexity to our economic realities. To be sure, addressing the core structure of healthcare is daunting indeed. But until a competitive marketplace comes to healthcare, it will continue to be a drain on budgets and also limit other aspects of knowledge use in the marketplace.
Indeed, many who lean libertarian don't even propose radical alternatives to today's system because of the challenges involved. Protesting Obamacare by reverting to concierge care -while perfectly understandable - is little more than shuffling towards inevitability, hence nothing to be proud of. However, fiercely defended limits in production supply, only further distort time use across the entire economic spectrum - distortions which government redistribution cannot adequately address. This is why present day government debt is a greater problem than debt loads from other historical time frames. How are true markets realistically possible, if freedom to participate in health related services is not considered a viable option?
Therefore, if a second tier becomes a reality, I would only view such a development as a partial solution: useful primarily for emergency scenarios and lifesaving measures. In all aspects of healthcare, everyone needs the right to heal. Healthcare in all its potential diversity, needs to be a part of environments wherever people live and work, so that entire populations do not become desperate to migrate to already full cities just to have a decent life.
For instance, does the American Medical Association realize its role in bringing U.S. citizens closer to a caste society? Of course, in their defense, this particular special interest group is far from alone. I get that supply side limitations are necessary, in terms of cutting edge care and new drugs. But I don't get the limitations, in terms of the care people could provide for one another, if only they were allowed to do so.
There are centuries of hard won knowledge to draw from and libraries full of useful information that can assist group collaboration in small communities. With a little luck, some of this knowledge may finally make its way to the digital realm. We can do better than today's version of healthcare, and give knowledge use the rightful role it has in all of society, so that people can keep their hope for a better future.