Not so much

Someone at The Wall Street Journal is writing about “The Coming Two-Tier Health System” being created under ObamaCare. Why is ObamaCare going to give us a two-tier system? Because:

- fewer doctors are willing to take Medicaid and Medicare patients;
- the “bloating coverage requirements” imposed by ObamaCare are increasing the cost of private insurance;
- reducing Medicaid and Medicare reimbursements increases costs for those with private insurance (or, I assume, no insurance at all);
- the government can decide at any time to enforce the ObamaCare requirement that it eliminate “affordable private drug-coverage options inside Medicare”;
- there are fewer, not more, health insurers available to those who buy insurance through the exchanges;
- narrow provider networks (and, yes, these are a result of ObamaCare not just business as usual) mean fewer middle-class Americans can get truly outstanding health care;
- really good doctors are looking at concierge practices that don’t accept any health insurance, meaning these doctors will be out of reach for those who can’t afford to both buy mandatory health insurance and pay their doctors themselves.

What’s the result of all this? The WSJ article puts it thusly:

The health-care law was generated by an administration promoting government as the solution to inequality, yet the greatest irony of ObamaCare is what will undoubtedly follow as a long-term, unintended consequence of the law: a decidedly unequal, two-tiered health system. One will be for the poor and middle class, and a separate system will be for those with the money or power to circumvent ObamaCare.

I have no argument with the writer’s list of reasons why ObamaCare will give us a two-tier health system. I also have no argument with the writer’s summary of what that system will look like: one for the poor and middle class, another for the rich and powerful. What I do dispute is the writer’s use of the phrase “unintended consequence” (and, thus, his use of the word “irony”). This two-tiered health system was very much intended.

Back in 2009, I wrote:

What is driving [some people’s] support for universal health care is not the desire to insure that everyone has some health care but rather their determination to insure that everyone has the same health care. This would explain why the House health care bill (HR3200) is apparently so sweeping. [snip]

... the House Democrats have not opted for any simple plan that would simply give everyone some health insurance. Instead they’ve opted for a Rube Goldberg machine that seems bent on giving everyone the same insurance. That leads me to believe that everyone having the same thing is far more important than everyone having something.[snip]

What this means, of course, is that the rich will continue to get superb healthcare, the poor will get somewhat better healthcare, and those in between will get not only worse healthcare than the rich but worse healthcare than they’re currently getting.

In other words, we’ve gone from our old three-tiered health care system - poor, middle-class, rich, with a relatively small gap between middle-class and rich - to a two-tiered one - rich and everyone else, with a yawning chasm between the two. And we haven’t done it by raising the poor to the level of the middle class; we’ve done it by raising the poor a little (maybe) and lowering the middle-class a lot (definitely). The system is more equal and that’s what was intended. Income inequality is far from the only inequality the Left opposes.

As for the rich and powerful, of course it was never intended that they would be part of the equalizing. That’s partly because it’s not possible to prevent them from getting superb healthcare. It’s also partly because the drivers of ObamaCare - people like Barack Obama, Nancy Pelosi, and Harry Reid - are both rich and powerful. There’s no way they’re going to be “[queueing] for ... underproduced [healthcare products and] services which in turn will also be denied far more regularly than is the case with insurance.”

Right now, it is mostly those who buy their own insurance via the private market who are subject to this leveling. According to recent predictions, however, at some point everyone who is not rich and powerful will be subject to it:

According to a report by S&P Capital IQ released Thursday, S&P 500 companies will likely move their employees from employer-provided health insurance plans to the healthcare exchanges under the Affordable Care Act, saving employers nearly $700 billion through the year 2025. If current healthcare inflation stays constant, those savings could be greater than $800 billion, researchers found.

Should that come to pass, I can see myself 20 years or so from now, surrounded by a group of teenagers listening with disbelief to my tales of a mythical past when I, a reasonably well-off but hardly rich or powerful woman, had insurance that covered the incredibly expensive, experimental cancer treatments that saved her life. I’m sure they’ll think I’m off my meds to even imagine such a thing was ever possible - and seriously in need of those meds to claim I experienced it in my lifetime.