Toward a Two-Tier Solution

Carl Smith is a self-described political animal from the Philadelphia area with a keen interest in fixing health care.

Why wouldn't a two-tiered approach work?

One tier, for those people with income who can afford the latest advances in health care, and another system for those who either can't afford the latest, or who choose to not pay for it? The first tier will continue with health care as we currently have it.

The second tier can consist of providers with less training, meds that are off patent protection, x-ray instead of MRI, and longer waiting times. Was medicine so bad in the 1960's? They weren't really complaining about it back then, were they?

We should have government-sponsored clinics, where the care providers don't have to have current medical school education. Like you have mentioned, nurses do most of the front-line work anyway, that in theory, doctors should be doing. If an MD isn't really necessary, is an RN certification really necessary? With a little experience and a little bit of bedside manner, 90% of health care needs should be able to be covered in such a free clinic.

It makes liberals happy because it's a government program, and it makes conservatives happy because it eliminates market externalities such as the regulated market power that is assigned to certified doctors and nurses.

Poor people may be able to get better health care through such a system, and the affluent, or those who are willing to pay will get better access, with cheaper insurance rates, which would then allow more people to be covered by insurance. The only ones who will lose are the certified doctors and nurses who for the first time will be facing price competition for their services. My heart goes out to them as they suffer driving home in their German imports.