James A. Betti

My friend is an English-born naturalized American citizen, and he is troubled.

His brother, who lives in England, was stricken by severe abdominal pain, diagnosed with an acute gallbladder, and hospitalized for several weeks. They sent him home and as an outpatient, he had a tube placed in his gallbladder. With the tube finally removed, he now waits months, on a National Healthcare list, to have his gallbladder removed. A walking time bomb (In America it would have been out the first week). My friend’s experience with his brother brought back memories of his aged father in a hospital ward crying on the phone because he had to wait to be changed – he was left by indifferent nurses, in his own excrement, a man who fought at Alamein and Normandy, and on the Rhine, was finally broken, not by the Nazis but by the callousness of the English National Health Service. My friend’s aunt, who at 80 needed a hip replacement, waited 11 months in pain. She died four years later after suffering 20% of her last five years. And his cousin who bragged about free Canadian Health Care until he had a back problem requiring surgery. The wait was two years, and this politically liberal Canadian Health Care braggart happily took his company’s offer to go to a private clinic and be taken care of.

My friend was so thankful to live in America where these horrors didn’t happen, but as the progressive schemes to socialize American healthcare gained strength, he wondered if it was only a matter of time.

There is no doubt Americans are becoming more dependent on government subsidies and government-run healthcare plans.

Combining Medicaid (welfare for the poor), Children’s Health Insurance Program (welfare for children), Medicare (Government healthcare for seniors), Obamacare exchanges (subsidies), Tri-Care (Veterans insurance) and the Veteran’s Administration Hospitals (VA) approximately 161 million (total population around 330 million) Americans have their healthcare paid for directly or subsidized by the government. What each of these healthcare-providing entities (except the VA) has in common is none pay healthcare providers (physicians) and healthcare facilities (hospitals) rates that allow sufficient profit to stay in business. Private insurance, mostly provided by employers and partially paid for by the employees, makes up the difference. This is referred to as cost shifting. By paying three to four times more than the government supported programs for the same service, working Americans subsidize the entire healthcare system.

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The Public Option

If President Biden is able to open the door to Americans buying into Medicare (The Public Option) a catastrophic series of events will occur. In a brief time, a critical mass of Americans will shift to the cheaper government-run program, which does not pay enough to sustain the system. The pressure on the private insurance industry to increase prices to support the new cost-shifting would not be sustainable and private healthcare insurance would collapse. Ushering in Government controlled, socialized medicine.

What’s happening to Medicare Physician Payment is ominous.

The government’s decision to have another decade of no appreciable physician reimbursement increases will drive change. In the previous decade, physicians accepted no Medicare reimbursement increases because losses due to inflation were minimal and could be matched with increased revenue from private insurance, but with the new progressive 8 to 10% inflation/year, this is no longer a viable option. In plain English, a Medicare patient is not going to be worth seeing, and the lines will start to lengthen.

•••

The Canary in the Coal Mine

All across America in places with a high percentage of Medicare patients, Concierge Medicine is starting to take root. Individuals pay a set yearly fee to join an entity (kind of like a health club) that provides health care. The club consists of a variety of providers with physicians making up the backbone. Other services, including laboratories, x-ray, and cardiology capability, might be on campus. The Healthcare Club guarantees efficient service with same-day doctor appointments. Often the Club’s doctors will follow a hospitalized patient and make sure the care given is top-notch. The price tag ranges {depending on services} from $1,200 per year up to $20,000 per annum.

A quick calculation (based on a real-life Florida example) demonstrates the point.

If a group of four top quality physicians was able to each obtain 200 patients paying $5,000 a year (club fee) the total revenue to the practice would be $4 million. In general, 50% of practice revenue goes to overhead costs, leaving each physician $500,000 a year in compensation. This does not include what they would collect from Medicare billing and all other ancillary services. The usual primary care doctor has a panel of around 1000 patients and is paid approximately $200,000/ year. In this case, the entire group would have 800 patients and be able to give more time and quality service to their patients. Top physicians would soon tire of being forced by managed care and large healthcare corporations to see a patient every 15 minutes and be paid much less. The migration to concierge medicine is in its infancy, but unless things change, it is the future. This future will be defined by the” haves” (club members) receiving top-quality physician services and the “have nots” waiting powerlessly in line. Praying, a spot opens up to see a nurse practitioner or a physician assistant.

What has set America’s health care system apart is the vast majority of Americans who have access {only 8% don’t} to healthcare (especially Medicare), regardless of race, gender, age, or social-economic status, are treated expeditiously and fairly. People with means don’t have a problem if quality care is readily available, and the less fortunate around them also have access. The rub occurs when wealthy people no longer perceive quality care is readily available. They will then find private options (think concierge medicine}. Once this happens, they will no longer have a stake in the average American’s healthcare pool and will not care about the system’s quality. The natural evolution to a two-tier system will occur with people of means enjoying the present level of service through a private option, while the masses have healthcare rationing. It’s not hypothetical, it’s happened across the pond and north of our border (think about my English American friend’s family) and it’s starting to happen here.

We have seen what unchecked progressive elected officials have done with 20 months of power.

Dividing our nation with the discrimination of equity, energy prices sky high, millions of illegals crossing our open borders with sex traffickers, and youth killing Fentanyl coming across daily. Inflation is ravaging people’s retirement, destroying their futures. The world is on fire and our great cities have been turned into crime-ridden cesspools. The DOJ and FBI have been corrupted {think Russiagate and the raid on Trump’s home} as our Military is weakened {think Afghanistan withdrawal} and Armed Service Recruitment is falling short because of “wokeness” in the ranks.

Washington, DC progressive elected officials are back in their states and districts lying about their culpability in tearing America apart. Make no mistake, if left in power, they will come for the progressive “Holy Grail” of nationalized healthcare, and just like the unfortunate brother of my English friend, it will be you or your loved one waiting in line for essential health care. Ticking time bombs, ready to go off while the progressive elites enjoy unlimited access to a private healthcare alternative.

James A. Betti is an occasional columnist for The Telegraph.

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