A research scientist writes in:
Your reader says, "If you're an insurance company, good luck trying to go into a neighborhood and offer a watered down plan at a price that people can actually afford - a plan that may not cover the $100k latest and greatest radiation therapy but does pay for the lower-tech radiation therapy that was all the rage 4 years ago that costs 85% less...."
So, here is the problem with the "lower-tech" treatment that was all the rage 4 years ago: they've in most cases moved on to a new treatment because it is more effective at treating the disease and not because it is "cooler" and more high-tech.
Let me give you a real example of where this matters. Take the treatment of brain cancer for example: at the moment there is something near a 95% recurrence rate (i.e., we aren't curing the patient) and median life expectancy from diagnosis is still under a year. It is becoming clear that the better, higher-tech way of treating patients is to use microarray analysis (simultaneous measurement of thousands of genes) of each individual's tumor to determine what specific gene mutations that patient has and to tailor the anti-cancer treatment to their specific mutations. This was highlighted by a recent clinical trial of a very promising anticancer drug that was effective in some patients but actually caused the tumor to grow faster and shorten the life of other patients in the trial. Now, the use of microarray technology is "high-tech" but it is not being used just for the sake of doing something fancier. The low tech way is to just try a common, effective drug and hope you aren't one of the unlucky 20% that will actually accelerate the tumor's growth because you have a different gene mutation in your tumor.
So, a two-tiered system would have the wealthy able to afford to pay for microarray analysis to guide their anti-tumor treatment, which in theory could lead to actual curing of brain cancer or you are on the other end of the economic scale and you are stuck with a 5% chance of surviving more than a year. Medical treatment usually moves on to the next best thing because the previous thing wasn't working, not just because of inertia. Are there examples where an improvement was minor but the cost increase was extremely large? I'm sure there are plenty. I'm just saying that for every one of those there are just as many advances in treatment that make huge leaps in effectiveness that would be unattainable to those patients on that "watered down plan" the reader wants to sell to the average person. This seems so morally wrong as to be obvious, I would think. Even the UK and Canada with their "rationing" of medicine are going to offer the treatment that actually cures someone over lower-tech, less expensive options that don't cure. However, in the two-tiered system this reader (and you?) envision, only the wealthiest would have access to the most effective option and that's the key, the "most effective" not the "highest-tech".
Of course newer treatments are often more effective. That isn't in dispute. The question is whether we can afford to always give the most advanced treatments to all citizens regardless of income without bankrupting the nation. Do nationalized healthcare plans always provide the most effective treatments? No.