Chris Rangel says there will always be two tiers, no matter how much the left denies it:

Patients pay more out of pocket for the convenience of shorter wait times, less paperwork, less bureaucratic limitations, and more personalized care. Whether these new models lead to better care or not remain to be proven but they definitely lead to better service and Americans are increasingly more willing to pay for this.

And this is not good news for liberals who are hoping that a universal health care system will be a driving force for social as well as health care equality. How can we have equality if people are willing to pay for better service if not better care? The scary solution to this is to outlaw most or all private insurance and private health care delivery systems. Then the health care system will be truly socialized and paying for better health care will be as illegal as paying for sex.