Clinic with two doors, a symbol of two-tier care

One side is for patients with insurance, the other for those who pay up front

updated 5:23 a.m. PT, Mon., Nov . 23, 2009

NEW YORK - In America, you get what you pay for. Those who pay more get better service. That's the way it is in restaurants, and in health care, too.

But imagine a restaurant with one kitchen, one chef, but two doors and two price lists. That's the model of health care that some doctors are practicing.

In New York City, msnbc.com heard of doctors locating their practices on corners, so they can have one door where they take insurance and another door offering services for patients who pay cash up front for each procedure.

We visited one of these clinics with two doors, to see how it works. The result is a glimpse into a two-tiered system of health care, a system that could be coming to a street corner near you.

On Manhattan's fashionable Upper East Side, the door on 77th Street says Lenox Hill Radiology. It's a busy place, with 20 or 30 people typically waiting in chairs. It takes insurance.

But if you walk a few steps down the block to Madison Avenue, and one block up to 78th Street, you'll walk through the door of New York Private Medical Imaging. The waiting room has only four chairs, usually empty. It takes cash, checks and credit cards. You can try to recoup some of your money later if you have insurance.

Both doors ultimately lead to the same area of changing rooms and scanning equipment. The same technicians perform PET scans and MRIs on the same machines. The employees are warned, in a written policy, not to tell the patients about the other door.

As Congress spars over how to fix the nation's health care system, w e've seen more doctors reject the managed care dominated by insurance companies, pushing patients to pay $1,500 to $2,000 a year for “conciergeâ€