You Wonder What Universal Government Health Care Might Look Like….

Well, look no further than the scandalous mess at Walter Reed Army Hospital. Crappy hospitals, endless waits, mountains of paperwork and, at the end of the day, no real accountability from the people who run the joint. Folks, if the government can't or won't take good care of our injured soldiers, what makes you think that it will take good care of little Sally or Uncle Bill?

Health care in the United States is screwed up. This is largely due to bad government policies, e.g., third party payment encouraged through the tax code and multiplying state insurance mandates that unnecessarily boost costs. As the example of Walter Reed is warning us, putting total control of all health care in the hands of those who wrecked it in first place--Congress, states and federal agencies--is the wrong way to go.

Comments

[tros]

The choices as I see them:

1. Put criminals in charge.

2. Put retards in charge.

3. Scratch the first two, let them each take half and crush the rest of us in the middle. That sounds about right.

I suggest sacking Diebold and hiring the Free Software Foundation to design our voting system in order to fix things.

[Guy Montag]

I thought those guys at Ezra Klein's 'blog proved that the VA and the military hospital systems were the best thing for the whole country?

I mean, they would assert this perfection as fact whenever a commenter brought it up in a bad context.

What happened to good old egg breaking for omlets on the way to a perfect Socialized State?

[Christopher Monnier]

> putting total control of all health care in the hands of those who wrecked it in first place--Congress, states and federal agencies--is the wrong way to go.

But, but, you don't understand...if the right people were in Congress it would be SO much better...

[joe]

Except for the part where conditions deteriorated at Walter Reed after anti-government ideologues decided to systematically privatize as many of its operations as they could, you make a good point about this being a result of the government running health care operations.

[Lamar]

Hmmm, an outrageous bureaucracy set up to reflexively deny claims......no way that could happen in private industry.

[Abdul]

Government-run health care doesn't have to be this bad. I know an Irish doc who worked for the VA for a while and she said that the socialized health service in Ireland had some problems, but was nowhere near as bad as the VA.

Here in America, there's high demand for health care professionals, and the VA can't easily compete for this talent pool. Ireland, on the other hand, has a surplus and exports most of its health care pro's. Only the best are able to get a job in their home country, the rest have to get jobs overseas.

[andy]

It looks like the mess at Walter Reed is somewhat of a Rorschach test- libertarians see it as a failure of government and joes see it as a failure of the market.

I'd say it's the result of sending thousands of American soldiers to be maimed in a pointless and seemingly endless war with a bunch of 8th century savages.

[Warren]

This is what comes of "Support Our Troops"

[Ron Bailey]

joe: Interesting point. Stupid privatization is of course bad. The government signed and oversaw the management of these support contracts. This makes you feel better?

Soldiers are beneficiaries of government health care--they have to take what they get--privatized or not. People with private health insurance using private doctors are customers. They can go elsewhere if they don't like how they're being treated. Under universal government health care complete with privatized services managed by ever vigilant government bureaucrats we all be beneficiaries.

[Gilbert Martin]

"Under universal government health care complete with privatized services managed by ever vigilant government bureaucrats we all be beneficiaries."

Beneficiaries?

I'd say prisoners is more like it.

[joe]

"joe: Interesting point. Stupid privatization is of course bad."

Ah, so we can differentiate between stupid and effective privatization, but similar differentiation about how the government operates are to be dismissed.

Is is really any surprise that when people who don't think it's important for the government to do its job well take over the government, it doesn't do its job well?

[neil]

Universal Government Health Care

You mean Universal Army Health Care.

[Cab]

I think I need to actively seek one of those comment filters I've read that some people have.

[Dakota]

joe's point is right on. Kind of.

Worse then goverenment being in charge of a program answering only to it's self, is government being responsible to oversee a private firm that has a locked in govement contract running things.

It's endless finger pointing and blame shifting. Usually the contracts go to the well connected and there is zero incentive to outperform, or even perform for that matter.

[bchurch]

The problem with the situation at Walter Reed isn't that it was privatised or government run. It was neither. It was a sort of bastardization of the two, in a worst of both worlds patronage mill. Our tax dollars were still spent, but went to a big money donor without even the sort of minimal accountability that accompanies a gov run program. The fact that the money was wasted through a Halliburton subsidiary instead of through the standard beaurocracy isn't and shouldn't be any comfort.

And I'm not sure how true privatization would really be possible here. Maybe vouchers to individual soldiers to get their care where they choose?

[steveintheknow]

joe

You are conflating "markets do a better job" with "its not important for the government to do a good job". In addition "bad privatization" IS a government mistake. That being said, I know little about this scandal - other then the horror stories - and am not supporting anyone in particular.

[fyodor]

Interesting what joe says. Makes me think of the response libertarians have to conservatives who want to sacrifice civil liberties for security at this point in history, which is: how will you feel about it when Hilary's in charge?!? So joe, IOW you're saying socialized medicine will work fine as long as Democrats are in charge but will work like Walter Reed Army Hospital if Republicans are in charge? That may be intended as an argument for voting Democratic, but it's an even better, if inadvertent, argument against socialized medicine!!

All that said, Bailey's point is too open to the charge of cherry-picking to be taken very seriously as an argument against socialized medicine.

[D.A. Ridgely]

Except for the part where conditions deteriorated at Walter Reed after anti-government ideologues decided to systematically privatize as many of its operations as they could, you make a good point about this being a result of the government running health care operations.

Except that such privatization began and was well under way long before the ideologues you have in mind were in office. Now, you can raise military specialty occupation salaries such as medicine and nursing way way above what they have already been raised to or you can reinstitute a draft or you can privatize the delivery of medical services to active duty personnel, their dependents and veterans. What's it going to be?

Privatization isn't the real culprit here, although I'd gladly acknowledge that the government contracting process is close to being broken beyond repair. Nor, for that matter, is it a question simply of inadequate funding, strictly speaking. The problem is how a command economy allocates and spends those resources; in other words, the military bureaucracy, itself.

A minor case in point. Years ago I worked for the U.S. Army in Italy and needed to make a dental appointment. My office was literally steps away from the dental clinic, so I walked to the front desk to make an appointment. I was informed by the clerk (an enlisted soldier, btw, who was, it must be noted, "just following orders") that dental appointments could be made only by telephone. I walked to the other end of the reception counter where a desk phone sat, got a dial tone and dialed one of the clinic's other numbers. The soldier answered the phone at her end of the counter and I made my appointment.

Now tell me that sort of mindset has anything to do with privatization?

[Ron Bailey]

joe: If you would like to learn more about effective privatization may I direct you to the work of my colleagues at the Reason Foundation's program in this area?

You may also want to learn about "government failure." See URL: http://www.catostore.org/index.asp?fa=ProductDetails&method=cats&scid=14&pid=1441050

[joe]

fyodor,

Actually, I don't want "socialized medicine."

I want socialized health insurance and privatre medical care. Single Payer. Medicare for All. I most certainly do not want the state legislature in 'Bama voting up or down on whether to supply the morning after pill.

I was just pointing out a flaw in Bailey's reasoning.

[Loundry]

I can think of only one thing that government does well: killing people.

[Matt]

The care at WR was awful, just like the "care" a majority of citizens receives each day. Ron Bailey sees an unequivocal lesson here, but I think that says more about him than the situation.

And Kevin Drum writes about the conflation of Walter Reed and the VA system here:
http://www.washingtonmonthly.com/archives/individual/2007_03/010860.php

[Gilbert Martin]

"Actually, I don't want "socialized medicine."

I want socialized health insurance and privatre medical care. Single Payer. Medicare for All."

Oh but that IS socialized medicine.

In fact, anything other than a situation where government has no involvement at all and healthcare is treated as just another consumer commodity availiable to those who can pay for it and unavailable to those who cannot is socialized medicine.

[D.A. Ridgely]

I want socialized health insurance and privatre medical care.

I want a real, live pony without any horse manure, too.

[sr2]

Except for the part where conditions deteriorated at Walter Reed after anti-government ideologues decided to systematically privatize as many of its operations as they could, you make a good point about this being a result of the government running health care operation

Again, and Mr. Bailey hints at this, *nothing* about this was privatization. The Government might have handed off the day-to-day, but in the end it was still a Government(read: taxpayer) funded operation. The soldiers had no choices for service, they were left with what the Government bought. This makes it a Government Subsidized company, NOT a private enterprise.

There is a distinct difference here. These problems result from the Government picking poor sub-contractors not b/c they got out of the game altogether. Therefore, it's a problem caused BY THE GOVERNMENT. This isn't "bad" privatization. It's just flat-out NOT privatization.

[Number 6]

Joe- You do make a fair point, but I'm not sure that it makes sense to look at privatization as in any way analogous to a market. That being said, if the government did a better job of running things, then perhaps that's the way to go in the case of the VA. But I'm not convinced that is the case. While I can't offer any concrete examples, it seems to me that the VA has had trouble long before privatization took place.

Also, Bailey's comment about the difference between beneficiaries and customers is an important one. A system without accountability to the person receiving care (and not just in a file a complaint with the bureaucracy kind of way) will always end up serving someone other than the recipient.

[Art]

Every now and then we get a glimpse at the future. This is one of those moments. But the treatment for this "ill" will be a call for more government oversight.

Might I add that "HMOs" and "managed care" were basically designed as socialist healthcare light, and people didn't think that was so great.

[R C Dean]

I want socialized health insurance and privatre medical care. Single Payer. Medicare for All.

Whoever pays the piper calls the tune, joe.

Talk to someone who knows something about health care about Medicare. It grossly underpays. If it were truly the single payer, health care would neither be as available nor have the quality that it does now.

I most certainly do not want the state legislature in 'Bama voting up or down on whether to supply the morning after pill.

That's the risk you'll run, putting the government in charge of health care. It may not be the hicks in Alabama deciding just for one state, of course. It will more likely be the crooks in D.C., deciding for everyone.

[downstater]

now i have not formed a firm opinion on the concept of a single-payer system/health insurance for all.

i think the biggest obstacle that those against such a system face is the fact that countries with those sorts of systems (as untenable as they may be) are not medical backwaters. people are not watching patients drop like flies in canada and western europe. instead, they're seeing face transplants and the like. yes, there are long lines and delays, etc. - but i think people are willing to wait for what seems to be modern and effective healthcare.

again, that's not a judgment for either system, just an observation from someone not completely convinced either way.

[MP]

Talk to someone who knows something about health care about Medicare. It grossly underpays. If it were truly the single payer, health care would neither be as available nor have the quality that it does now.

In my limited exposure to this, I thought it was Medicaid that had the shortfall? Medicare dollars were actively chased by the town run nursing home in my former town because they were full reimbursement dollars.

[Guy Montag]

I walked to the other end of the reception counter where a desk phone sat, got a dial tone and dialed one of the clinic's other numbers. The soldier answered the phone at her end of the counter and I made my appointment.

OT: Almost the same thing happened to me many years ago with a speeding ticket in Maryville, TN. I walked into the court house, stood in line for the clerk, presented the ticket with my open check book and asked how much it would be for that ticket. The clerk told me I needed to call in to find out, then come back there to pay it!

I finally talked her into "pretending" that I was calling in. Might have been something about pretending that it was $10 instead of the unconcionable amount that they wanted.

[joe]

"I can think of only one thing that government does well: killing people."

Cutting checks, too.

DA, I guess we're just going to have to live with the fact that we disagree.

"Again, and Mr. Bailey hints at this, *nothing* about this was privatization. The Government might have handed off the day-to-day"

In other words, there was privatization. You and Gil can play the "one drop" card all you like, the government took a chunk of work that used to be done by government employees, and paid a private party to do it instead. That is the dictionary definition of privatization.

Number 6, " A system without accountability to the person receiving care (and not just in a file a complaint with the bureaucracy kind of way) will always end up serving someone other than the recipient." Is that what you see happening on the news every night with this episode - a lack of accountability and complaints going nowhere?

"That's the risk you'll run, putting the government in charge of health care." That's why I don't want to put the government in charge of health care, like the Brits did.

[Schempf]

Matt,
I am actually very happy with my health care.

[Dan T.]

Mr Bailey writes:

...at the end of the day, no real accountability from the people who run the joint.

That's wrong. Several high-ranking Army officials lost their jobs over the problems at Walter Reed.

[joe]

Actually, VA patients and Medicare patients report much higher levels of satisfaction with their health care and insurance than the public at large.

[Morat20]

Just a note: Walter Reed is an Army hospital. It is not, in any way shape or form, affiliated with the VA system.

Conflating the two should be avoided, since it's akin to claiming what Catholics say is somehow binding on Protestants.

Walter Reed and the VA system should be evaluated seperately, as they are completely seperate institutions -- from management to funding.

[jake]

I want socialized health insurance and privatre medical care. Single Payer. Medicare for All.

One size fits all . . . really means one size fits no one.

Medicare for all is a disaster waiting to happen.

[Some James]

With all this back and forth of privatized va socialized, and the fact that under the definition up there (and in my own view) the health care system is already socialized, I was curious what the thoughts were on Sen. Wyden of Oregon's proposal to end the employer taxbreak for health care and direct the cash toward individuals. Doesn't sound perfect to me, but quite a bit better than the current system.

Slate had an article on it a few days ago:
http://www.slate.com/id/2160834/

[Dan T.]

"You Wonder What Universal Government Health Care Might Look Like...."

We really don't have to wonder about what it would be like - there are plenty of countries that do have it and many of them have healthier populations than the United States does.

[StupendousMan]

"They can go elsewhere if they don't like how they're being treated."

Yep, never mind the open wound or compound fracture. I don't think people use medical facilities often enough for their complaints to have much impact- "I'll never come back here... if I ever need to... and live in the area" -staff "yeah, whatever".

[Number 6]

Is that what you see happening on the news every night with this episode - a lack of accountability and complaints going nowhere?
I see Congressional hearings and people getting fired. I don't see the sort of systemic change that might prevent this sort of thing in the future. Ask yourself if what we're seeing now would have happened if the WP hadn't splashed the story across the front page.

BTW-Don't take this as being directly related to single-payer care. While I'm deeply suspicious of that model, I haven't completely made up my mind about it. Eris knows that what we have now is an unmitigated clusterfuck. But I'm simply talking about this particular incident.

[Bill Pope]

Further to Dan's comments, I think it would be instructive to see how much private providers would charge to give wounded soldiers the care they deserve compared to what the DOD is actually spending.

[Number 6]

As far as Medicare/Medicaide: Yes, they do tend to underpay. I say that based on experience with an ambulance service. Also, there is a very specific set of bureaucratic terms one must use to write claims if you want them to be paid. I won't go into detail, but I will say that mastering that language, and learning how to phrase things is a skill that takes a long time to learn.

I do not know how that compares to private health insurance companies. I do know that the willingness to pay claims varies from company to company.

[Gilberrt Martin]

"i think the biggest obstacle that those against such a system face is the fact that countries with those sorts of systems (as untenable as they may be) are not medical backwaters. people are not watching patients drop like flies in canada and western europe. instead, they're seeing face transplants and the like. yes, there are long lines and delays, etc. - but i think people are willing to wait for what seems to be modern and effective healthcare."

The real dynamic behind it is that people think they have some inherent right to something (in this case healthcare) regardless of whether they can pay for it or not. A lot of people are looking for a free ride where they can sponge off of other people. And there is also a class envy dynamic where people resent that those with plenty of money and/or good jobs with good healthcare benefits have better care than they do so they want to force everybody into an allegedly "egalitarian" system where those who have it better now will be forced down to the same level as the folks who resent them.

[Number 6]

Gilbert Martin- That, or some people have a problem telling poor people, "Sucks about that cancer. Too bad you don't have more money-we could fix it if you could pay."

[Gilbert Martin]

"Gilbert Martin- That, or some people have a problem telling poor people, "Sucks about that cancer. Too bad you don't have more money-we could fix it if you could pay.""

Yes some people are always quick to volunteer other people's money for something and try to spin that into being a virtue.

Nobody is stopping you or anyone else from helping anyone you like - up to the extent of your own finances that is.

[jake]

"Sucks about that cancer. Too bad you don't have more money-we could fix it if you could pay."

That is the heart of the matter. Do all people in the US have the "right" to receive all possible medical care regardless of their financial situation.

I don't believe that right exists.

[Number 6]

Yeah, Gilbert, I used to be an Objectivist too. I've heard all the arguments, and used most of them. And I'm not going to bother explaining where they fail. You'll figure that out for yourself, eventually. Or not.

[Gilbert Martin]

There aren't any affirmative rights that exist - it's not in the Constitution.

Nor for that matter, is any delegated power (asi is required by the 10th Amendment)that authorizes the federal government to create a socialized medicine system and compel all citizens to participate in it.

[Gilbert Martin]

"And I'm not going to bother explaining where they fail."

Because you cannot prove that they do.

[Number 6]

Congrats on resisting the urge to call me a second-hander or a muscle-mystic, Gilbert.

[R C Dean]

In my limited exposure to this, I thought it was Medicaid that had the shortfall? Medicare dollars were actively chased by the town run nursing home in my former town because they were full reimbursement dollars.

Medicaid is worse than Medicare. Medicare is insanely complicated - worse than the tax code - and there are a few areas where it pays adequately, but for the most part, not so much.

[Number 6]

BTW, Gilbert, if you read (and perhaps check your premises), you'll find that I didn't call for anything. You asked a question, and I answered it. Whether or not it meets your standard of rationality, you'll have to deal with why people would favor some sort of government-provided care. And a big part of that is the unwillingness to tell people "tough shit."
I will grant you this: I said several posts ago that I'm undecided on the single-payer issue, although I tend not to favor it. But that's hardly what you thought I was getting at, is it? After all, why respond to what I said when you can respond to what you think I said?

[downstater]

#6,

i think you are running along a similar line i am - undecided about the issue on the whole - but there are some realities that are not easily addressed. or if they are easily addressed - not in a way that is either un-flippant ("tough shit") or socially palatable. these include the fact that not all socialized medical systems provide bad care and that society in general is unwilling to let people physically ail for lack of funds.

That is the heart of the matter. Do all people in the US have the "right" to receive all possible medical care regardless of their financial situation.

i think relying on the "it's not a right" argument is somewhat of a dodge - as if to say the issue is moot. which i don't believe is the case - even if there is no right. and no, i'm not saying you're dodging, i'm just saying the possibility that it may not be a right, shouldn't preclude it from being considered an issue.

[downstater]

and just as i post about considering issues and what not, i must dodge myself. sorry, but i seriously must run. weak, i know.

[Gilbert Martin]

"Congrats on resisting the urge to call me a second-hander or a muscle-mystic, Gilbert."

LOL

Well I couldn't have called you a "muscle-msytic" because I've never heard that term before now - and I have no idea what it means.

"BTW, Gilbert, if you read (and perhaps check your premises), you'll find that I didn't call for anything."

I never said you did.

[Paul]

Except for the part where conditions deteriorated at Walter Reed after anti-government ideologues decided to systematically privatize as many of its operations as they could,

Uh huh. This, joe, is what we call a "public/private" partnership. Creating a non-competitive monopoly to be run by a non-government entity is not an example of a market condition. It is what it is, a government appointed monopoly. I'll take a true, private hospital any day over a government hospital-- "privatized" or not.

[grumpy realist]

I don't know whether private health insurance has been any better: deny stuff under the aegis of "prior condition" so you have to hire a lawyer in order to get a payment out of them.

Come to think of it, wouldn't the pure libertarian position be against health insurance at all? You are being forced into a pool of shared risk where you end up, through your premiums, to pay for other people's medical conditions.

If you hate paying taxes for it (which you can vote against, right?) then I don't see why you don't hate paying insurance premiums just as much.

[Ken Shultz]

I have heard some good things about the VA health system.

...Someone once told me that MRIs only cost $15!

[uncle sam]

Typical wait time when I visit my Kaiser doctor: 15-20 minutes. Typical wait at the county clinics (before we adopted our youngest): 45-90 minutes or more.
I don't want government health care of any kind. Giving up control of your money is giving up your power.

[uncle sam]

If you hate paying taxes for it (which you can vote against, right?) then I don't see why you don't hate paying insurance premiums just as much.

Because you can choose from different insurance companies. IAC, the ideal state is to carry catastrphice coverage and pay ordinary costs out of pocket or accounts set up for the purpose.

[Bobster]

My mother-in-law is a Scottish citizen. She had a stroke last week. She is in the hospital now but could not get any attention over the last six months because she "was not sick enough". She would have gone to a private hospital at her own expense but I understand that is now illegal. Bummer for her I guess. Why would she want to anyway? The health care is great and free in the U.K.

I also understand that the Health Ministry over there is not so quick to treat those who have ailments that are self-inflicted. "Sorry Betty but your smoking or exposure to second hand smoke or your diet has caused your problems. You go to the back of the list."

If you think Nationalized Health Care is a good thing, ask those who have had to live with it for decades.

Picture the mess that would be made of Nationalized Auto Insurance. "Everyone deserves the right to be insured while driving." (I might wreck my car when it is out of gas just to get a new "free" car.)

[Ken Shultz]

...Someone once told me that MRIs only cost $15!

I forget exactly how she said that price worked out--I think it had something to do with a magic unicorn that laid golden eggs.

If you hate paying taxes for it (which you can vote against, right?) then I don't see why you don't hate paying insurance premiums just as much.

Because Medicare and Medicaid only pay a fraction of the cost of care, your premiums don't go to other policy holders--your premiums (and the services they pay for) go to people who didn't pay for them. So the government's refusal to pay for the costs of the services they consume really does turn insurance premiums into a form of taxation--just not the way you seem to think it does.

...but, you're right if you're suggesting that anyone who goes on Medicare or Medicaid or sends their kids to public schools or... Shouldn't throw rocks at welfare queens.

[Guy Montag]

I am going with those Ezra Klein folks and saying this is just a big hoax and VA/Military healthcare is he perfect USAian system.

At least that is what they used to shout at me when I went there and dared to say anything bad about that system. Have not been there in months.

[George H.W. Bush]

Nationalized Health Care

...all the efficiency of the U.S. Post Office combined with all the compassion of the I.R.S.

[Guy Montag]

Yea, they said the USPS was a model of success too.

I suppose for the Left that the Stalinist Soviet Union is the standard and anything that exceeds that is gravy.

[douglas westerman]

Sending soldiers to Walter Reed is like mandating that everyone go to a certain restaurant with bad food and lousey service. Let the soldiers and their families go to local health care professionals of their choice, and send the government the bill.

Take some funds out of Bush and Cheneys salary, they deserve minimum wage at the most.

[The Wine Commonsewer]

Walter Reed and the VA system should be evaluated seperately, as they are completely seperate institutions -- from management to funding.

But the end result is precisely the same. Separate but equal, both systems suck.

[bj]

Libertarian ideas, so-called, about health care are so fucked up, it's hardly worth the effort responding. Take a look at countries--(oooo, evidence isn't our long suit) that have government-run healthcare and see how much healthier on average the citizens of those countries are than the citizens of our priviatized medical paradise. Stupid fucks.

[Barry]

"...at the end of the day, no real accountability from the people who run the joint.

That's wrong. Several high-ranking Army officials lost their jobs over the problems at Walter Reed."

And this helps the victims -- oops, beneficiaries -- of medical services exactly how?

This isn't the sort of "accountability" that matters a whole lot.

I want good medical services when I need them, not the satisfaction of knowing someone lost his job while I suffered or even died.

BTW "health care" as we hear it used is a misnomer. Health care is eating right, getting exercise, and not working yourself to death. Medical services are provided by a doctor when you need something broken, fixed. It makes me shudder to hear the prescription of 8 to 10 drugs indefinitely, to deal with lifestyle-related problems, as "health care", either by the government or by private entities.

[pappy]

I spent 21 years, 7 months, and 7 days as a receipent of Army health care. First, the Army sees sick or wounded Soldiers as overhead charged against its operating budget, and so seeks to reduce this overhead cost. Second, the government employees that work in this system have such a strong union that they just cannot be fired, even for imcompetance. I was so glad to retire and be able to see a private, for profit doctor that I could fire if I didn't like the service.

[david still]

If govt hospitals for military are No Good, as is implied anything done by govt, why not privatize the VA and pour entire military? If govt is No Good, then explain Enron et al as crtooks? If govt is no good, will you refuse social security?

If govt no good, what would folks do when disaster hits, as in Katrina, of course mismanaged, but would state or localos be able to take care of things>?

Ifg govt is no good, why the Patriot Act..that is govt
If govt no good, why FDA--let the buyer take whatever some advertiser tells him is good for him

clue: I spke a yhear ago to a nurse at VA hospital and she said she had always vboted GOP but would not next time because of the cuts they made to VA Hospital where she works...perhaps that is what makes it no good?

[Guy Montag]

For Army "health care" specifically, I have a real long story from my days as a National Guardsman and breaking my thumb while on duty at Annual Training.

The short version is, the only person who showed up anyplace and did anything for my care was me. Added bonus: lost plenty of money and was never reembersed for my trip to the doctor to be put back on flying status.

[tyree]

One of the major forces in ruining our health care has been the tort industry. John Edwards was awarded 20 million dollars in just four years as his share of malpractice claims. You can't have thousands of lawyers pulling that much out of a system and keep it working. My fathers malpractive insurance rates went up $20,000 in one year, and that was 30 years ago.
One point about Walter Reed that I have not heard anyone in the MSM mention yet, and that is the hospital is due to be closed in 4 years. That doesn't excuse the poor care but it helps explain why the Army wasn't gold plating a building that is going to be mothballed or torn down in a short time.

[UglyDuckling]

I'm coming a bit late to the party, but a relevant point that I think lots of commenters are missing: the Army healthcare system (e.g., Walter Reed) and the VA healthcare system *are not the same thing*. In fact, the VA healthcare system is run extremely well now, which makes such blanket condemnations of government meddling in healthcare more difficult.

I cast my vote for the Rorschach test.

[Jennifer]

People with private health insurance using private doctors are customers. They can go elsewhere if they don't like how they're being treated.

In my case (and I suspect I'm not unique), "going elsewhere if I don't like how I'm being treated" would be a simple matter of quitting my job and finding a new one whose health benefits happen to be offered through the insurance company of my choice.

I'm not saying socialized medicine would be a good idea, but what we have now is NOT a free market in medicine, nor anything close.

[Gilbert Martin]

It was government inteference in the free market that caused health insurance to be tied to employment in the first place - wage and price controls set up during World War II.

[Herb Schaffler]

"Except for the part where conditions deteriorated at Walter Reed after anti-government ideologues decided to systematically privatize as many of its operations as they could, you make a good point about this being a result of the government running health care operations."

The VA has had a bad reputation for a long time, long before any privatization was introduced.

[Herb Schaffler]

"Hmmm, an outrageous bureaucracy set up to reflexively deny claims......no way that could happen in private industry."

HMO's were set up to deny claims because medical costs became too high because of overuse of the system due to Medicare, Medicaid, and pre-tax insurance that pays for routine medical visits. We need market incentives to bring down prices like vouchers for Medicaid and Medicare patients and high deductible policies, catastrophic policies, medical savings accounts to encourage people not to overuse the system and to encourage people to shop around for routine care. This would tend to bring down the prices of medical care and the premiums of health insurance.

[Guy Montag]

Gilbert Martin,

Well said!

Side note: the last time I mentioned that on that 'blog I was bringing up at the beginning of this thread, the refutation of that statement was 'employer sponsored health insurance occurred during boom times'. Yes, I shook my head and giggled too.

[Shannon Love]

The problem with military health care is a long standing one going back to the founding.

The historically reoccurring problem with the military is that politicians do not want to spend money on boring routing things, like non-emergency medical care or training ammunition, that actually make a huge difference in the welfare and effectiveness of the military. They'd rather sink the money into some gold plated wizbang weapon that looks good in an ad.

The military itself does not like to cashier incompetent military doctors because it has so few of them (they make something like half civilian pay) and they have so much training invested in them. My son-in-law was permanently maimed when Army doctors bungled the care of his knee following a relatively minor training accident. Subsequently, virtually the entire senior staff and command of the medial facility was "reassigned."

From the perspective of an organization, there is nothing magical about the military. Just because people serve out of a sense of duty doesn't mean they can escape the information problems and perverse incentives that bedevil any large organization. Combine that with political management and you have a recipe for failure.

[Dan Croak]

Little Sally is currently healthy as ox, but thanks for your concern.

[Herb Schaffler]

"i think the biggest obstacle that those against such a system face is the fact that countries with those sorts of systems (as untenable as they may be) are not medical backwaters. people are not watching patients drop like flies in canada and western europe. instead, they're seeing face transplants and the like. yes, there are long lines and delays, etc. - but i think people are willing to wait for what seems to be modern and effective healthcare."

In Canada, they're not dropping like flies because their able to come to America to get their health care rather than wait on lists. Otherwise, some people are dieing while they wait for their names to come up on the lists.

[Herb Schaffler]

"In other words, there was privatization. You and Gil can play the "one drop" card all you like, the government took a chunk of work that used to be done by government employees, and paid a private party to do it instead. That is the dictionary definition of privatization."

True privatization is when health care is run completely by the private sector without any government involvement.

[Herb Schaffler]

." That's why I don't want to put the government in charge of health care, like the Brits did."

Socialized Health Insurance would still be a giant one payer HMO with rationing to cut costs.

[Herb Schaffler]

"Actually, VA patients and Medicare patients report much higher levels of satisfaction with their health care and insurance than the public at large."

Ofcourse they do, since others are paying for it.

[Herb Schaffler]

"We really don't have to wonder about what it would be like - there are plenty of countries that do have it and many of them have healthier populations than the United States does."

An unfair comparison as most of them don't have the large minority population we have.

[Herb Schaffler]

"Gilbert Martin- That, or some people have a problem telling poor people, "Sucks about that cancer. Too bad you don't have more money-we could fix it if you could pay."

We do have charity hospitals in this country where the poor can get their health care. It is only in countries with socialized medicine where people are allowed to die because they don't come to the top of the list. Some countries with socialized medicine even put the elderly at the bottom of lists because the thinking is that they have lived their lives. I know a woman from Holland who says that is the case in her country. Because of our partially private system, our health care is second to none. We assure that everybody gets the medical care they need.

[Herb Schaffler]

"not all socialized medical systems provide bad care"

Some countries don't have a large minority population, so the bad aspects of socialized medicine havn't shown up in them yet. That would not be the case in the US with its large minority population.

[Herb Schaffler]

"Come to think of it, wouldn't the pure libertarian position be against health insurance at all? You are being forced into a pool of shared risk where you end up, through your premiums, to pay for other people's medical conditions."

As long as private insurance is voluntary, there is no reason for libertarians to oppose it.

[Herb Schaffler]

"I have heard some good things about the VA health system."

"...Someone once told me that MRIs only cost $15!"

They cost a lot more because of the taxes charged to pay for them.

[Veteran]

The Walter Reed hospital scandal has a pedigree. Nixon was embarrassed at one of his press conferences in, I think, 1974 by a reporter who called out the VA over horrible conditions at VA hospitals and miserable treatment of Vietnam veterans. Nixon fired the head of the VA the next day, but the scandal died quickly, as I predict this one will also do. We never learn.

[Kevin Carson]

I guess what they really need is to be COMPELLED BY LAW to purchase private health insurance. Much more libertarian.

[Rich]

"But the funnier reason to slam that argument is that the building in question, building 18, isn't managed or maintained by the government, but by a private corporation: one that's also been accused of over-billing the government and of turning in shoddy work for work they did to "support" the active duty troops still in Iraq. But even then, there's more going on than meets the eye. That company had only been managing building 18 for two months, and things had actually gotten better in that time, if not all the way up to liveable. But wait, before you exonerate them: they got that contract despite the fact that they weren't the low bidder, and we're being asked to believe that this has nothing to do with the fact that they're major campaign contributors to Republicans including the President."

http://bradhicks.livejournal.com/318736.html

(and yes, I am well aware what all you domain snobs think of livejournal. doesn't change the fact that it's a good essay.)