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Socialized Medical Care for Veterans:

If private companies had mismanaged outpatient care for veterans the way the V.A. system has, there would be strong calls from all the usual quarters for a government takeover, and proclamations of how we can't trust "greedy" for-profit companies to take care of veterans. Funny how this thought process doesn't seem to work in reverse, except among "free market ideologues," who have been criticizing the V.A. for years.

Related Posts (on one page):

  1. "People Who Don't Believe in Government Do a Bad Job of Running It":
  2. Socialized Medical Care for Veterans:
Stacy (mail) (www):
Interesting angle. Since it's not just another "look at the big spending!" thing, libertarians should add this to their bag of evidence that the current GOP leadership doesn't have any commitment to shrinking government.
3.5.2007 9:02am
Mike BUSL07 (mail):
VA medical care was disastrous during my experience with it in early 2000's. It's characterized by inconsistent demands of a sprawling bureaucracy, professional incompetence, and rudeness.

The only good thing the VA gave me was a veteran's ID, which gets me out of most speeding tickets.
3.5.2007 9:16am
Justin (mail):
This would be more persuasive if it was, you know, true.


Here's John Cole's piece, refuting:

http://www.balloon-juice.com/?p=7939

The real lesson of the VA scandal isn't that this proves that the GOP is right. It's that it proves that the GOP is incompetent.
3.5.2007 9:20am
Humble Law Student (mail):
The piece you reference only cites a Phillip Longman article for support. Phillip Longman has produced such shody journalism over the past several years that I'd almost believe the opposite of anything he says, just because he says it.
3.5.2007 9:34am
Anderson (mail):
I always love it when Republicans (1) grossly underfund gov't programs and then (2) argue that the resulting poor performance means that gov't just doesn't work.

It's like the sound of one hand clapping.
3.5.2007 9:35am
ed o:
VA care has been poor for a long time. Of course, instead of being strictly for veterans for service related illnesses, it treats all who have been in the military for basically any health problem. the VA expanded its mandate as government programs often do and lost its focus on its real job.
3.5.2007 9:36am
ed o:
how many billions of more dollars would you give it to get it up to snuff. will the additional money magically make the mismanagement disappear. if you argue more money is the answer, you have the obligation to tell us exactly how much and what structural changes will be put in place to ensure that it simply doesn't add an additional layer of bureaucracy to an organization that doesn't need it.
3.5.2007 9:39am
Anderson (mail):
Oh, and here's Scott Horton's summary of an Army Times article:

Today's Army Times reports: "The committee wants to learn more about a letter written in September by Garrison Commander Peter Garibaldi to Weightman. The memorandum 'describes how the Army's decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of 'highly skilled and experienced personnel,'' the committee's letter states. 'According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed.' The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official." Fancy that: a former senior Halliburton official.

I would advise y'all holding off yet on exactly *what* the Walter Reed mess is an example of.
3.5.2007 9:48am
stevesh:
Jason van Steenwyck at Countercolumn blog has an interesting point: the medical facilities are often located at bases that the DoD wanted closed but were required by Congressional infighting to remain operational. DoD wanted many of them closed precisely because they were outdated and crumbling. Keeping them open reduced funding for new facilities and upkeep of existing bases.
3.5.2007 9:51am
Andrew W (mail) (www):
I wonder what the relationship between Congressional knowledge, Congressional funding, and VA-system efficacy is. In interviews and speeches, members of Congress always seem surprised at how many vets are in the system--especially upon hearing there are 20,000 Iraq War battle casualties but 400,000 Iraq War vets in the VA system. Or that 10%-12% of Iraq War vets (according to the Pentagon, via that ABC News special last week) suffer brain trauma (from being close to blasts, etc.), which is an expensive injury requiring life-long treatment.

So the biggest problem may in fact be political: as the situation at Walter Reed shows, the VA system, and the executive branch in general, has a strong motivation to understate the strains on the military health care system, leading Congress to be underinformed, leading Congress to underallocate resources.
3.5.2007 9:57am
alkali (mail) (www):
I would point out that the linked article confuses VA medical facilities with Army medical facilities. Walter Reed, for instance, is an Army Medical Center, not a VA Hospital. Fort Dix, Fort Campbell, and Fort Irwin are also Army facilities.
3.5.2007 9:58am
Viscus (mail) (www):
Seriously,

Let us forget whether this tells us something about free market versus government for just a moment. My understanding is that Walter Reed formerly provided excellent care. Just as plausible of an explanation, is that the Bush administration cannot do anything right, because it is run by people like David Bernstein who do not believe in government. It is hard to run something well, when you fundamentally despise the existence of the organization you run. It is kind of like criticizing the idea of FEMA because the current director of FEMA is an idiot Republican more interested in image than results. There is only one conclusion that can be honestly made. This sort of scandal is not all that informative to the larger debate, since it is hard to seperate specific (i.e. Republican) incompetance from theoretically existent systematic failures.

It should also be noted that when corporations are run badly, you don't see a whole lot of conservatives running out demanding an expanded government role. When corporations screw up, conservatives see it as an isolated incident. (Enron and its ilk are "bad apples," nothing more) But if there is a similar screw up in the government, this is evidence of how government is always destined to fail. Does this seem slightly self-serving to anyone else?

Okay. So liberals are probably guilty of their own self serving biases too. (To a liberal, Enron is no mere bad apple, but an example of everything that is wrong with greedy corporations with little accountability.)

But what amuses me, is that conservative/libertarians like Bernstein can only see bias in others. He fails to see it in himself. As when he tries to exploit this incident to advance his free market ideology, when any intellectually honest person would have to say that it is not that informative one way or another. Just as any intellectually honest person would have to say that Enron is not that informative one way or another.

But really, how many times in a day, week, or year do you think someone like David Bernstein questions the superiority of markets for all things? This is a guy who does not believe there should be public universities, even though he works for one. Overall, I do not think we should give much weight to the ideas of people on the left or the right who seem to hold their ideas with a religious fervor. Obviously, when they find "evidence" for their views, their conclusions (though not their evidence) should be dismissed. They always see the evidence for their views, never the evidence against.
3.5.2007 10:01am
Viscus (mail) (www):
Anderson's post above is an example of what I am talking about:


The memorandum "describes how the Army's decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of "highly skilled and experienced personnel," the committee's letter states. "According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed." The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official.


Does it not tell us everything we need to know about confirmation bias that Bernstein did not need to investigate this actual incident before suggesting that the problem was obviously one of too few markets?

Exhibit 1A on why ideologues of any type cannot be trusted.
3.5.2007 10:06am
RBG (mail):
So, for supporters of universal health care, I suppose the point is that Americans should join the crusade, and then hope to God that the Democrats stay in power permanently to ensure that the quality of state-provided health care stays high? Even if you're right--that Republicans are incompetent and that we can't judge the success of any government program while the ship of state is being captained by that rabble--isn't the inevitability of swings in electoral politics a powerful reason to be suspicious of turning over my health care to Leviathan. Just asking, you know, 'cause it kind of matters to me whether I have one provider whose competence might be very high or very low depending on the results of the last election or a diverse group of providers, of admittedly varying quality, among which I can choose.

That may very well be one of the worst legacies of the Bush Administration: giving its opponents the impression that only incompetent administration produces governmental incompetence and that competent administration is sufficient to overcome all the inherent inefficiencies of a government monopoly. That's a frightening delusion.
3.5.2007 10:10am
Viscus (mail) (www):
RBG,

Your right. And for the same reason, we should abolish corporations. You never know when some incompetant will manage to get his or her hands on the steering wheel of a corporation.

In fact, I think the mere possibility of incompetance is reason enough for us to discontinue all activities and hide under our beds.

Brilliant argument. Simply brilliant.

I do wish the GOP would make this one, though.

New GOP slogan:

Smaller government now! Because you don't know when we might end up in control. Mwahahahaha!
3.5.2007 10:24am
Spitzer:
Let's assume, arguendo, that the problems at Reed and elsewhere arose because the government failed to fund the programs properly. Let's assume, also arguendo, that the GOP is entirely and absolutely responsible for the insufficient funding. Finally, let's leave aside, for the moment, arguments to the effect that the level of funding only relates to performance in relation to a program's efficiency - that is to say, more efficient programs will perform better than less efficient programs at the same level of funding.

If the first two points are true - and if we ignore efficiency arguments - they still point to the fundamental problem with a socialist (i.e. single payer) system: it is entirely and absolutely reliant on the single payer's political will to fund the program properly. In a perfect world, governed by Platonic Guardians gifted with omniscience, omnipotence, and the morality and incorruptibility of saints, such programs would always receive the perfect amount of funding to maintain the proper level of services. But in the real world, to borrow Oscar Wilde's bon mot, predicating the success of a program on the appearance of such Guardians represents the triumph of hope over experience. Instead, history and common sense teach us that politicians are corruptible, fallible, prone to misjudgment, and focused on their personal interests which rarely coincide for any time with those of vulnerable constituents. Squeaky wheels get the grease, and I doubt not that the VA and associated medical systems will benefit from this negative publicity with a temporary injection of funds (although, as with all political quick-fixes, the "solution" rarely bears much interest to a program's actual needs), but the essential problem remains: the program remains entirely dependent on the good will and omnicompetence of politicians. In short, the problem is one of monopoly (or monopsony, technically), but in this case the monopoly has the power of government.

In multi-payer systems, where (preferably) consumers themselves, or (less preferably) private companies pay for services from competing service providers, the spirit of competition improves efficiency and (more importantly, from the patients' standpoint) offers patients their own choice among service providers, enabling them to flee to another provider when problems like those at Walter Reed appear.

In short, the original post has it exactly right: the problems at Walter Reed would inevitably crop up in most places under a universal single-payer system. That is to say, private entities are not immune from creating such problems on their own, and private companies are equally (or even more) fallible than the government, and all systems are self-correcting to the needs or preferences of those who foot the bills. Where patients foot the bill, the service providers will endeavor to meet their needs - especially where the consumers have a choice of providers. Where governments or monopolistic private entities foot the billl, however, the service providers care only for the stated preferences of those payers, and needs of patients are recognized by the service provider only to the extent that the payers (government or monopolistic private payer) chooses to pass on patients' complaints and concerns. Those who pay the piper call the tune.
3.5.2007 10:27am
Ian D-B (mail):
If you're going to criticize the VA system, it would be good to use VA hospitals as an example, rather than ones run by the military. It turns out that the VA actually has, by a lot of measures, better performance than nearly any other health system.
3.5.2007 10:27am
bobolinq (mail):
The Philip Longman article about the VA system relies on a study published by the New England Journal of Medicine. I'm not a subscriber so I don't have access to that study, but it is described in this Slate article by Timothy Noah.

It is a big mistake to think that the Walter Reed problems illustrate the inherent incompetence of government and superiority of markets, as many commenters have rightly pointed out.
3.5.2007 10:31am
RBG (mail):

It should also be noted that when corporations are run badly, you don't see a whole lot of conservatives running out demanding an expanded government role. When corporations screw up, conservatives see it as an isolated incident. (Enron and its ilk are "bad apples," nothing more) But if there is a similar screw up in the government, this is evidence of how government is always destined to fail. Does this seem slightly self-serving to anyone else?


Sheesh. Where to begin? You may have noted that Enron failed; it's bankrupt, gone, kaput. When a corporation is run badly, people suffer, yes, but it's a limited number of people, and one generally has other options. Ford and GM may suck, but there's always Toyota, Honda, and Subaru. When the Soviet Union had a state monopoly on automobiles and they sucked, everyone suffered.

The point is the irony that those in favor of government tend to call for further government oversight even when competitors may have avoided (or competition may encourage other firms to avoid) the very behavior/conditions that prompted the call for government oversight in the first place, but a market response is hardly ever countenanced on the left to failures by government providers, even where doing so might produce its own efficiencies and/or expose fewer people to the caprice of the (albeit government) monopolist (see, e.g., school vouchers).
3.5.2007 10:32am
T.:
WALTER REED IS NOT RUN BY THE VA
3.5.2007 10:33am
anonVCfan:
If you're libertarian enough, every imperfection in the government is proof that it should be disbanded.
3.5.2007 10:33am
RBG (mail):

Your right. And for the same reason, we should abolish corporations. You never know when some incompetant will manage to get his or her hands on the steering wheel of a corporation.


See my post at 10:32. The risks you cite (as best I can decipher them) is largely avoided by (1) a diversified investment portfolio, (2) a plethora of competitors (even in retail--I haven't shopped at a Walmart in goodness knows how long), and (3) tort actions. I've never seen a government program that offers the same three brakes on abuses of the government's monopoly power.
3.5.2007 10:37am
Stacy (mail):
I'm going to self-servingly argue that my earlier comment wasn't hip-shooting since I said that it would make a good political issue--something I think we all agree doesn't depend on factual accuracy...

That said, this comment thread is off to a terrible start WRT the conflation of Army and VA hospitals, discussion of the quality of medical treatment when the issue is apparantly facilities maintenance and bureaucracy, etc. I'm guessing not many of us understand the organizations involved here and that it would behoove us all to do research before talking too much about it.
3.5.2007 10:38am
Ian D-B (mail):
RBG, the problem though is that privatization is not the same as a plethora of competitors. It very often means simply government patronage. Yglesias makes this same point today. There are important differences between a free market and the government paying a private contractor.
3.5.2007 10:40am
Ian D-B (mail):
Stacy, you're right. It would have been nice if Bernstein had done the same research, since he obviously made a fairly serious factual error.
3.5.2007 10:41am
RBG (mail):

RBG, the problem though is that privatization is not the same as a plethora of competitors. It very often means simply government patronage. Yglesias makes this same point today. There are important differences between a free market and the government paying a private contractor.


True, which is why the thought of single-payer health care scares the s**t out of me--indeed almost as much as truly socialized medicine does.
3.5.2007 10:42am
Ian D-B (mail):
RBG,

I guess the theory is that if the government is basically giving consumers the money with which to buy medical services. That allows for a market to exist. It's in that way preferable to the government simply providing all services.

I know that sounds very much like redistribution (which I imagine I'm more sympathetic to than you), but I think the important difference is the insurance mechanism -- it's redistribution based on illness, rather than based on poorness.
3.5.2007 10:48am
J. F. Thomas (mail):
Where patients foot the bill, the service providers will endeavor to meet their needs - especially where the consumers have a choice of providers.

But of course, in this case we are never (I hope to God) going to ask the patients to foot the bill. David is suggesting we turn the military medical care system over to private entities because they will presumably be able to provide care more efficiently and also a superior product. He doesn't explain how this will this will occur, just that it would be. The government would still be paying the bills, and the private companies' first priority would still be profits, not delivering quality care. No matter how much he bitches about government healthcare, the simple fact remains that overhead on government healthcare programs are generally much lower than on private programs.
3.5.2007 11:09am
Viscus (mail) (www):
Ian D-B writes:


When a corporation is run badly, people suffer, yes, but it's a limited number of people, and one generally has other options.


Yes and no. If a corporation providing you health care screws up, you may not have other options. But in other cases, you are right.

However, in general, government failures, like market failures, are corrected. If those in control do not take action to correct problems, they will be voted out of office. Also, most government failures affect a limited number of people, and one often has other options. If you don't like a particular public university, go to another university, public or private. If you do not like a particular public school, go to another, public or private. If you don't like the post office, use fed ex. If you don't like the DMV, take the bus. Just as in the private sector, you usually have other options. Just as in the private sector, those other options may or may not be attractive to you, assuming you can afford them. Your distinction here, while not totally meaningless, is overwrought.

We have a political process to keep government accountable.


The point is the irony that those in favor of government tend to call for further government oversight even when competitors may have avoided (or competition may encourage other firms to avoid) the very behavior/conditions that prompted the call for government oversight in the first place.


This point is nonsensical. There is competition within government, just as there is competition within markets. Note that the Walter Reed scandal has destroyed the career of a 2 star general and the Secretary of the Army has resigned. They will be replaced by competitors.

It would be as if I complained that when companies like Enron were involved in scandal, that conservatives call "for further market oversight" instead of having the function in question taken over by government. It is an empty criticism, because the market actor exercising "oversight" is different. Likewise, your criticism about "further government oversight" is meaningless, because the government actor exercising oversight is different.

Competition is not the exclusive province of the private sector. Especially at the higher levels of government.

There are advantages and disadvantages to different structures, whether government or market, for different situations. But I don't expect "free market ideologues" to recognize this anytime soon. They will, instead, say that market solutions are always or nearly always superior. And as I said, for anyone who is intellectually honest, their conclusions (though not their evidence) should be discarded and ignored, because they are ideological in nature, and typically not subject to reasoned discourse.
3.5.2007 11:13am
J. F. Thomas (mail):
True, which is why the thought of single-payer health care scares the s**t out of me--indeed almost as much as truly socialized medicine does.

Well, if the alternative is a system that spends 50% more on health care, delivers inferior care and still leaves one in six people completely without health insurance, single payer begins to look like a more rational choice.
3.5.2007 11:13am
JosephSlater (mail):
This reminds me of DB's post on the Iraq war -- it seemed like a good idea at the time, but gosh, he just forgot how fundamentally incompentent government in general is.

It must be very reassuring to be a right-winger/libertarian. You endorse or push through certain policies: the Iraq war, privitization schemes, whatever. Then, if they work, great; it shows you were right because your side had the best policies. If they don't work, you were still right because you knew all along government couldn't accomplish anything.

Several posters have pointed out the Bush administration's peculiar incompetence already. I'll just add that this incompetence isn't accidental. The Bush admin., more than any other I know of, has made it an intentional policy in staffing and running federal agencies, to stress political loyalty over expertise.

The FEMA/Brown scandal was only the tip of the iceberg. That sort of thing is going on all through government, and it's a conscious policy. Read some turn of the 21st Century Heritage Foundation publications explicitly urging loyalty over expertise in federal personnel matters. The most recent example? Look what's happening to U.S. District Attorneys. Then, after competent DAs are fired for making the mistake of prosecuting political allies of the administration and replaced by loyal cronies, look forward to future posts on this blog about how government can't do criminal justice effectively.
3.5.2007 11:29am
davidbernstein (mail):
Hey, commenters: Before you go spouting off, how about taking a glance at the link I provide which IS NOT specifically about Walter Reed, but about care in the VA system more generally.
3.5.2007 11:34am
Randy R. (mail):
I recall a debate on Bill Maher, and he had on Tucker Carlson. The issue was universal health care and the Canadian system. Carlson spouted off about how superior our system was, until Maher cut him off and said, yeah for those who have health care coverage. For those who don't, the Canadian system works better for them.

inefficient health care is better than no health care.
3.5.2007 11:35am
Steve in CA (mail):
But what does Walter Reed have to do with the VA system? It's not a VA hospital.
3.5.2007 11:40am
SeaDrive (mail):
Spitzer made my point better than I could.

My wife asked me if Paul Krugman had chimed in on the Walter Reed fisasco.
3.5.2007 11:46am
alkali (mail) (www):
Hey, commenters: Before you go spouting off, how about taking a glance at the link I provide which IS NOT specifically about Walter Reed, but about care in the VA system more generally.

Actually, it isn't: as I pointed out, many of the facilities referenced in the article are Army not VA. It's not clear to me that the reporters on the piece (one of whom is Dana Priest, who is generally a very good reporter) understand the difference.
3.5.2007 11:57am
davidbernstein (mail):
Alkali, if I mistakenly relied on misrepresentations by the Post reporters, I stand correct. HOWEVER, if we substitute "VA system" for "Army-run hospitals," the point is exactly teh same: when the private sector screws up, the usual suspects call for socialization; when the socalized sector screws up, the usual suspects do some combination of calling for throwing more money at the problem, and claiming that it's all about the incompetence of particular individuals, not the system itself.
3.5.2007 12:05pm
Viscus (mail) (www):

Before you go spouting off, how about taking a glance at the link I provide which IS NOT specifically about Walter Reed, but about care in the VA system more generally.


Where is the admission that you failed to consider that privatizing support services might have contributed to this fiasco and that you failed to consider that in your initial post, before going off on how this was proof of the need for markets to take over this particular function?
3.5.2007 12:11pm
Viscus (mail) (www):

when the private sector screws up, the usual suspects call for socialization; when the socalized sector screws up, the usual suspects do some combination of calling for throwing more money at the problem, and claiming that it's all about the incompetence of particular individuals, not the system itself.


And when the government sector screws up, the usual suspsects call for privatization. When the private sector screws up, the usual suspect say that this is just an example of a "bad apple" and replacing/punishing the particular private sector actor in question is enough.

What I find interesting is not that you have identified a bias in others, but rather, that you fail to see it elsewhere as well. You appear biased in your ability to detect bias.
3.5.2007 12:17pm
Anderson (mail):
HOWEVER, if we substitute "VA system" for "Army-run hospitals," the point is exactly teh same: when the private sector screws up, the usual suspects call for socialization; when the socalized sector screws up, the usual suspects do some combination of calling for throwing more money at the problem, and claiming that it's all about the incompetence of particular individuals, not the system itself.

And if the "socialized" sector does really well, as the VA system has, then we hear the crickets chirping.
3.5.2007 12:20pm
wburgjo (mail):
Most "usual suspects" I know aren't suggesting that its incompetence of individuals, but rather systemic, ideological indifference - from the president on down - towards the lives and well-beings of working-class people. How else could the nightmare of Walter Reed be allowed to have happened? How else could so many people turn a blind eye to this problem for so long, to let injured and maimed soldiers suffer such inhumanity and indignity for so long? Our leaders don't care, and they don't want to know. To them, the suffering of soldiers is incidental and inconvenient, secondary to the cause of war.

Trying to wedge this into a "free-market versus socialization" ECONOMIC question WILLFULLY OBSCURES a searing, and very simple, MORAL question: Our government sent these men and women to war; shouldn't our government take care of them when they return?

Why are so few people from the right asking that very simple question? Why has there been so little gut outrage from the right over the Walter Reed issue? It's because it exposes, so blindingly, the utter emptiness and mendacity of their "support the troops" mantra.
3.5.2007 12:36pm
davidbernstein (mail):
WB, "well-meaning" bureaucrats engage in not-so-benign neglect all the time. Witness many indifferent social workers, lazy teachers, hospital workers at the army hospitals, and so forth, many of whom went into their fields burning with idealism. Being well-meaning is not a substitute for giving people an incentive to perform, especially over the long-term. 99.999 percent of the public isn't like Mother Theresa.
3.5.2007 12:42pm
RBG (mail):

I recall a debate on Bill Maher, and he had on Tucker Carlson. The issue was universal health care and the Canadian system. Carlson spouted off about how superior our system was, until Maher cut him off and said, yeah for those who have health care coverage. For those who don't, the Canadian system works better for them.


Except that many, if not most, Americans without health insurance receive completely adequate health care when they really need it. Nevertheless, even if you're correct, I'm not sure whether this is a point you want to advertise in the campaign to persuade Americans to follow Canada down the road to socialized medicine: "Vote socialized health care. It'll be an improvement for the 15% of Americans who lack health insurance. For the remaining 85% of you, sure, you'll see a decline in efficiency, but that's a small price to pay, eh?"
3.5.2007 12:44pm
Adeez (mail):
Great post wburgjo. Michael Moore had the temerity to show the American public actual clips of our Commander in Chief telling the very wealthiest Americans, "the haves and have-mores" that they indeed are his "base." For this service, people routinely equate Moore with the rabid Coulter-types of the right.

Jokes like W's are only funny if they're true. No matter what one labels him/herself, everyone should be disgusted by this administration's raid of the treasury for the benefit of the few.
3.5.2007 1:01pm
wburgjo (mail):
And if our government puts soldiers in harm's way, whose responsibility is it to provide "incentive" for their caregivers back home to "perform"?

Some other folks here that engage in not-so-benign neglect here include IAP Worldwide Services, a private corporation that took over operations at Walter Reed last year (same one that couldn't seem to get enough ice after Katrina) and gutted the staff of experienced workers, resulting in "a risk of mission failure" according to an Army Medical Command memo. Its actually far worse than not-so-benign neglect in this case. Its a systematic dismantling of services, driven by the ideology of profit.

Here again, the fundamental lack of moral concern in your response is truly telling.
3.5.2007 1:05pm
Justin (mail):
Except that many, if not most, Americans without health insurance receive completely adequate health care when they really need it.

Depending on your definition of the italicized part of your statement, I call shenanigans. Either people like Deamonte Driver are obtaining "completely adequate" health care under your definition, or your empirical argument is false.
3.5.2007 1:27pm
JosephSlater (mail):
Well said, Viscus, in all of your posts.
3.5.2007 1:27pm
ed o:
a mother ignores her child's toothache until it is too late and I am supposed to infer something chilling about our health care system? why not do something like define how much less health care you will take from the system to ensure "adequate" care for the poor? will you take a 6 month wait for an MRI? 3 months to see a heart specialist for those nagging chest pains? will you exchange universal mediocre coverage for being able to get into that specialist or get that diagnostic test right now? how far does you compassion go-would you sacrifice one of your own for it?
3.5.2007 1:37pm
JohnAnnArbor (www):

Well, if the alternative is a system that spends 50% more on health care, delivers inferior care and still leaves one in six people completely without health insurance, single payer begins to look like a more rational choice.

Those of us near the Canadian border can disabuse you of that. Our hospitals have all sorts of Canadian patients, crossing the border to pay for what is supposedly free (but unavailable) for them at home.
3.5.2007 1:42pm
wburgjo (mail):
Here's what happens when you combine right-wing war-mongering with a marketplace approach to health care. Some quotes from David Chu, the Pentagon's undersecretary for personnel and readiness.

Re veteran benefits: "The amounts have gotten to the point where they are hurtful. They are taking away from the nation's ability to defend itself."

Re veteran retiree benefits: "Benefits that apply mainly to retirees and their families are making it harder for the Pentagon to afford financial incentives for today's military…"

"(Retiree benefits) are starting to crowd out two things: First, our ability to reward the person who is bearing the burden right now in Iraq or Afghanistan. Second, they are undercutting our ability to finance the new gear that is going to make that military person successful five, ten 15 years from now."

So, apparently, our priority is in funding new wars OVER caring for those who fought the old ones.
3.5.2007 1:49pm
Will Roberts (mail):
Hate to burst everyone's libertarian bubble, but the VA provided the best care in America under Clinton, and has only started declining again under Bush. The problem is administration policy, not "the gumnit."


Roemer [a VA patient] seems to have stepped through the looking glass into an alternative universe, one where a nationwide health system that is run and financed by the federal government provides the best medical care in America. But it's true — if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.

According to a Rand Corp. study, the VA system provides two-thirds of the care recommended by such standards bodies as the Agency for Healthcare Research &Quality. Far from perfect, granted — but the nation's private-sector hospitals provide only 50%. And while studies show that 3% to 8% of the nation's prescriptions are filled erroneously, the VA's prescription accuracy rate is greater than 99.997%, a level most hospitals only dream about. That's largely because the VA has by far the most advanced computerized medical-records system in the U.S. And for the past six years the VA has outranked private-sector hospitals on patient satisfaction in an annual consumer survey conducted by the National Quality Research Center at the University of Michigan. This keeps happening despite the fact that the VA spends an average of $5,000 per patient, vs. the national average of $6,300.


Whose report is this? Those commies over at Business Week.
3.5.2007 1:53pm
William Tanksley (mail):
When corporations screw up, conservatives see it as an isolated incident.


Good point -- many seem to. However, the economics on which the "conservative" claims are based is simple and clear: When corporations screw up, their failures are caused by the same forces which will cause similar failures in governments.

Governments have all the same failure modes as corporations, plus unique ones caused by their unique ability to use force. The worst failure modes of corporations -- for example, internal politics -- are amplified in governments. Finally, governments tend not to have the financial negative feedback that corporations necessarily have (however suppressed that feedback might be for a megacorporation).

Too many people in this debate (liberals especially) seem not to realize that governments aren't special. "Market failure" is a concept that applies to government as well as private industry.
3.5.2007 2:05pm
Stacy (mail) (www):
Seems like someone linked this post at DU or some such place.

Not that this will make an impression on the populist types, but the accusation of 'willful indifference from the President on down' is at least as big a leap as summarily blaming 'government-run healthcare'.

And Micheal Moore isn't the leftwing Ann Coulter, Markos Moulitsas is.
3.5.2007 2:14pm
wburgjo (mail):
Stacy, its awfully hard to watch the Walter Reed hearings today and NOT see willfull indifference at every level of the system... as experienced by 3 quite credible individuals on the receiving end of that willful indifference. How else to explain why Kiley was so reluctant to hear complaints?

Speaking of Kiley, here's some interesting and relevant observations about him from an article in today's Washington Post: "In interviews, some said he was a deft leader, but others criticized his apparent desire to stick to the budget and increase productivity while sacrificing care.

"His last concern was his concern for the patient," said retired Col. Robert M. Tabachnikoff, chief of obstetrics and gynecology under Kiley at Landstuhl in the mid-1990s. Tabachnikoff said Kiley wanted to discharge new mothers within 24 hours of delivery to keep beds free and counted phone calls as office visits. "

All about the bottom line.
3.5.2007 2:23pm
RBG (mail):

the VA provided the best care in America under Clinton, and has only started declining again under Bush


Again, I take it your point is "Vote for nationalized health care, and hope to God the Democrats stay in power. Perpetually. 'Cause otherwise you're screwed." As I commented earlier, even if I grant the difference between highly efficient, expertise Dem bureaucrats and incompetent Republican ones, your argument gives me little cause for comfort at the prospect of expanding government's monopoly power over ever larger sectors of our economy.

And, the name of the magazine notwithstanding, BusinessWeek is no Wall Street Journal, editorially speaking.
3.5.2007 3:00pm
Jim Rhoads (mail):
There is no excuse for allowing any single one of our fallen heroes to slip through the cracks of bureaucratic stupidity. These young men and women are all volunteers. They deserve at least the A-1 care that each of our elected officials and civil servants get.

All of our Congressional Representatives and Senators should quit posturing and authorize immediately the following:


Include any member of the armed services serving in Iraq and Afghanistan who has been injured or contracted an illness in the line of duty in the Congressional Health Care Program; and

Provide each such member with a volunteer advocate who is an experienced attorney, trained in healthcare law who can help the member steer through any remaining bureaucratic bullsh**.

My legal foundation is now recruiting volunteers for the advocacy program, whether or not Congress acts on the first part of this suggestion.

Please let me know by email or comment if you are willing to help by publicizing this idea or otherwise.
3.5.2007 3:00pm
J. F. Thomas (mail):
Those of us near the Canadian border can disabuse you of that. Our hospitals have all sorts of Canadian patients, crossing the border to pay for what is supposedly free (but unavailable) for them at home.

As our underinsured and elderly cross over the Canadian border to get cheap prescription drugs.
3.5.2007 3:25pm
Seerak (mail):
Overall, I do not think we should give much weight to the ideas of people on the left or the right who seem to hold their ideas with a religious fervor.

Would that include that peculiar religion known as "belief in government"?

And if the "socialized" sector does really well, as the VA system has, then we hear the crickets chirping.

No, that's the sound of tapping feet. Socialized systems fail because they are socialized -- that's their basic flaw -- and they cannot keep "doing well" for long.

inefficient health care is better than no health care.

David, there is the source of your "ratchet". Once the government nationalizes something and the inevitable disaster starts happening, the left keeps in in place by intoning that if the government doesn't provide "X", then there will be no "X". If it weren't for the government, then we'd have no roads, no schools etc.

A milder version of that, used for the slightly more aware voter, is that "only the rich" would have X.... but it's the same kind of willful ignorance of free markets.

Trying to wedge this into a "free-market versus socialization" ECONOMIC question WILLFULLY OBSCURES a searing, and very simple, MORAL question

Free markets versus socialization IS a searing and very simple moral question: freedom versus tyranny. The "free" in free markets and the "free" in freedom are one and the same.

Those of us near the Canadian border can disabuse you of that. Our hospitals have all sorts of Canadian patients, crossing the border to pay for what is supposedly free (but unavailable) for them at home.

When I emigrated to the US from Canada in 1997, I was struck by the carefully maintained ignorance of what was happening in Canada, by American advocates of socialized medicine, especially with the ease of access to Canadian news via the Internet. I made a habit on Usenet of linking to articles on globeandmail.com and thestar.com with hardly any commentary of my own, to greater effect than most argumentative posts, even those operating from valid principles. If I had the time, I'd buold a network of Canadian correspondents and start a blog documenting the continuing failure of the Canadian system.

I'll say it again: socialized systems of any kind fail because they are socialized. Period.
3.5.2007 3:31pm
BobNSF (mail):
If you think the VA provides long-term care -- inpatient and outpatient -- that is inferior to privatized care, go visit your grandmother or aunt in her rest home. CORRECTION: go visit the grandmother or aunt of someone whose income is just like yours... minus a digit or two.
3.5.2007 3:32pm
Stacy (mail) (www):
wgburgjo: "Stacy, its awfully hard to watch the Walter Reed hearings today and NOT see willfull indifference at every level of the system... as experienced by 3 quite credible individuals on the receiving end of that willful indifference. How else to explain why Kiley was so reluctant to hear complaints? "

Oh I see willful neglect and lousy management, I just don't follow you in raising it to some sort of conspiracy in the White House to squeeze a few bucks out by making childbirth an outpatient procedure. The guilty parties are lower down the totem pole, and while we can legitimately worry that the administration won't hold those folks accountable, this isn't the kind of thing that the President should fall on his sword over. Chances are that the system worked alright until casualties with long term care needs started to build up, but we're not going to know for sure until an investigation takes place.
3.5.2007 3:35pm
MDC:
Throughout all this discussion, the most amusing part is the extreme extrapolation that goes on. CLEARLY it represents how Bush doesn't care about the little man! Sure... that's what it demonstrates. Hyperbole is an invitation for mockery, either side.

The only thing this event demonstrates is that there were some problems in a bueaurocracy. Earthshaking, that.

This isn't an indictment of military hospitals, the VA, the President, Democrats, anybody but the hosptial administrator. This is a single point in space, not an obvious line (up or down). It's an issue because it was made into an issue. Hell, I'm not even blaming our idiotic, generally incompetent press... it's just the event dejeure. I do resent those that are opposed to the war using this as an example of how they really do care about and support the troops, but the Walter Reed Disaster has no real substance at all. It might be the starting point for addressing issues (you know, fixing problems, not blame), and certainly a wake-up call for other facilities to get their houses in order. Those are good things. But indicting (or supporting) any system based on this is kind of stupid (IMHO).
3.5.2007 3:36pm
jimmy (mail) (www):
I've often wondered why they don't just treat VA benefits like a big group health plan and send the vets through the private sector.

My father in law died of bladder cancer at the hands of the VA. Being an unaccountable government institution; they just didn't care whether the patients improved or not. When he finally got out and into the private sector they diagnosed and treated him quickly but it was too late.
3.5.2007 3:58pm
JosephSlater (mail):
MDC writes: I do resent those that are opposed to the war using this as an example of how they really do care about and support the troops,

Maybe we would have less of that if the Republicans, from the top leadership on down, hadn't made it a repeated talking point that liberals, war opponents, and Democrats in general really don't care about or support the troops.
3.5.2007 4:01pm
wburgjo (mail):
Seerak: You ignored/avoided the question that followed your cut-and-paste of my post, which is quite telling. My question was:

Our government sent these men and women to war; shouldn't our government take care of them when they return?

Or should that, too, be left up to the market?

Its easy for free-market conservatives to make abstract, circular pronouncements ("socialized systems fail because they are socialized"). But when it comes to addressing (or even thinking about ) on-the-ground realities of health care for war veterans today (a system that is failing in large part BECAUSE of a privatizing, profit-driven approach to health care prevalent in this administration) - there doesn't seem much appetite for discussion.
3.5.2007 4:03pm
wburgjo (mail):
Stacy:

No one's talking about conspiracies. We're talking about an ideology of warfare that neglects those who actually fight the war.

You say: "Chances are that the system worked alright until casualties with long term care needs started to build up, but we're not going to know for sure until an investigation takes place."

If the system can't anticipate long-term casualties in a time of war, then there's a problem. The larger meaning here - which is the right wing's utterly disingenuous approach to this entire war - is "How were we to know?" "How were we supposed to prepare for - gasp - long-term casualties?" Please. Its a war! Its the exact same do-it-on-the-cheap approach to health care that Rumsfeld had to warfare.

And again, who pays the price? And again, why aren't the "support the troops" right-wingers paying any attention to this? It's not just Walter Reed, by the way, veterans' health care is a mounting disaster everywhere. Does the right wing "support the troops" only when they go off to die, and not when they come home to recover?
3.5.2007 4:23pm
J. F. Thomas (mail):
You know its nice for all of you free-market advocates to disparage "socialized" medicine, but the simple fact is that this country spends more on healthcare (50% more than the next most extravagant country) and delivers an inferior product when put up against any comparable country. Until you can explain away the seemingly better health care results with more complete coverage (most industrialized countries manage to cover 100% of their population, not just 85%) in countries, at lower cost, with "socialized" medicine, your undying belief in the market looks kind of silly.
3.5.2007 4:34pm
Adeez (mail):
"Free markets versus socialization IS a searing and very simple moral question: freedom versus tyranny. The "free" in free markets and the "free" in freedom are one and the same"

Seerak: is it your position that the freer the market, the freer the society and we the people? If not, I apologize for the mistake and please clarify this point if you will. If so, I strongly disagree.

Coincidentally, I just heard today a report of a study revealing a list of the freest markets in the world. The only ones I heard were nos. 1 &2: Hong Kong and Singapore. Nuff said.
3.5.2007 4:37pm
Stacy (mail) (www):
You guys need to stop claiming that "rightwingers" are silent on the Walter Reed issue. Michelle Malkin, Glenn Reynolds and most of the military bloggers have been all over it. I don't go around saying Kos, Arianna Huffington etc. aren't talking about something--I don't read them so I don't know if they are or not.
3.5.2007 4:39pm
david still (mail):
Frankly, I find this funny and very amusing.
The govt has the army, not private enterprise, owned by a stockholding goup. Are you suggesting we privatize the military? Instapundit merely cites your post of an example to claim that if this were private (the Reed Hospital), the Left would say it ought to be taken over by the govt. In fact, if it were private it would get (1) get away with it (2) get govt subsidies, (3) get swallowed up by another big organization. Now it is nice to think all things can be viewed from a Libertarian perspeictive, but either you want the govt to have a military or you do not. The issue here is that the govt, under Bush, has screwed up the very gujys that have served us so faithfully (I don'[t even get into VA budget cuts), .

Stacy claims that the Right bloggerfs are not ignoring this issue. Oh? Reread Instapundit and note how he shifts the arguement to another issue., refusing to fault the guy and the placw where the buck is supposed to stop Pardon ref to a Democrat).
3.5.2007 4:50pm
wburgjo (mail):
I actually read Michelle Malkin's "coverage" and it sure as heck wasn't "all over it." 2 incredibly dismissive posts. 1 entitled sarcastically: "Newsflash: Government-run health care sucks." Another says: "these failures are damnable--and nothing new" and her commentary is more about pre-emptively smearing anyone on the left who cares about this issue as "grandstanding." Not exactly sincerely "all over it" if you ask me.
3.5.2007 4:54pm
RBG (mail):

delivers an inferior product


What is the metric you're relying on here? Certainly, our medical system may not be sufficient to overcome the deleterious effects of our gluttony and aversion to exercise on our longevity stats, but certainly there are far too many factors involved to make that an accurate indication of the quality of the product. Indeed, it's almost as absurd as arguing that the level of traffic congestion justifies nationalizing the automobile industry.

As with the auto industry, I would think we'd be looking at the quality and efficiency of the goods and services that are actually delivered. My Canadian friends would certainly envy me for my ability to schedule an MRI and a sleep study within two weeks of seeing a neurologist (with whom I made an appointment the day before); I suspect they'd've been put on a wait list of several months, at the very least. I'm not sure how this qualifies as an inferior product, but it's one I'm more than happy to pay a 30-40% premium for, thank you very much.
3.5.2007 5:09pm
elendil (www):
Did everyone else see this Army Times article saying that Walter Reed had been privatised? According to the article:

The memorandum "describes how the Army's decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of 'highly skilled and experienced personnel,'" the committee's letter states. "According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed." The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official.

Halliburton... Halliburton, where have I heard that name before? Further, they're implying that it's being covered up:

Committee Chairman Henry Waxman and subcommittee Chairman John Tierney asked Weightman to testify about an internal memo that showed privatization of services at Walter Reed could put "patient care services at risk of mission failure." But Army officials refused to allow Weightman to appear before the committee after he was relieved of command.

I don't know, maybe the Army Times is well known for its liberal bias and doesn't really support our troops.
3.5.2007 5:11pm
ed o:
are the socialized health care systems "better". how long do you have to wait for diagnostic testing? surgery? what medicines have been developed there as opposed to here? when you make a blanket statement and still don't answer the simple question of what you are willing to sacrifice in the quest to cover that 15% figure you like to throw around,your argument becomes irrelevant and whiny.
3.5.2007 5:13pm
RBG (mail):
The pernicious influence of Prez. Bush is indeed at work in the NHS as well. No other possible explanation for the incompetence of their health care planners. Poor Brits! No wonder the Guardian worked so hard to swing Ohio Kerry's way.
3.5.2007 5:14pm
tioedong (mail) (www):
Hmm...but how many of you guys have actually worked in government hospitals?
I spent six years in a state ICF/MR (long term care) and ten plus years in the IHS (federal Indian hospitals). They all had the same problems: Red tape and pressure to stay within the budget. And, in contrast to private care, the physical plant is ugly,(ugly concrete walls, ugly furniture, ugly linoleum or carpet) the waits for non emergency care is long due to lack of personnel, and the hiring system to get more personnel is slow.
You have limited physician choice (many foreign docs) and limited medicines. The physical plant can be fixed, but requires a long paper trail of proposal, approval, contract bids, and then it might be done.
If you need open heart surgery, it's great. They will send you to a center that does it or subcontract. If you need less acute care it's not. You wait. Priorities, you know.
Another thing to remember: Walter Reed was so old it had been scheduled to be shut down; I suspect many problems simply weren't fixed.
My solution? Approve vouchers for the non emergency care. That can be done faster than trying to work thru the system.
3.5.2007 5:21pm
RBG (mail):
tioedong, your point needs to be made more often. Having spent nearly a decade in Japan, I can attest to the generally high quality of their medical personnel, but the vast majority of Americans would wheel their gurneys to the barricades rather than put up with the dismal quality of the physical facilities provided by most medical institutions. Depressing, ugly, dark, dank, gray, dirty, moribund, grimy, exposed--I always found myself surprised that anybody managed to make it out alive, rather than becoming psychologically overwhelmed with the grimness of it all. If advocates of nationalized health care were honest with the American people and showed them what health care would really look like--even if they also proved that the outcomes would be no different and costs would be 40% lower--they would still lose overwhelmingly.
3.5.2007 5:30pm
Bruce Hayden (mail) (www):
The Army Times is one of the papers published by the Military Times Media Group, a subsidiary of Gannett, Co, not known as a supporter of this Administration. I am not commenting on the facts provided by them, but rather on their slant.
3.5.2007 5:34pm
Visitor Again:
David Bernstein wrote:

Alkali, if I mistakenly relied on misrepresentations by the Post reporters, I stand correct. HOWEVER, if we substitute "VA system" for "Army-run hospitals," the point is exactly teh same: when the private sector screws up, the usual suspects call for socialization; when the socalized sector screws up, the usual suspects do some combination of calling for throwing more money at the problem, and claiming that it's all about the incompetence of particular individuals, not the system itself.

Except in the case of the private company running Florida's post-sentence sex offender commitment program, described in part two of a three-part series in today's New York Times. It's screwed up and it's calling for throwing more money at the problem and claiming it's about the incompetence of the system itself, not the individuals who staff it.
3.5.2007 5:39pm
J. F. Thomas (mail):
I suspect they'd've been put on a wait list of several months, at the very least. I'm not sure how this qualifies as an inferior product, but it's one I'm more than happy to pay a 30-40% premium for, thank you very much.

It's nice that you can get it immediately, assuming of course it is covered by your insurance or you can afford it out of pocket. And that is the difference. Although 100% of Canadians might have to wait a couple months for a non-emergency MRI, maybe the 70% of the Americans with good insurance can walk right in (actually even we have to wait a week or two for our insurance companies to approve it) and get the MRI. The other 90 or 100 million Americans who would benefit from a non-emergency MRI (and I bet a good number who go to an emergency room who probably should get an MRI but who have lousy or no insurance who need an MRI) are SOL.

are the socialized health care systems "better". how long do you have to wait for diagnostic testing? surgery? what medicines have been developed there as opposed to here? when you make a blanket statement and still don't answer the simple question of what you are willing to sacrifice in the quest to cover that 15% figure you like to throw around,your argument becomes irrelevant and whiny.

The way you judge anything, by results. Infant mortality, heart disease, life expectancy, any measure of health you care to use. The numbers in this country are at best middling. Yet we spend around 15% of our GDP on health care, while the next closest country spends around 11%.
3.5.2007 5:43pm
Gaius Obvious (mail):

The memorandum "describes how the Army's decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of "highly skilled and experienced personnel," the committee's letter states. "According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed."


I don't see how this is supposed to represent a failing of the privatization effort. To me it seems the intended outcome. Let's say I run a small business and have a night staff who come in and clean up but I think I am spending too much on them. I find a private company that can do a better job for less money than I spend on my own employees. So I hire the new company to do the cleaning. Would anyone be surprised to find that this was causing "an exodus of highly skilled and experienced personnel" among my janatorial staff? Or that the new contract cleaners were leading to "a precipitous drop in [janatorial] support personnel" at my company?

It seems to me that those are loaded phrases chosen specifically to make it appear that something alarming was happening, when reducing staff support personnel and replacing them with less expensive contractors was the goal all along. I don't see it as an example of a failing privatization effort at all as some here have painted it.
3.5.2007 5:44pm
Gaius Obvious (mail):

The way you judge anything, by results. Infant mortality, heart disease, life expectancy, any measure of health you care to use. The numbers in this country are at best middling.


The infant survival rate in this country is better than most any other country in the world. The numbers are inflated in terms of mortality in that premature babies that live only a few hours would be reported as stillbirths in other countries but are reported as live births here. You need look no further than the recent example of Amillia Taylor who was delivered at 22 weeks gestation in Miami. After intensive support she was released from the hospital. That would not have happened in many other countries that have a less aggressive approach to premature infants.
3.5.2007 5:53pm
Bruce Hayden (mail) (www):
It's nice that you can get it immediately, assuming of course it is covered by your insurance or you can afford it out of pocket. And that is the difference. Although 100% of Canadians might have to wait a couple months for a non-emergency MRI, maybe the 70% of the Americans with good insurance can walk right in (actually even we have to wait a week or two for our insurance companies to approve it) and get the MRI. The other 90 or 100 million Americans who would benefit from a non-emergency MRI (and I bet a good number who go to an emergency room who probably should get an MRI but who have lousy or no insurance who need an MRI) are SOL.
I am not clear on how you are getting your 90 to 100 millions, and you should note that they are not all the same. Indeed, a lot of those are young singles who voluntarily choose not to spend the money on health care insurance regardless of its low cost to them (working at a ski area, accident policies are offered at $10 a month to empoloyees. One of our guys forwent that payment, spent it on beer, tried to do a flip on his own time, landed on his neck, and couldn't get a CAT scan to release him for work. I don't have a lot of sympathy for him, given the cost of the policy he didn't buy).

One thing to keep in mind with your MRI example is that the demographic that presumably uses the most MRIs per capita is also the demographic that is covered by socialized medicine in this country, i.e. Medicare.

The other thing is that you seem to be unestimating some of the wait times. We go to Canada most years on a male bonding ski trip. One of our usual guides needed hip surgery or he would be out of work. The Canadian system put him on a waiting list, and he was told it would take 3-4 years. All of course, without pay, since that was his livlihood. So, he flew to India, paid cash, and was back home w/i a week, and on skis w/i a month.
3.5.2007 6:32pm
michael (mail) (www):
I think a mixed system, yes, 'You call THIS a system!', is helpful for maximizing outcome. I'm a physician who worked in the VA and now work out of it. My evaluation of my performance is that it was better at the time I was with the VA for being in it and better for being out of it, and having been in it, now. Who's on first, right? If you will allow a 'lifer' line, the mission of the VA is patient care, research and education. You are appointed at your perceived rank for productivity in the VA system and have a supervisor who, periodically, will discuss your care of patients with you, and make suggestions. The fact that research and university affiliation is part of the VA means that that person, and others in the system, have a better chance of being able to educate. There are people who benefit from that and from the 'free from the market' orientation the VA provides and can be more productive. Others, or the same person at other times, may be in a different situation; may be more productive in private practice. The market between public and private and university is itself a 'market' that, I think, may contribute to an optimized outcome.
3.5.2007 6:57pm
BEB (mail) (www):
My father, a combat veteran of WW2, multiple tours of Korea and multiple tours of Vietnam, was lying on what ultimately was his deathbed at the local hospital suffering from a stroke and heart attack.

Our attempts to have his records forwarded down from the VA, where he insisted on being treated before, were met with indifference. After I finally created enough of a stir, they agreed to fax them down late in the day. Nothing was legible. The person on the other end made no effort to take the slightest care in providing us with what might have been critical information at that moment.

My father died soon after. I can't say with certainty that the VA contributed to his death but they certainly did not contribute to his health.

It is a national disgrace that the men and women who make the greatest sacrifices for our country are so badly treated.
3.5.2007 7:32pm
milwife (mail):
Jim Rhodes as a military spouse, thank you for your efforts. Also, I can confirm through personal experience from every place we've been stationed that the military health care system is just like described above by tioedong:


Hmm...but how many of you guys have actually worked in government hospitals?
I spent six years in a state ICF/MR (long term care) and ten plus years in the IHS (federal Indian hospitals). They all had the same problems: Red tape and pressure to stay within the budget. And, in contrast to private care, the physical plant is ugly,(ugly concrete walls, ugly furniture, ugly linoleum or carpet) the waits for non emergency care is long due to lack of personnel, and the hiring system to get more personnel is slow.
You have limited physician choice (many foreign docs) and limited medicines. The physical plant can be fixed, but requires a long paper trail of proposal, approval, contract bids, and then it might be done.
If you need open heart surgery, it's great. They will send you to a center that does it or subcontract. If you need less acute care it's not. You wait. Priorities, you know.
Another thing to remember: Walter Reed was so old it had been scheduled to be shut down; I suspect many problems simply weren't fixed.
My solution? Approve vouchers for the non emergency care. That can be done faster than trying to work thru the system.
3.5.2007 8:08pm
J. F. Thomas (mail):
The other thing is that you seem to be unestimating some of the wait times. We go to Canada most years on a male bonding ski trip. One of our usual guides needed hip surgery or he would be out of work.

What, he didn't go to the U.S.?

And on the other hand I tore my ACL skiing at Whistler. My total ER bill, including X-Rays, crutches, and a knee brace was CN $400. A prescription for Tylenol 3 filled at the pharmacy across the street was CN $5. (I presume that if I was a Candian citizen it would have all been free.) A similar ER visit 8 months later in the U.S. for stitches was $2000 (U.S.).
3.5.2007 9:50pm
J. F. Thomas (mail):
working at a ski area, accident policies are offered at $10 a month to empoloyees.

I'm curious, what exactly do these policies cover? Would they pay for an ACL repair? Mine, ten years ago now, cost $25,000, and that was without any meniscus or secondary damage at all.
3.5.2007 9:56pm
J. F. Thomas (mail):
You need look no further than the recent example of Amillia Taylor who was delivered at 22 weeks gestation in Miami. After intensive support she was released from the hospital. That would not have happened in many other countries that have a less aggressive approach to premature infants.

My parents and brother live in the UK (my family emigrated to the U.S. when I was a baby and my parents returned there when I was in college).

My niece (who is now 14) was born almost three months premature. She is happy and healthy. Her birth weight was just over two lbs and she spent the first three months of her life in a neonatal ICU in the UK in the care of the dreaded NHS. My sister-in-law is from New Jersey and her parents went over and kept insisting that they would help pay for the medical bills. They just couldn't wrap their minds around the fact that all that top notch care wasn't going to cost a penny.
3.6.2007 9:03am
eddie (mail):
Any cost/benefit analysis of health care delivery will lead one to the same conclusion: It is simply not profitable to take care of sick people (unless they happen to be outrageously wealthy).

Part of the problem at Walter Read were the very units that were "privatized."

All the rest is simply ideology place on top of a reality that does not conform.

But if private free enterprise is the only way out of this mess, then I suggest that every single taxpayer dollar that is used in any hospital for research or otherwise be immediately re-directed into health bucks. And in the end when all of the health bucks have been spent and there are still poor and untreated sick veterans languishing, please then tell me how your wonderful theories are providing those who have served our country with anything useful.

If government sucks because of the bureaucracy, why do we trust our national security on one of the largest and mot inefficient groups known to man? Why not just hire a private army?

At some point all of the "originalists" and conservatives and "libertarians" have to decide which is their actual deity: our constitutional democracy or "free market capitalism" because capitalism certainly does not care about the commonwealth of our nation.

But of course, let us not blame our fearless "war" leaders. Some sacrifices must be made and anyway this provides a perfect illustration for all of the liberals about why the government sucks.

This is intellectual dishonesty at its highest and I am personally affronted that it is being propounded by someone who has been licensed by the state to teach our youth about law and justice. Bravo.
3.6.2007 9:42am
Brian K (mail):
It was worth reading this whole discussion for this one line:


New GOP slogan:


Smaller government now! Because you don't know when we might end up in control. Mwahahahaha!


HILARIOUS. Given the current situation, it's most likely true too
3.6.2007 10:11pm
Stacy (mail) (www):
eddie: "Any cost/benefit analysis of health care delivery will lead one to the same conclusion: It is simply not profitable to take care of sick people (unless they happen to be outrageously wealthy)."

That's ridiculous. Healthcare is an excludeable private good that's in demand. If it's not profitable to provide it, that's because some deus ex machina makes it so. The biggest item ex fee-for-service healthcare is insurance. In effect there is no private healthcare because the person recieving the care rarely or never is the one holding the purse strings.

Decoupling health insurance from employers and eliminating any extant legal requirements for people to be insured would be a good first step towards introducing market forces into healthcare. Nationalizing healthcare providers would be about twenty steps backwards into a situation with even less connection (if that's possible) between service providers and customers.
3.7.2007 12:53pm