Government Health Care

SEARCH BLOG: HEALTH CARE

The present public airing of conditions at Walter Reed army hospital had come as a stunning revelation to many in the U.S. But it probably comes as no surprise to many Brits or Canadians who deal with the universal health care systems there.

I'm not going to go into an argument about whether privately or publicly sponsored health care is better. My own opinion is that neither approach is perfect. The record of privately funded health care has been pretty good for those who can afford it. The record of publicly funded health care has been pretty good for those who can't afford private health insurance... it's a whole lot better than nothing.

The question of whether publicly provided health care is preferable to privately provided health care is somewhat different. This is not a question of where the funding is coming from, but how the health care is delivered.

The issues at Walter Reed remind me of the experiences of my WWII veteran father who received health care through the VA. Remember, soldiers who come out of the military hospital system may be eligible for VA care. Here were my observations:

• He would not have lived as long as he did without the treatment he received through the VA. He could never have afforded the insurance or the cost of treatments he received during his last decade. All other points after this must be tempered by this reality.
• He often had to travel over 100 miles to get treatment when he became ill.
• He often had to wait in long "sign in" lines before he waited in lines to be seen by the doctor; a minor re-check could take all day.
• Some of the treatment he received was sub-standard. This a a pretty serious charge, but the VA doctors at a nearby Michigan facility were stunned that, after surgery, the Minnesota doctors did not perform the appropriate follow-up treatment which ultimately led to his death. [Would he have died without the surgery; yes. Would he have lived with the appropriate follow-up; perhaps. Was the fact that he was mis-diagnosed delaying the surgery by 6 months a factor; definitely.]
  

Now anecdotal "evidence" is not data; perhaps it is datum. But it certainly was etched into my mind that "there had to be a better way."

One of the more successful publicly funded health care systems is Medicare. Sure, there are those who say it only works well with supplementation. But it does work.

I have argued on other discussion forums that the VA could be improved by providing eligible veterans with a "VA Health Card" that allowed them to seek treatment from any available hospital, clinic, or family doctor for minor or emergency needs. If longer term care is needed, the veteran would receive that at a VA facility if it is within a reasonable distance (to be defined) or continue receiving treatment locally.

This would accomplish two things:

• Provide quicker care for the veteran while reducing the workload at the VA for short term care
  
• Ensure the veteran receives long term care for chronic problems while focusing VA resources toward ensuring long term care is available.

This certainly doesn't solve the problem for Walter Reed. That's just an administrative mess caused by the normal "processes must come first" mentality of the government at any level and for any mission. But combining the issues of Walter Reed with the anecdotal experience at the VA convinces me that government funding of health care may work, but providing the actual treatment often leaves much to be desired.

So, the next issues are:

• How would the government fund its role of a super-insurance agency (massive new taxes)?
  
• Would it be an expanded medicare program or a whole new agency with new costs?
  
• How would eligibility be determined and monitored (come one, come all or restricted to U.S. citizens meeting specific, provable criteria)?
  
• How would it affect the way health care is delivered (would it create an administrative nightmare and reduce the system to something like the British or Canadian's)?

If we have learned anything from Walter Reed and the VA, it should be that the government may be well-intentioned, but it puts administration and rules ahead of the mission too often.

Is that what we want?