RSS Feed MenuWilliam Kristol was recently taken to task by that well known health care economist, Jon Stewart, regarding an example of successful government run health care- military medicine. Stewart insisted that this example of government run medicine proves the validity of the proposed “public option” or other government run aspects of the hotly debated healthcare (health insurance?) reform debate now underway.
Military medicine is of course composed of two very different entities: the Veterans Administration (VA) and true military installations and programs like Walter Reed Hospital in Washington. The latter is successful, in fact wildly successful, in treating severe injuries sustained by military personnel. However, it caters to a very narrow patient group with a generally limited range of services although a few key centers like Bethesda Naval Hospital have a wide range of clinical services. How costly or inexpensive these institutions are would be very hard to assess. How effective they are would require some ability to compare them to civilian practice. This is not easily assessed in the U.S. The recent tragic experience of care of brain injured Iraq war personnel at Walter Reed Army Hospital may or may not be representative of chronic care at military facilities. Military hospitals are so different in scope from acute care hospitals in the civilian sector that the comparison is really impossible.
The VA is a different story and there is lots of data about the comparison to private healthcare. The VA can only manage the full range of healthcare needs of American veterans by being embedded in a private healthcare system. For example, while the kidney transplant programs and other surgical programs offered in the VA system are generally of high quality as documented in the surgical literature, the number of programs is very limited. The VA maintains only 4 kidney transplant programs in the country. If a veteran lives in Iowa City, Pittsburgh, Portland, or Nashville he or she has easy access to a facility and once a kidney is available to them, the procedure can be performed. But if you live in North Dakota, you will need to get your transplant locally through some arrangement with a local hospital that performs transplants. It is the limitation in access for veterans that has led to the need for increasing amounts of outsourcing in the VA system. The VA system strongly relies on a referral center system and the liberal use of local facilities to fill in the gaps in service that are inherent in its organization. While it does a good job of caring for the primary care needs and many of the more complex needs of veterans, it relies heavily on such outsourcing for as much as 30% of the care delivered. The only way the VA system avoids the sort of delays in care seen in other government run healthcare systems around the world is to rely on the non-government run healthcare system in the U.S.
I routinely care for veterans transferred to our hospital for specialized treatments not available at the local VA Medical Center. While this is a rational and, in fact, laudatory approach for the VA to achieve efficiency, it surely shows that when the government needs to provide a service, you may get what you need but perhaps not what you want. Patients generally do not like to be transferred from one hospital to another to access a needed service.
So Jon Stewart is right. There is nothing wrong with government run medicine such as military medicine. But military hospitals do not deal with chronic conditions, for the most part, and the VA system could not work if it did not rely on private hospitals and practitioners with whom it contracts to provide the care it cannot provide. Also, if Mr. Stewart was similar to the other veterans who are dually eligible for VA care and for Medicare provided by the private system, he would be much more likely to choose the private system as has been well documented to be the case for such dual eligible veterans. While he might say that is a good argument for Medicare, it would be, if that government run health insurance plan were not to be in deficit by $37 trillion in the coming years.
barker13 // Aug 6, 2009 at 1:41 pm
Re: Liv&Win // Aug 6, 2009 at 12:02 pm –
“This is a program that the socialists on this blog think is running just fine. Great, thanks for your opinion, now let the adults get back to work.”
(*SIGH*) You know, L&W… these… er… folks are actually allowed to VOTE…
(*SHAKING MY HEAD*)
BILL
ottovbvs // Aug 6, 2009 at 2:24 pm
24 liv&win // Aug 6, 2009 at 11:00 am
“My data was based on 5 years.”
…….Not if it was based on the Fortune analysis YOU directed us to and quoted it wasn’t which was for a single year……why not have the grace to admit you were wrong
“Yours however was COMPARATIVE data for investors interested in which industries were most profitable TODAY. Your comparative data from within a recession shows that Health Insurance can be a very good defensive investment in difficult times like ”
………….That’s true health insurance makes lots of money in good times and bad………and btw it tends to make rather less money in a recession because enrollments fall as was widely commented up when Wellpoint published their results …….Btw to address your other point Wellpoint’s ratio is 17.6% NOT 15% although I accept your assurance this is the figure in CA as I’m not familiar with the numbers …….As to whether a net of 6.5% is good I’d say given that we are in the midst of a huge recession it’s actually very good it was after all 28th on the list……the health insurance industry isn’t a cyclical business like autos and given the sums involved (the insurance industry disburses about $1.1 trillion a year) it’s an enormously profitable low risk business.
” I am curious Otto, what is the socialist postion on profit versus non-profit firms?”
……….How would I know I’m not a socialist ……..I just spent over 40 years in business (about 27 in oil and another 15 in auto parts and construction equipment) and ended up running some companies with as many as 3-4000 employees and always regarded the the whole healthcare industry as a scam aimed at transferring wealth from the people from the people that made and sold things to financial institutions and medical providors……It’s a complete scandal that were spending twice as much as everyone else and it’s damaging our competitiveness
ottovbvs // Aug 6, 2009 at 2:32 pm
25 liv&win // Aug 6, 2009 at 12:02 pm
“this is a program that the socialists on this blog think is running just fine. Great, thanks for your opinion, now let the adults get back to work.”
……….For the millionth time Medicare’s funding problems arise from the cost of providing the care not the cost of operating the admin system ………If you want to make junking Medicare a central plank in the GOP program …..good luck……..far better to address the costs of providing care which will be a by product of reforming the entire system
….as for the socialist children……more ad homs….tut tut
liv&win // Aug 6, 2009 at 4:01 pm
Otto: Only a socialist would demonize one industry while espousing the benefits of another. And for the 10 millionth time, medicare’s funding problems, which are still problems with medicare, don’t soley arise out of the cost of care. The program’s socialist ideals have, almost since the program’s inception, run up against demographic changes which have also contributed greatly to the $37 Trillion dollar defict the plan currently has. In addition to having fewer taxpayers to every beneficiary, we are living much longer than previously expected. And not only has the cost of care increased, but the expectation of care as well as the availability of intensive care has increased. That is not a minor problem. In so much as medicare is working just fine from a patient perspective, again, how can I argue that paying into the system ten cents to get a dollars worth of benefits is a bad deal. Its a great deal. And seniors know it. they know they are getting the best health care for next to nothing while the rest of us are pulling our hair out trying to even concieve of $37 trillion dollar deficit that my children and their children will be burdened with. that number is so big it is nearly insurmountable.
Just heard this…the Obama care bill has a provision which will allow the government to access your bank account and automatically debit your account for health care services. More socialism in action.
ottovbvs // Aug 6, 2009 at 4:42 pm
liv&win // Aug 6, 2009 at 4:01 pm
“Otto: Only a socialist would demonize one industry while espousing the benefits of another.”
……..Just can’t help yourself with those ad homs can you……I’m not demonizing anyone I’m just complaining about being overcharged!!…..and you’ve clearly never had a real job because industries constantly complain about being screwed by other industries
” run up against demographic changes which have also contributed greatly to the $37 Trillion dollar defict the plan currently has”
……..The demographic changes are a cause of an increase in the cost of providing care…..nothing whatever to do with how Medicare functions…….And the plan doesn’t “currently” have a deficit of $37 trillion…..it’s conceiveable it could have in 50 years time if we do nothing but pick our noses and let things continue as they are but as of now it’s fully funded……As I say by all means push to make the ending of Medicare a plank of the GOP…..I’m sure it will be enormously popular with all those people who have been paying their taxes and FICA (btw one of the keys to properly funding Medicare is removing the cap on FICA)
” Just heard this…the Obama care bill has a provision which will allow the government to access your bank account and automatically debit your account for health care services. More socialism in action.”
………..I thought we were have a serious discussion……there are five bills btw
barker13 // Aug 6, 2009 at 11:52 pm
Re: Liv&Win // Aug 6, 2009 at 4:01 pm –
“…demographic…”
L&W. You do understand that “big words” aren’t one of Otto’s strong points… right?
Reality is NOT Otto’s friend. (*WINK*)
BILL
* Seriously, L&W… I too once tried to reason with Mr. Haphazard Multiple Periods (………) (*CHUCKLE*), but every time I’d try he’d “thank” me by reverting to type. Listen… you can reason with Balc… Spart is pretty bright and has a sense of humor… but Otto…??? You’re wasting your time. Expecting reasoned responses from Otto is like expecting integrity from Frum. GOOD FRIGG’N LUCK! (*RUEFUL SMILE*)
ottovbvs // Aug 7, 2009 at 9:26 am
barker13 // Aug 6, 2009 at 11:52 pm
………..Pleased to see I continue to exercise an irresistible fascination for you Baarking
sinz54 // Aug 7, 2009 at 1:23 pm
ottovbvs sez: “far better to address the costs of providing care”
Barring a medical breakthrough in something like stem-cell research, I don’t see any real way to bring down the cost of care for the elderly ill.
I get to see plenty of elderly in my dialysis center. They’ve got coronary heart disease, diabetes with all its complications, kidney failure of course, and arthritis and renal osteodystrophy so bad they can’t walk. They’re brought back and forth from their old-age homes to the dialysis center by ambulance, three times a week.
Those diseases are usually incurable, and frightfully expensive to care for. 40 years ago, many of them would have been dead within a couple of years after diagnosis. Now they’re kept alive–but at a staggering cost.
Studies have shown that for health care, the most expensive year of life is typically the last year of life. ObamaCare’s supporters have poo-poohed the idea, but ObamaCare has put the nose of the camel inside the tent of euthanasia by mandating end-of-life counseling for the elderly who are desperately ill.
Maybe in the future, medicine will discover how to regenerate damaged heart tissue and kidney tissue–and the cost of caring for those diseases will be reduced dramatically. There is hope.
Spartacus // Aug 7, 2009 at 1:59 pm
sinz54 // Aug 7, 2009 at 1:23 pm wrote: “ObamaCare’s supporters have poo-poohed the idea, but ObamaCare has put the nose of the camel inside the tent of euthanasia by mandating end-of-life counseling for the elderly who are desperately ill.”
ObamaCare’s supporters “poo-poohed” the idea because it is patently false as evidenced by the link below.
http://blumenauer.house.gov/images/stories/documents/myth%20vs%20fact.pdf
Sinz, how come you’re not embarrassed that almost everything you write is factually incorrect? Seriously, you are continuously debunked on practically every issue, and you’re completely impervious to facts.
I’m starting to wonder whether or not you are actually a troll disguising himself as a conservative for the purpose of embarrassing other conservatives. There are conservatives out there who are able to make legitimate, fact-based criticisms of Obama’s policies, but you seem to no interest whatsoever in facts.