From Mark Kleiman, via Matt Yglesias:
Since the Veterans Administration, since its reform under Bill Clinton,
now has the best medical-records system going and produces high-quality
health care at a reasonable cost, could we move a baby step toward
national health insurance by allowing non-veterans to buy into the VA
system at a price equal to whatever the VA figures is its marginal
cost?
I find this idea appealing: this is a market test of whether the federal government could take better care of most of us. (In case you are wondering, I wouldn’t buy in.) In any case, a reform like this could deflect the pressure for trying a related idea on a non-experimental basis. But if you think more government involvement in health care is desirable, well, this change should suffice to get us where we need to go. And if you don’t think the VA could handle the extra demand, for whatever reasons, let’s set up a copycat institution. If you are too worried about adverse selection, read Alex’s earlier post.
I knew somebody that dealt with the VA a lot. The impression he gave me of the VA doctors was similar to that I have of DMV workers. They are given a guaranteed paycheck and he said he had a very hard time finding a doctor who would “give a damn.”
Now, that’s just what I heard. However, we could all agree that medical outcomes cannot be tested in purely dollars and cents. We could decide to pay much less for doctors or for technology and the medical outcomes could become much more “efficient.”
It is more important [to our leaders] to continue to prop up i.e. an Israel with big tax dollars, for another 50+ years, than it is a priority to attend to the needs of groups I’ve mentioned.
Foreign aid is a much smaller percentage of the budget than Medicare or Medicaid. It’s about one percent, a drop in the bucket comparatively. And I see that there still is no gratitude for the tremendous spending involved in adding prescription drug coverage to Medicare either– it’s still apparently ignoring the elderly.
I’m not sure anyone who has worked in the VA system-as I have- would use it as a model for universal healthcare. The VA lives under a budget that doesn’t allow much for unexpected costs that might arise.As a result the pharmacy has a limited formulary and rationing of sorts is very frequent.Elective testing and surgery can take weeks or months. Obtaining new equipment takes more time than it should. I have taken care of patients who have died waiting on their cardiac surgery. Most of the staff physicians work a forty hour week, do not take night or weekend call and use a tremendous amount of residents-doctors in training-for the routine care. Since most of the VA physicians are government employees they are somewhat immune from liability and sometimes it becomes difficult to remove an incompetent professional. Certainly the US healthcare system needs major changes, but the VA is not the model I would pick.
Maybe the VA could help out the DOD with Tricare and healthcare for active duty and retired. That would be a first step in finding out if the VA program is workable for a more mobile population.
The VA hospitals I have any knowlege of I would stay away from. Couldn’t stop my father in law because it was free. They fed him poorly (macarony), the test took days to weeks to get the results of. The doctors acted inexperienced.
The medical records may have been fine and readily excessible all over the world electronically. That isn’t very important if the care is poor.
Actually foreign aid only makes up 0.22% of our federal budget. However, this does not include any bit of the half-trillion we spend on our military – some of which presumably is to defend our and other interests around the globe – so how much money we spend aiding Israel appears to be an open question.
Sorry this is (sort of) off topic.
john dewey: It is easy to bring, to the table, statistics, examples of personal knowledge and the etcetera to support our positions… I don’t wish to compete with that because it clouds the issue.
To refine my point, let me say this:
“Free health care” in the largest capitalist economy on earth is not free… somebody, somewhere is paying for it. What is available to US, depends very much, upon WHO you are; “All things are political”.
It is dishonest to pretend that our children are of value, when a quality education amounts to little more than what one can afford. It is dishonest to pretend that our elderly are of value when so many cannot afford Rx’s (I invite you to inspect the history of the medical & pharmacological industries in the U.S.: “An American Health Dilemma” Vol’s l&2 by Byrd & Clayton); I recommend you read: “Mis-education of the ‘negro” by Dr Carter G Woodson (1933), and Howard Zinn’s “A Peoples History of the United States”.
Accept this challenge, apply some new information to your experience and knowledge and see what you come up with.
The other part of my point is this: In a country with so much wealth & abundance… something is very wrong, we are on the same ill-fated track as the former “Great” empires such as Rome.
A commenter said: “foreign aid only makes up 0.22% of our federal budget.”
So what. In the case of an Israel, what are they doing with our tax dollars and would not those funds be better invested here!? Since 1949 that share of 0.22% is huge. As Malcolm X use to say: “Don’t take my word for it, check it out”.
Those of us whom have fought America’s wars, did so for “…the land of the free and home of the brave”, and not for king and corporations.
john, your former comments are most revealing, I’m sure it is not as simple as: “I don’t understand…”, after all, you present yourself as a reasonably bright fellow.
However, for the sake of this valuable space, I’m going to exit the discussion here. Well, almost, I will acknowledge this one facet concerning the seniors in MY family, and that is: They are all doing very well.
Sincerely,
Ron Brown
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