The Questionable Authority

Yesterday, I took the kids to the doctor for their school physicals. I wouldn’t normally subject you to an account of the day-to-day minutia of my personal life, but given the current debate about how we should handle health care in the United States, the details might be of interest.

We arrived – without an appointment – at a medical facility that we had not been to before. We did not have medical records with us, and the only paperwork of any kind that we had brought were the forms that needed to be filled out to enroll the kids in sports programs. When we checked in, the only thing I had to do was hand the clerk a government-issued photo ID. I did not have to fill out any insurance forms, I did not have to hand over any payment of any kind, and I didn’t touch a clipboard. Within two hours, both the children had been seen by a doctor, received physical exams, had their shot records checked and brought up to date where necessary, and I’d been given the completed school and sports forms.

That’s not fiction, and it’s not a prediction of what could happen in the future. That happened yesterday, it happened in the United States, and it happened in a health care system that’s owned and operated by the Federal Government.

That’s right. I got to use the dreaded socialized medicine yesterday, because I’ve got access to the Department of Defense’s medical system.

We didn’t have to fill out forms yesterday because all the paperwork that needed to be done to switch our primary care doctor from one in Florida to one in Alabama was done when my wife checked in to her new assignment. We didn’t need to bring records, because both facilities have access to the same electronic system. All that the clinic needed to access the records was my wife’s information.

The no appointment thing wasn’t an everyday occurrence. The military, like most health care providers, normally requires appointments for routine care. Yesterday was different because the people who run the local primary care clinic are familiar with the military lifestyle. They know that lots of families move around every summer, and that there will be a lot of people who are new to the area and need school and sports physicals this time of year. To address the demand, they set up a few days before school starts to do physical exams on a first-come, first-served basis.

Yesterday was one of those days. The primary care clinic has, I would guess, about 10 providers. They handled over 100 kids in the first two hours, and they did so with both courtesy and efficiency. They had planned ahead, and borrowed a couple of extra medics to run extra waiting areas so that the clinic wouldn’t be flooded with people. They had several people available to run the eye charts, several more doing heights and weights, and good people making sure that the paperwork was being handled correctly throughout the process.

I would probably be the last person on the planet to claim that the military health care system is perfect. It’s not. Different clinics in the system have different bosses, different patient loads, and different ways of doing things. In other places, we’ve been assigned to clinics that were not quite as focused on customer satisfaction as this one seems to be, and we know people who have had some truly bad experiences. All in all, though, we’re very happy with the military’s health care, so we continue to use it.

We don’t have to. We choose to. We have other options. The military, through the Tricare program, allows you to choose a civilian primary care doctor, and the year we lived in Texas we did just that. Unless we have to, we probably won’t again. It’s not as convenient, and the care doesn’t seem to be any better.

There are certainly reasons to be concerned about the effects of going to a single-payer health care system in this country, and there are certainly very good reasons to make sure that whatever changes we make are well-thought out, well-planned, well-executed, and (most importantly) well-funded. There are also legitimate ideological reasons to oppose a system that would have the government do something that private industry could do. But arguing that the government simply cannot provide high quality health care and good customer service is just factually wrong.

Anyone who argues otherwise just isn’t giving the military enough credit.

Comments

  1. #1 Brian D
    August 6, 2009

    Mike, did you see Bill Kristol’s appearance on the Daily Show, where he basically argues against government-run healthcare while praising the government-run healthcare of the military, because (I wish I were making this up) the civilian population deserves lower-quality care than the military because they aren’t serving their country? It would seem like a twisted satire of your point were Kristol not serious.

    (For the record, I’m Canadian, and my routine health experiences are similar to what you described above. As such, I find arguments against government healthcare interesting in that they often seem to come from another world.)

  2. #2 Isis the Scientist
    August 6, 2009

    This is a really interesting story, Mike, and different from my experience working with vets in the VA system. Have you found your experience with your children different from your own?

  3. #3 Mike Dunford
    August 6, 2009

    Not substantially, no – but then I get care through the same system. In fact, since we typically elect to go through the Family Medicine clinics, my primary care doctor is usually the same as the one my kids see.

    To date, I think the longest delay I’ve had getting an appointment to see my primary care doc for routine care was about 5 weeks or so. There was only one time when I couldn’t get a same day urgent care appointment, and that time I was seen first thing the following day. I’ve had to wait a bit longer for specialist care (6 weeks for an MRI, 8 weeks for a nutrition consult), but on the rare occasions when the need for the specialist was acute, I was seen promptly.

    Our son has received incredibly good care. He was a 985g birth weight preemie, and has some developmental delay, speech, and minor learning issues. We’ve never had significant trouble getting him seen by a specialist in the military system, and our total out of pocket expense for his health care has been about $300. And that was only because officers and their families, by tradition, pay for their meals even when in the hospital.

    It’s not a perfect system – the Walter Reed scandal from a few years back is proof enough of that – but on the whole it’s worked quite well for us. I’ll try to take some time tomorrow to dig into the details on that a bit more, and might do another post on that.

  4. #4 Nick Anthis
    August 6, 2009

    That’s a compelling story Mike. It reminds me of similar positive experiences I’ve had… in England.

  5. #5 John Karabaic
    August 6, 2009

    Mike, I was in the Air Force 20 years ago, stationed at Wright-Patterson Air Force Base, OH.

    My experiences with military health care agree with yours, but with one possible exception: OB/GYN care.

    The USAF’s OB/GYN care was worse than that available in the civilian world. As a first lieutenant married to a senior airman, I was surprised that both the pre-birth and post-birth care my wife received was inferior to that my next door neighbor’s wife received through his private insurance plan. He was a tradesman, an entry-level machinist at a local job shop with employer-provided insurance.

    I won’t go into specifics, but I was pretty shocked at the time. If I had stayed in the USAF, I would have gone Tricare for any other children we would have had.

    A fellow officer was one of many folks who sued USAF OB/GYN’s for malpractice for the damage his child suffered at the hands of Air Force doctors. At the time, I remembered hearing a statistic that something on the order of 2/3 of USAF medical malpractice suits were OB/GYN related.

    I rationalized this at the time using the age-old military excuse: “If the Air Force wanted you to have a spouse and kids, they would have issued them to you.” :-)

    That said, the pediatric care was pretty good, as was my own and my wife’s medical and dental care.

    I left the service when my daughter was 2, 20 years ago this year.

  6. #6 More Human than human
    August 6, 2009

    For excellent healthcare debates see:

    http://robhood.us/weblog.php

  7. #7 red rabbit
    August 6, 2009

    Just another Canadian saying, yup, that’s what it’s like most of the time.

  8. #8 Barb R.
    August 7, 2009

    Thank you so much for writing this. In a time when conservative media does nothing more than fuel anger and hostility towards government, its refreshing to read a positive perspective from someone with actual experience with a government run health care system.

  9. #9 A3K
    August 7, 2009

    It seems like the “debate” over this issue takes the form of both sides insisting that their proposal is the only sane one while the other is a horror show. Offering testimonials like this one, while interesting, is of virtually no value to the actual debate. It’s just more noise.

    Those arguing for single-payer need to take seriously the concerns of people who simply do not want to turn over full control of health care finance to a government agency or agencies. I’ll consider your arguments if you consider the weaknesses of your arguments and try to address them honestly.

    Meanwhile, those entirely opposed to any “public option” need to address the weakness of their argument, namely that none of them seem to be providing a reasonable path to full coverage. Instead they argue that healthcare isn’t a right. The sophistry encapsulated in most of those arguments could only be offered by those who already have sterling care through a private employer or ironically for staffers of certain Congressional opponents, through the government itself.

    So for advancing the debate, this entry, which is predictably featured on the NYT online version scores a D-.

  10. #10 Cecil
    August 7, 2009

    Yet another Canadian chiming in with…

    This is novel? This is what happens to me every time I get sick or have to go to the hospital.

  11. #11 Ariel
    August 7, 2009

    Also a Canadian, and again this seems perfectly normal to me. A prof at my university does a class on why private healthcare doesn’t work. I haven’t taken it personally, but here is the basic theory of it (just to be clear, I’ve only heard this second hand.)

    It’s basically the only industry where competition drives prices up instead of down. Imagine your 2 year old needs heart surgery. Do you shop for the cheapest surgeon you can find, or the most expensive one you can afford? You need an MRI, do you get the 30 year old machine, or the brand new super duper fancy one that charges twice as much? Net costs for running similar technologies in Canada are much lower because the American health care industry inflates prices of just about everything.

    Anyways, you just can’t argue that national healthcare is pure evil, there is just too much evidence (Canada, Europe, etc.) that it works.

  12. #12 Brian
    August 7, 2009

    Are there 300 million people in that system? Just curious.

  13. #13 Dirk Strong
    August 8, 2009

    Wonder if you have read any part of healthcare reform bill?
    Its a whole lot different than the military plan.
    Does the military plan give the government access to your bank account?
    If its so great then why aren’t the senators/congress signing up with this plan- they will use their own private plan. Better think about it.
    Also – if you really think this is about healthcare, you are a fool.
    Obama spent more time deciding on a dog than pushing this plan out to the entir nation. Also you better do a little research on who actually wrote the bill – the Apollo Project- these are some scary folks. Wake up folks- turn off your twitter, facebook, dancing with the stars, American idol- all designed to confuse, disorient you from what really is going on here.

  14. #14 sg
    August 8, 2009

    I wonder what the per participant cost is annually for the program. Also, the military only accepts healthy young people with stable mental traits and IQ over 90 and their families. Healthy, sane, intelligent people tend to marry healthy, sane, intelligent people and have healthy families. The military directly discriminates against people who do drugs and generally cannot control themselves. Any program for the general public would be serving and different population, specifically one with far more health problems including self inflicted. What is it like in the military system to get a second opinion when you aren’t sure of the doctor’s recommended treatment plan? etc. I am confident in the gov’t ability to provide routine physicals to healthy kids, it is in their ability to deal with complex issues in a cost effective manner that I will require convincing proof.

  15. #15 John
    August 8, 2009

    Quick question for the Canadians. My wife has several relatives in Canada and England, while they don’t complain about the system in general, they often describe situations that surprise us.

    The stories that make my wife nervous usually seem to be around not having doctor choice, ie they have a problem with a doctor and don’t seem to be able (allowed?) to just go to a different doctor. The other is around not getting any info, just being sent on to another doctor without any clear idea of what’s next.

    A few times my MIL has been along and started asking questions and the doctors are always surprised (or even irritated) and always say “you’re american aren’t you?”

    I’ve never been clear if it is a system thing or just my in-laws are the kind of people who don’t ask questions.

  16. #16 Chuck VA
    August 8, 2009

    Mike, you state that there are legitimate ideological concerns about the government doing something private industry can do. Fine, but there is a problem when the business model for that industry includes refusing to provide care if there is any way it can be done. That borders on the immoral.
    Simply because private industry can perform a function or service does not mean that they should have exclusive right to do so.

  17. #17 handyman
    August 8, 2009

    John,
    As yet another Canadian – I can choose any doctor I want just so long as the doctor is accepting new patients. OHIP (the Ontario Health Insurance Plan – the public plan for the province of Ontario) has absolutely no systemic restrictions on who I see as a doctor.
    Some areas of the province have a shortage of doctors, particularly rural areas, and that may restrict whom I see, but the government is not telling me whom I can and cannot see.

  18. #18 red rabbit
    August 8, 2009

    Echoing handyman: doctor choice is only an issue where there are not enough physicians: rural areas.

    The government has no say in who you see. Consultants use family docs as a gateway to avoid frivolous visits and because they get paid more for a consult than a primary visit.

    I am a doc in a rural area. If my patients want to see a particular cardiologist in Toronto, I refer. I have my preferences: I send all hepatitis patients to a particular (fabulous) guy in London for a plan, and he sends them back to the local GI guy for follow-up. Anyone who has a preference, if the person they want has a medical license and is not- say- a serial killer, I will refer.

    Americans (and actually, Snowbirds) in an office generally ask a very particular type of question regarding cost of services and “can I get an MRI?” It is irritating. Given types of test or imaging are appropriate for certain things, and people are accustomed to MRI being the “gold standard” because of the expense involved. News flash: often it is not appropriate or helpful and can be a real waste of time.

    For me, questions about an illness or a proposed treatment and other options are always welcome.

  19. #19 machleidt
    August 9, 2009

    @ Brian
    I am not sure if that answers your question, but:
    The EU has about 500 million residents. Most countries in the EU have a national single payer system (like the UK) or a mixed public / private system (e.g. Germany). So, yes those “socialist” health care systems have (at least) 300 million people in the system.

  20. #20 sinz54
    August 9, 2009

    What this proves is that we should let the Pentagon deliver our mail for us too.

    There is absolutely no reason to believe that anything done by the military can carry over into civilian life. Military efficiency is legendary; the inefficiency of civilian government bureaucracy is equally legendary. The fact that our Air Force can answer the call anywhere in the world in a few hours, doesn’t make Amtrak run on time.

    One reason being that it’s a bad and highly visible thing to lose wars, and military medicine is part of our military machine. So is military logistics.

    Nobody pays any attention if you’re stiffed by the USPS clerk when you try to mail a package. Or if you have to wait 6 hours at the DMV to renew your driver’s license. Or if it takes 6 hours to travel Amtrak from Boston to Washington, versus one hour by air.

  21. #21 machleidt
    August 9, 2009

    @sinz54
    Give me a break – corporate effiency is soo much better, like car companies and airlines that need to be bailed out at tax payers expense. healthcare companies that let you get stranded for hours in their oh so efficient automated answering systems to resolve billing issues,. Airlines that have their passengers sitting for hours on end on the tarmac. Bureaucracy is bureaucracy no matter if goverment or corporate. Don’t try to sell the fable of corporate efficiency unless you have some hard (and credible)evidence to suppott your claim.
    BTW – never waited longer than 30 min to renew my drivers license

  22. #22 Steve
    August 10, 2009

    The big players in the insurance racket aren’t about to let Congress smash their ricebowl. I haven’t read that monster Obamacare bill either, but I have no doubt about where most of its details came from. Of course, before it actually passes, various Congresscritters will need to add their own tweaks, if only out of vanity. What we’re likely to wind up with is a Frankensteinian mashup of American, British and Soviet healthcare, with some corporations getting even richer, a new corps of government employees making a comfortable living, and the rest of us getting royally screwed.

  23. #23 antipodean
    August 10, 2009

    “There are also legitimate ideological reasons to oppose a system that would have the government do something that private industry could do.”

    But private industry can’t actually DO it. So what are the ideological reasons for opposing reality then?

  24. #24 sinz54
    August 10, 2009

    Here’s my suggestion: Let all those who are so enthusiastic about ObamaCare drop their own private coverage and jump right into that “public option” themselves. That includes all the Congresscritters.

    It is unconscionable that Congress is creating this ObamaCare thing for the rest of us, while they enjoy the luxury of a choice of TEN different health care plans. Why don’t our Congresscritters volunteer to beta-test ObamaCare themselves?

    I don’t trust them as far as I can throw them. I’m old enough to remember such liberal catastrophes as the “urban renewal” that destroyed entire neighborhoods, the welfare projects like Pruitt-Igoe which had to be dynamited because they turned into high-rise slums.

    And yet now they want to restructure 16% of the U.S. GDP, all by themselves.

    They’re not good enough for that.

    They’ve got the power and they’re going to use it, whether we like it or not.

    And then we voters are going to kick them out in November 2010.
    And the Congress we elect, is going to make Obama’s life miserable from that point forward.

  25. #25 sinz54
    August 10, 2009

    Steve sez: “What we’re likely to wind up with is a Frankensteinian mashup of American, British and Soviet healthcare, with some corporations getting even richer, a new corps of government employees making a comfortable living, and the rest of us getting royally screwed.”

    I have read the bill.
    And you’re absolutely right, that’s what it is.

    And one more thing: Instead of reining in costs, it’s going to explode costs.

    The entire fuzzy math of the budget projections is based on finding $500 billion in “savings” from Medicare. Anybody seriously believe Congress will actually take ANYTHING away from seniors? Those cuts will NEVER go into effect.

    So the actual cost of this thing will be $1.5 trillion, just for starters.

    The entire bill is a $1.5 trillion welfare bill to get the poor, blacks, and Hispanics the same kind of generous coverage that affluent whites are used to. That’s all it is, really. The rest is just window dressing.

  26. #26 El Guerrero del Interfaz
    August 12, 2009

    Well, I think that, except for the filthy rich ones, everybody who had, like me, tested both the USAmerican system and a modern public health system like the ones in most European countries will always choose the public system over the USAmerican nightmare.

    But what I don’t understand is the *cost* aspect. As it is, with all his failures and problems, the USAmerican system *costs* more than any public health system. So why do people that continuously critic the government’s supposedly excessive spending want to keep such an inefficient “pork barrel” system instead of adopting a more efficient one like in most European countries? This is something I don’t understand.

    And, although I don’t like the usual inefficiency of government burrocracy, I certainly prefer it to the extreme greediness of private insurance companies.

  27. #27 El Guerrero del Interfaz
    August 12, 2009

    machleidt, you’re right.

    When I lived in the States, what astounded me the most was the efficiency of the state and government burrocracy compared to what we have in Europe. What takes days or even weeks in Europe is a matter of hours or even less in the States. Driving licence, bike and car registration, anything…

    USAmerican usually don’t know or value this. They are proud of their freedom. But I felt much less free there than I feel in any European country. They are proud of their democracy. But I felt that Republican and Democrats were just two sides of the same coin. They are proud of their standart of living. But I found there more people living without running water and sanitation than in Europe. They are pround of their technology and science but I found there people still defending creationism and even geocentrism. But all USAmerican whine about their burrocracy when it’s probably the most efficient of the whole world. Go figure…

  28. #28 Shayna
    August 12, 2009

    A little off topic, but I thoroughly enjoyed reading this post and the comments that followed. Most blogs with public comments activated spiral into incredible generalized cultural slams like “the spicks are the problem!” or personal insults like “you’re a dumbass, what the hell do you know?” Instead, every person was extremely polite and most seemed to be well-informed. And strangely, the ones in this blog who got just a little to close to saying “you’re stupid” were the Americans. I’m an American and I want to live in a country where we can share our opinions without someone personally attacking us. Having absolute freedom of speech doesn’t mean we have the right to say whatever pops into our minds.

  29. #29 Lori
    August 12, 2009

    I am very happy to see your post about military care surrounding the conversation about government-run health care.

    I am a veteran ‘chick’ who fought in Desert Storm (’90-’91). Because of service connected issues, I’m still seen at the VA medical center. I am also a biochemist, later receiving my Ph.D. after my honorable discharge from the military.

    My care from three different VA centers (San Diego, San Francisco, and Minneapolis) has been nothing but exemplary. I still see see civilian physicians for routine care b/c of the nature of my service, but I am constantly amazed at the level of professionalism and care I receive from the VA. For example, my VA neurologist uses EMAIL to keep in touch with me in between visits! I’ve never had a non-VA doc reach that level care.

    Granted, the VA has its problems, but anyone who is afraid of a government-run healthcare system is simply ignorant.

    Thanks again for posting on this topic!

  30. #30 VonMises
    August 13, 2009

    Nice story. Now let’s assume everyone in the USA can go for any health service for free with no appointment……[eyeroll]

    OK, the story is irrelevent and only shows what happens when a bloated military budget is available. As to the current debate, the rationing and waiting periods and refused care in ‘health is a right’ countries are known FACTS.

  31. #31 Kelly
    August 18, 2009

    VonMises,
    The rationing and waiting periods and refused care in privatized health insurance systems are known FACTS. You already have the problems and private corporations are not going to provide the asnwers — they have had years to do so. We can look at other public systems and *laern* from them. We do not have to copy them wholesale.
    There is an extraordinary amount of waste that goes to insurance companies. US citizens undergo more testing but don’t get better results. These kinds of things are the kinds of issues that will reign in costs.
    All — why do people keep referring to poor people? The truly poor have Medicaid. It is everyone who is not poor enough for Medicaid and not old enough for Medicare that can fall through the cracks.

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