The news has been swamped with Obamacare for weeks. Will it work? Will it take care of the uninsured? Will it bankrupt us? Will there be health care rationing? What about the British and Canadian systems; they aren’t exactly great?
The friend who quoted a number of CNN talking points to justify her revulsion towards the Tea Parties (and everyone in them… only partially slowed by the discovery that I attended two) finished her claims with, “Well, this isn’t British health care, so it isn’t at all valid to compare the two plans. Obama’s plan is going to emphasize prevention.”
Like the British don’t?
That difference, she claimed, would’ve helped my friend who would’ve died from her cancer before she got to the front of the queue for the first diagnostic test. Under the new plans being discussed, we would’ve paid for the test. Hmm. Sounds nice, but the British would’ve paid for the test, too… too late.
The problem with the argument is two-fold:
1. Preventive tests cost money. If the incidence of the disease is low, it doesn’t make economic sense to do screenings. Good for you if you’re lucky enough not to get sick. Not so good otherwise. Apparently, even the Congressional Budget Office has (again) had to pop a budgetary fantasy balloon, saying that, no, “prevention” is not going to shave billions off our health care spending. CBO director Doug Elmendorf, quoted in an article by Charles Krauthammer, said, “Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness.”
2. Preventive tests take time. If fewer people are becoming doctors, as has happened in Britain, you wind up with shortages of people to do the tests. Sure, once you’ve been identified as possibly having a problem, you can have the cancer screening… in ten months or so. Of course, as we keep hearing, early detection is key to beating cancer, which may account for the fact that Great Britain’s cancer suvival rates are significantly lower than those in the U.S.
Of course, this doesn’t even touch the discussion of whether or not you will want the government running your health care.
I’ve been in government-run health care: the Navy’s. Some of the doctors were really great, caring, talented people who you got the impression would be doing medicine no matter what. Some others were people who gave you the impression they were in the Navy because they would’ve been sued for malpractice too often in the civilian world and had their medical licenses yanked. In government medicine, suing is not allowed, no matter how egregious the problem. Being a heavily military area, our local paper ran an article on the lack of protection from malpractice in the military.
As a midshipman, we all laughed at the sign in Medical insisting to the doctors (and trumpeting to the patients) that, “Our patients are not an interruption in our day, they are the reason for our day.” The joke was that, really, the driving principle down there was more of, “There are going to be another 1,300 or so midshipmen arriving again next July, so why worry if we lose a few from the current classes?”
I had several tests denied not because my concerns were illogical or easily explained, but because, “That test is too expensive.” My acne medicine that I had been taking in high school (which worked) was changed to a different medication with no explanation at all. It didn’t work, but I was told that was what the Navy had decided it was doing for acne. A friend of mine was denied a biopsy on a lump she’d found in her breast; they didn’t want to check it because, if it wasn’t just a cyst, they’d have to operate, and, “That would be a pain.” She couldn’t get anything done about it until we graduated (three years later) and went to a different duty station (and different medical department).
The Navy was very good at delivering babies (or so I hear), and very bad at dealing with infertility. Their basic operating procedure was to sort of dither around doing next to nothing (except badger me about my *roll eyes* antiquated religious beliefs that wanted my fertility fixed, not medically forced) until they’d convinced you to cough up your own money and go get IVF out in town.
I hear the Navy is also very good at repairing sports injuries in knees (often of the knee-meets-metal-deck kind, because all the floors on the ships are metal, so that’s your only option for basketball). When my own knees ached and swelled constantly and made odd crackling noises, the chief in charge of Medical on the destroyer shrugged and said, “Everyone gets that. Take some pain killers.” Without his referral, I couldn’t go get a second opinion from an actual doctor, much less specialized help. (On the aircraft carrier, we had a specialist who x-rayed my knees and discovered major cartilage deterioration.) A painful skin condition on my hands was similarly dismissed several times (“Use more handcream,” they said), until I changed duty stations again and got a doctor who actually pulled out the skin disorders book and figured out what was wrong.
Of course, on a lighter note, there is also the issue of BCD’s, popularly called “birth control devices” (no, I don’t remember what it really stood for). These were the awful, chunky, date-repelling, plastic glasses that the Navy issued. (The Catholic Midshipmen Club had a running joke about how we ought to get better looking glasses, since we were religiously opposed to artificial birth control.) My eyes are so bad that my lenses could not be made that small properly; straight lines appeared bent, and I never wore my issued glasses. I had to pay out of pocket for years, in spite of allegedly being covered. On a positive note, about thirty years after the BCD’s went out of style, the Navy finally decided to offer a few new frames that actually looked good. (Some cynically claimed that was only because the chunky, retro glasses were coming back into style.)
Our daughter was sent to a civilian pediatrician who accepted the government’s low payments for services; many doctors limit how many Tricare patients they will accept, because they can’t afford to take too many. As soon as we were out of Tricare, we found a new pediatrician. Many Navy families put the spouse and children on the non-Navy spouse’s medical coverage if they can, in spite of having to pay for it.
Although some of the doctors were good and cared about their patients, although preventive care was covered (and mandated- your command was notified if you’d missed a required check-up or screening), many people still considered Navy medicine to be much less than ideal.
The final impression you left with, nine times out of ten, was of long lines, uncomfortable waiting rooms, hurried doctors, and more concern over cost than the patient’s health. Yes, civilian doctors have that, too, but not to the extent I saw it in the Navy.
Is that what we really want? Do we really believe that, somehow, the national government’s health care for everyone will look all that much better or different than what it already provides for the people who volunteer to serve our country in the military?
When the government is the payer, the government is the customer. The patient becomes only a secondary, costly consideration.