Friday, July 31, 2009

The Shape of Things to Come, Redux

In a recent post, we wondered if the American health care system--or, at least Barack Obama's vision of it--would come to resemble that of our military. With certain exceptions, the armed forces already operate a "single payer" system, featuring limited choices and bureaucratic decisions that govern the quality of care.

While many military doctors (and hospitals) are considered excellent, others have a less-than-stellar reputation. There's a standing joke in medical schools that 75% of the graduates are referred to as "doctor," while the bottom 25% are called "Captain." Other physicians wind up in the armed forces because of past difficulties, including an inability to maintain malpractice insurance. Practicing medicine in uniform, physicians don't have to worry about malpractice coverage and the Feres Doctrine protects them from lawsuits by military members and their dependents.

But beyond those concerns, the military health care system faces more basic problems. Stretched thin by the medical requirements of two wars, at least one of the services is finding it difficult to provide required services to its core clientele. According to USA Today, the number of Army medical centers and clinics that provide timely access to routine medical care has hit a five-year low. As a result, more soldiers and their families are being sent off-post for treatment, by civilian doctors.

About 16% of Army patients, particularly family members, can't get appointments with their primary physicians and are sent to doctors off the installation, according to the results of a nine-month Army review finished late last year. Some of those patients end up in emergency rooms or urgent care centers, says the study, which the Army provided to USA TODAY.

Army records show that 26 of its medical centers, hospitals and clinics are unable to meet the Pentagon standard requiring that 90% of patients get routine care appointments within seven days. Those are the worst results since the start of the wars in Iraq and Afghanistan. That's a 13% increase from 2005 in the number of medical facilities unable to meet the standard.

To some degree, this problem was inevitable--and preventable. Almost eight years into the Afghan conflict (and six years after the Iraq invasion), the Army knows how many doctors, nurses and other medical specialists are required to support deployed operations, and the "gap" that creates back home. But according to the USA Today article, the Army surgeon general has only recently authorized the hiring of more physicians.

And, as you might expect, getting doctors to "sign on" with the service (in uniform, or as civilians) is difficult. As a newly-commissioned officer, military physicians earn only a fraction of what they could make in private practice; the same hold true for doctors who accept civil service positions with the armed forces or the VA.

So the military winds up with more doctors that have (ahem) "fewer career options" than other physicians. That, in turn, brings us back to the quality-of-care issues that have long plagued DoD's health care system.

Thankfully, the Army still has the option of moving patients into the civilian system, and the on-going drawdown in Iraq will ease pressure on the service's network of clinics and hospitals. But there is a cautionary tale in the problems now facing the Army. Creation of a national, government-run system (the ultimate goal of many Democrats) would result in the same types of access problems that Army members and their dependents are now experiencing.

Consider Great Britain, where 60 years of socialized medicine have prompted many physicians to opt out of the system (and work exclusively in the nation's small, private health care network), or seek more lucrative employment in the United States. As a result, the U.K. has been forced to recruit more doctors from abroad, creating potential security problems. Five of the eight individuals arrested in connection with the 2007 Glasgow Airport terror attack were Muslim doctors, recruited to work for Britain's National Health System.

Beyond security risks, there are the more pressing concerns of access and quality-of-care. Almost everyone has heard horror stories from the U.K. and Canada where patients died awaiting their turn for "rationed" procedures, or were denied expensive medications by health care bureaucrats.

In our country, military members and their families can tell similar stories. Getting certain types of medications through an on-base pharmacy can be difficult--if not impossible--because of cost. Conversely, almost everyone in uniform has a seemingly endless supply of 800 mg Motrin, the pain-reliever-of-choice in the armed forces health care system.

We certainly hope the situation improves for Army members (and their dependents) who are now having trouble getting needed health care. Thankfully, the service still has our current hybrid system to fall back on, allowing it to send patients to physicians and hospitals off-base. But we wonder how long that option will remain, given Democrats' 60-seat majority in the Senate, and the willingness of House "Blue Dogs" to roll over on the issue.

There's also the matter of past, broken promises on military health care. Military retirees were once guaranteed access to on-base medical facilities, with virtually no out-of-pocket expenses. But along came something called TriCare and more than a decade later, most retired military personnel and their dependents are in a system that gives them more choices, but at a higher cost.

Army families now struggling to see providers on base should remember this lesson from the TriCare episode: military promises on health care aren't always kept. The same applies to grandiose promises associated with current efforts to "fix" our health care system.

5 comments:

What is "Occupation" said...

So why not use the infrastructure of the US Military and start using those MASH type operations to service rural and urban areas?

These MASH units could be used to train General Practitioner MD's, Nurses & a hugh slew of medical personal that could enlist get training, served 2 years then move to the private sector where there is a shortage of domestic MD's?

CT Guy said...

Any of us who has had the "pleasure" of either military or VA hospital care will run screaming from the newest 'Obamacare". The government couldn't even run a car rebate program for more than 4 days. What makes anyone think they will run health care any better ?

tfhr said...

Occupied,

Did you miss the salient point that the "infrastructure" of the military health care systems is already stressed to the point that it frequently fails to adequately provide medical care for service members and their dependents? So now you want Alan Alda and Hot Lips to cover down for Kansas and Detroit? It doesn't sound like you're all that interested in providing the best care for rural, urban or military patients.

Isn't a "MASH" trainee just what any trauma victim wants to see? Enlistments for medical training is a grand idea if you have the time and the money to spare. How much would it cost the DoD to train vast amounts of personnel and how long would these freshly minted medical professionals then spend repaying that expense?

Oh, and by the way, thanks for offering us and our families up as training aids for wannabe civilian doctors with less than two years experience. Its kind of ironic but I think you should also know that the military already sends many of its trauma surgeons, nurses and technical specialists to civilian emergency rooms to get experience treating gunshot wounds!
http://content.nejm.org/cgi/content/full/357/26/2723

"The Shape of Things to Come, Redux" is a good post. I think you should read it again.

Paul said...
This comment has been removed by the author.
Paul said...

My wife and I have experienced Navy medicine first hand and I have to say that it is horrible at best. Apparently Air Force medicine is not that good either.

http://www.airforcetimes.com/news/
2009/07/ap_airman_amputated_072109/

The part that I like best is that the surgeon will get away with it somehow. The Airman and his family will not be compensated properly since servicemembers are unable to seek legal retribution. If universal health care gets implemented everyone else will get to enjoy this type of treatment as well.