Government Health Care
Tuesday, June 30th, 2009I am a physician. I am a full-time faculty member at a University hospital, but as an unpaid care-deliverer, I also frequently work in a the real government health care establishment, the VA Hospital, ….not the NIH where the docs can do anything they want. If we, in real life, would do some of the things done at the NIH under the auspices of research (and, by the way, virtually all care at the NIH is research), we would be guilty of Federal crimes such as Medicare Fraud. It is a Federal crime to offer free or discounted care to anyone without offering the same to all Medicare recipients, basically. Your government calls it ‘fraud’.
The real government system exists in the many VA’s of this country. Some are good. Many are horrendous. And none of them are equipped to deal with their mission as stated. Those of us who have seen the returning casualties from Iraq and who also take care of the now-aging Vietnam War patients are acutely aware of the deficiencies. Whomever wrote that recent glorious endorsement giving the VA system the highest grades among the country’s health systems did a marvelous job of cherry picking with blinders so narrow that to those of us who actually work out here, the entire document sounds like fiction based on absolutely no reality.
The one government system for health delivery which actually is working is the TriCare system. This system is available only to those who actually retired from a career of military service. This system gives them choices like most of the rest of us have, with little interference regarding pre-approval. As regards the issue of pre-approval, be informed that the vast majority of pre-approval by insurance carriers is performed by non-experts who actually don’t even qualify as care-givers. I suspect this will be the case with a government directed universal program as well.
In the VA system, for instance, the vast majority (and I’m not exaggerating) of primary care practitioners are not even board certified…not even in general medical specialties! To those of us used to dealing as sub-specialists in systems where we are referred to by board-certified generalists (Internal Medicine or Family Practice) most requests from VA primary care doctors for testing and consultation are pedantic, lack foresight, are unintelligent, inappropriate, and at times a virtual comedy. Large numbers of these instances can be classified as ‘defensive medicine’ requested by poorly trained care-givers all concerned about their employment backed by Directors concerned about career and their budget. By contrast, in the TriCare system virtually all the doctors are board-certified, most are not ‘career militarists’, and therefore do not look at triage decisions as having a negative impact on their personal goals…they think of the patient first. Not so in the VA system.
In the real VA system, which is actually the largest government health system, Department heads, Section Chiefs, etc. are not chosen on the basis of merit. They are chosen from those doctors who have made it a point to join a VA faculty in order to boost their potential retirement income. When a spot comes open, it is filled generally by someone who is ’shutting it down’ at the affiliated University. They are chosen by tenure in the system. In the non-physician category of health care providers at VA’s, incompetence is rampant. Nurses with long service are often promoted to positions where they cannot even provide the care they supervise. In many cases, they have no special expertise in the subspecialty they are supervising.
A veteran with a spouse who has health insurance must utilize the private health insurance before the VA kicks in a dime? In fact, the VA won’t even take care of the deductable when they have been relieved of the responsibility of six-figure treatments. I am a veteran. I could use the VA for my health care, if I so choose. However, I would be forced to drop all my other health insurance or I would be charged for the service. As is the usual case…those who have made a conscious choice to have you and I pay for their health care are completely covered by the VA….until they qualify for medicare. Great system? I would pound that drum quite a bit softer if I were you.
In my opinion, the only government health service that works at all is the TriCare system; and that is because it puts much of the decision-making into the hands of the patient rather than some unqualified generalist or beaurocrat. NIH / NCI / NHLBI don’t count because they aren’t ‘real’. They deliver excellent health care, but only to the chosen few, all within research protocols, and operate under a totally different set of financial rules which, if used by the rest of us, would land us in Leavenworth because outside that system they amount to Medicare Fraud.
Perhaps the government should rethink this health care strategy. Perhaps it should finally place regulation upon the insurance companies. Perhaps it should enact meaningful tort reform instead of protecting the income of the legal profession. Perhaps it should cease it’s incessant outlay and support of studies of ‘alternative therapies’ which has yet, after 10 years and over a billion dollar expense, failed to find a meaningful alternative therapy for anything at all.
Somehow, with the TriCare model, the government hit on a workable idea. Does anyone in government recognize that fact? With Obama’s recent statements and apparent plans, seemingly not.
Thomas D. Sears MD, FACC


John Edwards, he’s cute in an odd sort of way, spends a fortune on his hair, likes to primp in front of the camera, and has an infantile fixation of the phrase *
“According to our source, Hunter confided to Young that she and Edwards talked about getting married should the candidate’s cancer-stricken wife, Elizabeth, pass away, even discussing what music they’d play at their wedding.”
But, la pièce de résistance:
My guess is that Hillary knew about the affair, and she wouldn’t touch Edwards with a ten foot pole. Obama, however, promised Edwards either a Vice Presidential or Attorney General position. And who did Edwards endorse?