In the wake of this midterm election season, with all its dramatic and rhetorical pledges to America, we should not lose sight of the pledges we have already made. We have promised as a nation to provide our disabled veterans with the best health services that modern medicine has to offer. We need to honor that promise to our veterans, and we need to pay the tab as readily as we funded the wars that harmed them. Calls for privatization of veterans' health benefits, touted by many fiscal conservatives as a way of tamping down big government, seems an odd way for us to try and meet those obligations.
Our civilian health care system, once the envy of the world, has suffered at the hands of the modern free market. We in the U.S. have, by a huge margin, the most expensive health care in the world, and we rank fairly low among developed nations in what that health care has achieved. The gap between our remarkable medical resources and the delivery of that as health care is widening all the time. We shouldn't be surprised. The economic incentives that we have allowed to drive our health care are the same as those applied to brokerage firms and electronics stores. Our private, third party health care system, based on profit, is by its very free-market nature focused on minimizing services, cost-shifting to the "consumer," and achieving short term goals. Its simply good business. Clinical effectiveness and rational public health policy take a back seat. This is the club that privatization gets you into, complete with plenty of out-of-pocket expenses, denied claims and gaps in coverage. Recent health care legislation has applied little more than a bandaid to these ills.
I learned firsthand about universal health coverage -- similar to what disabled veterans now receive -- by serving for eight years as a medical officer in that great bastion of socially progressive thinking known as the U.S. Navy. Health care priorities were set by -- I swear I'm not making this up -- health care professionals, based on clinical evidence, rather than what insurance company executives decided in strategy meetings. Drug formularies were driven by pharmacists working with physicians, not by marketing executives. There was no incentive to create medical conditions just so we could implement expensive tests and treatments. And no money ever changed hands; just show your ID and you were in. Before any of us dismiss universal, single-payer health care on the basis that it is socialism -- or, even worse, European -- it is worth taking a closer look at what our own military and veteran systems have managed to accomplish. And before we take the VA health system away from veterans, we should look at the facts.
The reality is that the VA health care system is one of the best in our country, based on physician quality, clinical outcomes and patient satisfaction. We should be studying the effectiveness of the military's and the VA's healthcare systems rather than devising ways to dismantle what works. Why would we want to insert veteran care into an overpriced civilian system that by almost all measures performs less well?
One particular danger of dismantling the VA system is the gap that would create in mental health services. Our civilian third-party-payer system has been particularly inadequate in dealing with psychological and emotional disorders for our population in general. In contrast, The VA, bolstered by recent funding increases, has been rising to the challenge of treating and supporting the growing number of our veterans who carry the invisible yet debilitating wounds of war in their hearts and minds. To release them into our civilian health care system, where psychiatrists get reimbursed for little more than monthly "med checks," and where talk therapy is a luxury that few can afford, would be unconscionable. As startling numbers of our troops return from war with emotional or neurocognitive disorders, overwhelming the VA's capacity, some indeed may be directed to civilian care. But even in those cases, it is important that the civilian psychiatrists be able to turn to a functional, experienced VA medical system for specialized training, guidance and support in the treatment of these uniquely military conditions.
This is the wrong time for talk of privatization of the VA system. While our nation debates what we want from a civilian health care system and how we are going to pay for that, let us all pledge to continue providing disabled veterans with the best option currently available -- that provided by the VA -- until we come up with something even better for all of us.
Maggie Kozel, M.D. is the author of "The Color of Atmosphere: One Doctor's Journey In and Out of Medicine," forthcoming from Chelsea Green Publishing.
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