Well I've actually worked at a VA -- The John Cochran in St. Louis. Occasionally, by some miracle of happenstance, the stars aligned and the patients got exceptional care; typically when they were transferred to Chicago. But for most vets, the care was oft times worse than the Homer G Phillips city hospital where I also worked. I quickly learned that you had to hand carry the blood draws to the lab and stand over the tech to make sure they actually did the appropriate test. Trying to get an image interpretation in a timely fashion was nothing short of a miracle. I was a 3rd year medical student and taking care of ICU patients by myself at night -- a great trial by fire learning experience for me, but certainly not great for the patients.
What we are seeing in the current VA scandal is simply a manifestation of human nature -- we all respond to what is being measured, be it wait times, etc. And yes, it does raise the troublesome quandary for folks advocating a single payer system: there is simply no evidence that any system based on political self interest works better than individual economic self interest. Indeed, the preponderance of evidence is quite the opposite. And simply putting all these folks in Medicare doesn't solve the basic economic problem with Medicare: it is economically unsustainable. However, this isn't an isolated scandal, it's simply the latest scandal in a series of recurring, non-recurrent scandals indicative of a broken system that doesn't work
I appreciate both your experience and your services, but neither has kept you from confusing single-payer systems with socialized medicine. A single-payer system is not based on political self-interest and does not remove economic self-interest. it
does often include price controls, a limit on economic self-interest, in both Medicare and in large, employer-based insurance groups that are the economic driver of the American health care system. Sometimes caps aren't calculated well and result in procedures that are not properly compensated; a problem to be addressed. Most of the time, though, this is not the case. I manage my father's healthcare and financies, and the finest clinics in this very competitive medical town (Charlotte, NC) gladly take him and many other Medicare patients. His Oncologist is in one of the best Hematology/Oncology clinics in the state. My father has supplemental insurance, but it is only necessary for the deductibles. They take what Medicare pays...from a waiting room full of Medicare patients.
Is Medicare sustainable? It's solvent. Whether or not it is sustainable into whatever future is a question of political will and future economic conditions. If you can tell me with any certainty how "sustainable" Medicare is going to be in...say, 2024? I don't want you worrying about Medicare, I want you managing my stock portfolio.
The truth, with all the political posturing out of the equation, is that, barring economic collapse, Medicare is sustainable as long as we're committed to sustaining it, and there are good strategies for making it sustainable and affordable for a long time that we have, so far, not had the political will to use. Adding veterans coverage is not on the list. That would be a burden on the system, though it would probably be the least expensive way to move veteran's coverage into the private healthcare system. Offering Medicare for sale to Americans and American businesses would make it much stronger, much more sustainable, and would, IMO, be a much better system than ACA. But you'll have to get the insurance lobby out of the way of that one.
To keep Medicare from getting mixed up with socialized medicine, remember that Medicare is not a healthcare system. It is simply the biggest insurance group, with the greatest negotiating power. Being government-run is not ideal. If it were one big private insurance company with that huge senior chunk of the market, its negotiating power would be awesome. But that would create a whole other set of competition-deficit problems that would be even worse than a bit of government inefficiency.
Tim
