Wednesday, March 21, 2007

"To care for him who shall have borne the battle" - These words from Abraham Lincoln's second inaugural address speak to the essential mission of both the military healthcare system and its counterpart in the Veteran's Administration. Both systems face all of the challenges that beset healthcare delivery in the civilian sector, plus one: too few public dollars (i.e.: dollars that are not associated with an expectation of gain or accountability for loss) targeted to meet the ever-increasing demands exerted by active duty military personnel, dependents and veterans. As we have all gathered from the coverage of circumstances at Walter Reed Army Medical Center (as seen in the Washington Post and elsewhere), it may be neither reasonable or prudent to assume that either purpose is being achieved.

Speaking as an Army veteran, it would seem that those military personnel who have given all that was theirs to offer in service to their country should have first claim on their nation's treasure. And at least in theory, this was the shared goal of government. In practice however, it seemed that Walter Reed was doomed to become a Stygian depth of despair for the wounded who sought mending for their bodies and minds. Things certainly were not helped by the 2005 Base Realignment and Closing Commission's decision to close the hospital (as reported by the NYT); one would reasonably expect that scarce government resources would end up diverted from Walter Reed pending its closing.

But even if Walter Reed were never on anyone's schedule for closure, it is highly likely that things would not have been appreciably better than they are presently. Certainly no one who served in the military is entirely surprised by this sorry state of affairs. (I will never forget my own experience as a newly-minted lieutenant with a medical technician who insisted that the cough associated with my then-incipient asthma was in fact indicative of HIV; he insisted that I take repeated AIDS tests, sure that one of them would come up positive.) For many years - decades really - it has been held that, beyond the battlefield, the idea of military medicine is a rich vein of oxymoronic gold.

It is the "why" behind this situation that informs much, and not just as it pertains to military healthcare. To be sure, as long as the care of military personnel, veterans and their families is a line item on a bureaucrat's budget, there will be constraints on the dollars available to meet the needs. And there of course is the rub, as the entire military health system is the ultimate single payer scheme. The care providers - with minimal exceptions - are all military personnel, in many cases trained under the auspices of the military. The facilities, such as Walter Reed, are owned by the government. And as we know, everything is paid for by Uncle Sam.

That there are too few dollars to provide sufficient care for wounded soldiers is a grievous tragedy in and of itself, and it is mitigated only by the fact that such a situation did not result from anything resembling an intentional act. Indeed, this is all the predictable result of an inevitable mismatch between need and capability. As I noted earlier, civilian healthcare faces many of the same constraints. Medicare and Medicaid budgets are similarly incapable of meeting the needs of their recipients. The question of course is why don't our neighborhood hospitals look like Walter Reed?

The truth is that in far too many cases, many hospitals - particularly in inner city or rural areas - do look like Walter Reed... before they close. (The same is often true for physician practices that are located in areas where the predominant payer is the government.) In more affluent areas where hospitals and doctors are not so dependent on public dollars (or more precisely, where public dollars have not crowded out private monies), cash flow and capital budgets are augmented by more plentiful private dollars from insured or self-pay patients. The salient point here is that when healthcare delivery systems are dependent upon the state for payment, they are often forced to provide less than optimal care, while the cost of such care inevitably exceeds the dollars allotted to provide it.

By now you can see the trajectory of my argument. If a "single payer" healthcare system is failing our wounded heroes and their families presently, and if state funded health systems are collapsing of their own financial burden - or are consuming resources to the point of outstripping the taxing capability of government (O.K., scratch that), what commends a national healthcare system to the attention of the country at large? To be sure, it is unclear how a nationalized health mechanism could satisfy the three imperatives that Americans have established for the delivery of health care: namely maximum choice of providers, immediate access to care and minimal cost. Currently, most of us can pick two out of three; left to the devices of progressives, most patients will be lucky to get have one of those needs satisfied.

Of course, it becomes apparent that the push for national healthcare is not about the delivery of healthcare at all. It is entirely about "equalism," the result of which is the enforcing of a faux equality where one does not and/or need not exist. Sadly, such thinking has become the province of the modern Left.

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