Free Markets, Free People

Government Health Care – A Cautionary Tale

Dale and I once interviewed Ezra Klein about health care on our podcast. Klein held the VA system up as a shining example of good government health care. Of course that was before the shameful condition of Walter Reed had been discovered. Since then other problems (for instance, contaminated colonoscopy equipment in various locations) have been discovered.

A commenter once asked “if VA is good enough for our veterans, why isn’t it good enough for us.” My answer was “it isn’t good enough for our veterans, it is instead what they’re stuck with.”

Today brings another example of the problems this sort of medicine is bound to have. It is a bureaucratic nightmare, even at the relatively small size of VA.

For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off.

Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.

It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.

He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.

The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.

That as they say, was the tip of the iceberg. No one reported the problem because there was no peer review. And, this was one of many mistakes made by this doctor that apparently no one knew about:

Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records.

The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.

Six years and no one had a clue. In fact, if you read the article in full, as you should, you’ll see that the discovery of this was essentially an accident.

This is government health care. This is what our vets are stuck with. This is not something we, as a society, should want any part of.


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73 Responses to Government Health Care – A Cautionary Tale

  • I lived for a time in the UK in 2005 (for a reason I will not divulge here), but had to see a doctor. A doctor of mine here in the States knew that I was going over to London for the entire summer, and recommended a doctor friend of his who has an office about two blocks from Harrod’s, in Knightbridge, south London. Pricey place, to be sure, but this British doctor was OUTSIDE the NHS structure – he was simply pay out of pocket for each visit; no bills, no Medicare, no nothing. I saw him about five times that summer, each time costing me anywhere from $200 USD (for the first visit) to $75 for the last visits when I merely had to see his nurse. For me, it was well worth it: I did not have to submit myself to the British NHS, which is a disaster, and I got my medical needs taken care of.

    Imagine if ObamaCare℠ is put through. We will rue the day that that garbage was foisted on us. Take my word for it: I have seen its effects up close.

  • The VA hospitals are simply awful, but if you are retired military, you no longer have to anticipate dying in one of these warehouses.  When military members spend 20 years on active duty, Congress promised to keep them and their spouses in the military medical system.  During the Clinton administration, they refused to honor their commitment.

    A lawyer who had retired from the USAF took Congress on and won.  No one paid him a cent for his years of legal work and tireless lobbying of Congress.  There is a new program called Tri-Care for Life, which provides excellent standard insurance type coverage to supplement Medicare.  The man we should thank is Colonel George “Bud” Day, winner of the Medal of Honor and John McCain’s cellmate in Hanoi.

  • Uh, guys?

    Walter Reed is an army hospital, not a veteran’s hospital. The two systems have nothing to do with one another. That’s why the problems at Walter Reed led to the resignation of the Secretary of the Army and not the Secretary of Veterans Affairs.

    • Uh, Walter Reed is a government run hospital … so the two systems are from the same source, aren’t they?

      • No.

        The Veterans Health Administration is not run by the Army.
        Walter Reed is run by the Army.

        • No one said it was run by the army. What has been said is both are government run entities.

          What’s the title again? Oh, yeah, “Government Health Care ….

  • well done bruce.  that pivot was flawless.
    of course, the problems with the colonoscopy procedures were clearly the result of the fact that the VA was gov’t run.  i mean, you NEVER see that kind of mistake made in the private sector.

    • But the VA IS government run and the problem appeared in multiple locations – is that a product of poor procedures, poor supervision or both?

      And in the private sector, when there are problems like that, patients have choices don’t they?

  • Right. I guess in the same way that the Marines and Social Security are both “systems from the same source,” so they must be the same.
    geez, buddy, get a clue.

    • Who pays for them and regulates them both JS? IS there a different source”

      Is it ok if Walter Reed is a disaster because it is an “Army” hospital? Is it ok if the VA hospital cited is a disaster because its not an “Army” hospital? Or is the point that government bureaucracies run both and in both cases the outcome hasn’t been good?

  • Wow, McQuain’s reply is disingenuous.  The VA hospital system is the one that is held up in multiple surveys of public and private systems as the most effective and efficient.  The Walter Reed scandal does not detract from those findings at all because the VA system and Army system are apples and oranges.  Saying they are from the “same source” is sophistry.

    • Really George – then explain how the story I cited happened, will you? And if you read it, which apparently you didn’t, you’ll find that one of those surveys you claim are so telling found this particular VA hospital good to go in the very area if failed so miserably.

      Anything to say about that?

  • No they do not come from the same source. Or they do in the same way a mailman and a ballistic missile come from the same source. The two different types of hospital are run by different people from different funds in different ways. The bottom line still remains that most Americans are in some way dissatisifed with their coverage, either aren’t covered or pay too much; and that over 70 percent of Americans want a public option. The only thing standing in the way are people who enjoy lying, (cough…cough…qando) or gutless politicians of both parties who are practically in the pocket of the insurance companies. Can’t we at least compromise on that idea, that our politicans should work for us rather than huge corporations?

    • You can’t be serious – you really believe that some other sources beside the US government pays for and regulates the VA system vs. the military system?

      Heck I can’t help you if that’s what you believe.

  • wow, since you seem fairly obtuse, I suppose someone should spell it out for you. As Ezra noted, they are two different systems and “have nothing to do with one another.” So to say that since they are both government funded or ran is similar to saying that the U.S. Marine Corps is the essentially the same as the Social Security system and can be expected to have the same problems because they are both funded and ran by the government. Just stop, it’s embarrasing.

    • Ezra doesn’t want to claim the military system because it is not supportive of the nonsense he’s trying to sell about the VA system.

      Read the freaking article and tell me why Ezra should want to tout even the VA system.

      Oh and your tired Marine Corps/SS analogy. For heaven sake we’re talking about two government run hospital systems, not lunar exploration and cooking shows. Once again, try reading and understanding the title – Government Health Care. The military and VA systems are both examples of government run health care.

  • “Government” is not an amorphous and homogeneous mass.  If the Army is doing things wrong that the VA is doing right, then the Army needs to be corrected, and it’s our job as citizens to correct our government when necessary.  But the fact that failure is possible doesn’t make it inevitable, and it certainly doesn’t justify throwing up your hands and walking away from the table.
    You might as well look at Enron and say “Corporations are fraudulent.  Let’s abolish them.”  Details matter.

    • Government is running both of these systems. We’ve had the same sorts of problems with both of them. But your conclusion is the fault isn’t in the entity in charge, it must be somewhere else.


  • Bruce,
    A singular piece of ancedotal evidence is a poor thing to base such a sweeping argument on.  There are literally *countless* stories of the free market healthcare system in the United States utterly FAILING on a magnitude and scope to dwarf to the single. solitary. little. weak. ancedote. you have dredged up here.
    Anything to say about that?

    • Myrtle, you have to have been born yesterday to think this is some “singular piece of anecdotal evidence” concerning VA. Either that or you have only begun to explore the VA system today.

  • what “choice” would having a public OPTION take away? enlighten me.

  • You are not reading correctly, Bruce.  The poster above *acknowledged* that both systems are run by the government.  However, this fact does not preclude other facts; such as the fact that the two different government programs mentioned have many dissimilarities as well.
    Is it really so difficult for you to hold both facts in your head at the same time?

    • It doesn’t matter if there are two different programs, they’re two government programs, government is running the health care and both systems have problems.

      How hard is that to wrap your head around. And these are the highly publicized problems simply because they were bad enough to come to the attention of the media.

      Again, for the slow on the uptake, read the freaking title of the post!

  • Yes, they are both government run and at the same time, they are very different systems.  See?!  Not so hard.

  • Bruce, you are clearly committing, both  two types of logical errors here.
    1. Category error.  Insisting tht things that are dissimilar are the same, when the differences are what MAKE the difference.  Your connecting tissue are two – “government” and “health care” – are the only things that matters.  But it is the differences between the Army and VA programs that account for the differences in outcomes.  And this is clear in the survey and effectiveness literature for both systems.
    2. Generalization fallacy.  Taking the information from one specific instances, and generalizing the bad outcome, in this case, to the system at large.
    Again, to gage effective outcomes, you have to look at the satisfaction and effectiveness surveys, and the VA hospitals come out ahead, of all other systems in the US, public or private.
    That doesn’t mean they are perfect, as your post shows – but your example is evidence only of that imperfection, no evidence about how horrible the VA system is as a whole.

    • 1. Government runs both health care institutions. Claiming they’re different is simply bogus. I grew up in the family of a career military officer. I went to military hospitals. The care was marginal in comparison to the civilian world. I then did 28 years myself. I went to military hospitals and finally decided I’d pay out of pocket for care vs. spending days trying to see someone. I’m now a vet. I’ve been to VA hospitals. I don’t go anymore. I’m a member of veteran’s organizations and have talked to vet’s affairs officers who can reel of horror story after horror story about how poorly the system addresses the needs of vets. I write for Blackfive and hear constantly from vets of Iraq and Afghanistan how poorly they’re treated in both systems. To even try to convince someone who has been a part of both for years that they’re categorically different is completely unpersuasive.

      2. I’m not generalizing anything. I called it a cautionary tale. I’ve also written extensively about health care on this blog for years. So to those who read this blog and don’t beam in and make certain unsubstantiated assumptions, this all flows quite well.

      Lastly, have you ever been in the VA system JC? Do you have that experience to compare to other health care? I’ve been in both systems (military and VA) and I work in the civilian world as well. So my characterization comes not only from stories such as the one I cited (and there have been plenty of others over the years I’ve cited on this blog) but from personal experience as well. And you?

  • Wow, a lot ridiculous hair-splitting in order to try and ignore the fact that both the VA and the DoD (in this case, the Army part) systems are run by the federal government. If it helps any of you understand the point, imagine that ONLY one of them exists, and then ponder the problems of ACCOUNTABILITY that Bruce was highlighting.

    And if anyone wants anecdotal evidence, I’ll be happy to point to a buddy of mine who walks with a deformed leg to this day because of what a military hospital did to him of a routine ankle injury.  A disability that was never compensated for despite years of wasted litigation.  If and when we reach a single-payer system, get ready for “sovereign immunity” to completely trump all med-mal lawsuits, leaving victims of government care SOL.

  • You know, when a damn dirty hippie uses Enron to condemn all corporations, people don’t say “you’re right, dirty hippie!  Bad behavior by a single corporate entity serves to automatically discredit the entire corporate system!”  Rather, a reasonable person might look and see whether there are other corporations that don’t defraud their customers, because if so, it probably means that corporations can either be run well, or they can be run badly.  That is to say, just because two things are similar in one respect (i.e., the category of institution to which they belong), however important, doesn’t mean that they’re similar in *every* respect.
    And, wow!  It turns out that most reasonable people don’t think that Enron’s malfeasance serves to discredit e.g. Apple Computer.  I know, that seems crazy – after all, both Enron and Apple qualify as corporations, and corporations behave poorly, both spectacularly (Enron) and just occasionally (Apple).  Yet, somehow, people can differentiate between entities within a system.  Goofy, right?
    Okay, how about a different tack: let’s reverse your argument exactly.  It’s a fact that private insurers routinely deny procedures that should be covered, and routinely deny or terminate coverage for specious reasons (I won’t bother to dig up links – everyone knows that this happens all the time).  Will you then agree that this shows private insurers to be unfit to provide health care?  After all, the private sector is running the current system, and we’ve had the same sorts of problems with every insurer.  Or, is your conclusion that the fault isn’t in the (type of) entity in charge, but that rather it must lie somewhere else?  Like, maybe in the individual insurers, or even with the agents making case-by-case decisions?
    Of course, this post is pointless.  Clearly you’ve made up your mind and have your talking points – government-run healthcare is bad!  one instance of poor govt-run healthcare discredits ALL POSSIBLE TYPES of govt-run healthcare! – but you’re responding in such a profoundly illogical fashion that you kind of invite a response.
    There are good arguments against government-run healthcare.  You’re making exactly zero of them in this post.

  • I see what it is now – the “I know a guy…” problem.  Say it with me…the plural of anecdote is not data.  We can trade anecdotes all day long:
    So I’m curious…how about some actual data?  What do health outcomes look like for people in the VA system compared to the average private insurer?  What about costs to the system per patient?  Overall patient satisfaction levels?  Etc.  Before damning the VA system, wouldn’t this be good information to have?

  • Since when do all corporations report to the same governing body?

    And you’re deluding yourself if you think that “the private sector is running the current system.”

  • Well, by that logic, all those horror stories in Michael Moore’s film really do mean the whole health insurance industry is evil.  Funny, I didn’t have you pegged as a Moore fan.

  • “Since when do all corporations report to the same governing body?”
    They’re all motivated by profit and competing with one another.  This isn’t a “governing body”, but it’s sure enough to create substantial similarity among the insurers.  Comparing them to one another, and grouping them together, is absolutely fair.
    “And you’re deluding yourself if you think that ‘the private sector is running the current system.'”
    Right.  A person working for a privately-held business (let’s say Dunder Mifflin Paper), insured by a privately-held company (let’s say Blue Cross Blue Shield), isn’t receiving private-sector health care.  ‘K.
    The bottom line is that you’re trying to define the current solution so that it can’t be criticized in this context.  Blue Cross looks, behaves, and is funded and organized similarly to other insurers?  Well, they can’t be compared – no universal governing body!  Got a person with e.g. BCBS through their (private) employer?  Well, that ain’t no REAL private sector, self-deluder!

  • the fact that bruce did not own up to his error concerning walter reed is proof that he is fundamentally uninterested in acting as an honest interlocutor in this argument. Bruce could have said: “i implied walter reed was run by the VA in my post, which was incorrect.  Walter Reed is for active duty soldiers and is run by the Department of Defense.  However, I still stand by my original point.”  instead, he dug in and pretended that the error didn’t matter.
    in other words, he wasn’t using facts to prove his point;  instead, he was fitting the facts to his argument.
    in the future, you can save all your readers some time and title all your posts: “Gummint Sux.”

  • From the world of private medicine
    People do the wrong things all the time.
    One aspect of consumer driven medicine is that it has improper incentives. In this case, doctors acted on the incentive to make money by performing procedures even when they were not necessary – heart surgery. Consumers pay for procedures because the there is no market for doctors on retainer, apparently. (In truth, that is the way I believe Americans view their health insurance – a doctor on retainer.)
    Additionally, consumers of health care are ill-informed. In this case, I’m confident that the people who received heart surgery did not over consume it because it was free but rather trusted their doctors judgement and education. Should they have gotten a second opinion. Yes. Would they have gotten a second opinion if they had to pay out of pocket? Well, yes, but, in fairness they likely would not be paying for heart surgery with saved money, but with catastrophic health insurance. Where were the insurers here? Did the doctors falsify their medical records to get the insurance company to pay for unnecesary surgery? Why doesn’t the insurance company require a second opinion before covering something expensive like heart surgery?
    In regard to the diff. between VA and Army hospitals, I think a better analogy would be a visit to one bad McDonalds doesnt mean the whole francise is rotten.
    Furthermore, it is important to get termonology right. The comment “If and when we reach a single-payer system, get ready for “sovereign immunity” to completely trump all med-mal lawsuits, leaving victims of government care SOL.” is a mis-use of ‘single payer’.
    Single payer is private sources of medical care all paid by one entity, Uncle Sam. You wouldn’t be suing uncle sam for malpractice, but a private provider of insurnace, so I don’t see how soverign immunity would apply. I think you are confusing single payer with ‘socialized medicine’ or ‘nationalized healthcare’ or something along those lines.

  • It is a fact that you have proferred exactly one piece of ancedotal evidence in this thread to support your argument.  Not two!  Not three!  One.
    Nowhere did I preclude the possibility of other ancedotal evidence to support your argument, but the fact is you have not offered up anything else in spite of the fact that you maintain it is so readily available.  That’s pretty telling.
    What’s more, it seems you are entirely uninterested in rebutting the claim that the free market health care system in the United States has generated such a large set of UTTER FAIL data points to entirely dwarf your single. solitary. ancedote.  Challenge me to provide some of this set and I’ll wash your comments with them.

  • Bruce,
    If you have those experiences, again, base them on hospital outcomes and effectiveness reviews – science, if you will.  Again, by referring to your personal experience – valid, for you, of course, not denying that – this again is a fallacy of generalization, from your experience, to the world at large.
    My experience would be similar – a generalization from my experience to the world at large. 
    If you want to look at personal experiences, you can look at horror stories regarding some of the denials of insurance dealt with up on the Hill last week.  Matthew Yglesias had a post today, on how even getting in to see his doctor for something minor, entailed a waiting period, while getting it taken care of in England was quick and simple.
    The essential point, whether you choose to ignore it or not, is that the vast preponderance of evidence is, that you get better health outcomes in a universal health care system.  Looking at the stats in:  England, France, Canada, Australia, Netherlands, Denmark, Germany, Sweden, Switzerland, etc, etc, etc, ad infinitum – all shows this to be true.    A LOT more cost for US healthcare, without better outcomes, and 20-25% of the population not covered at all.
    Fair point, on you calling this a cautionary tale. However, you end with:
    “This is government health care. This is what our vets are stuck with. This is not something we, as a society, should want any part of.”
    And that is the – very clear and obvious – generalization of which I speak.

    • My goodness JC – I’m not basing this on my personal experience alone – one more time: I’ve been writing about this for years. But unlike you and Ezra I do have personal experience in both systems.

      Yglesias should write about getting something serious done – it’s not the primary care where the wait times are a problem. Have a cold – easy to treat in England. Need a hip replacement? Good luck.

      Looking at stats is only half of the picture. How those stats are gathered is another. The simplest example is infant mortality rates. Although reported statistically, never does the fine print reveal that almost every nation reports them differently. Many of those you cite above, for instance, have far less stringent reporting parameters than does the US (in fact, when I researched this I found that the US was almost the only country which reported infant mortality in accordance with WHO guidelines). And of course we then begin to understand how the rest of the mortality averages are effected?

      As to the last – call it whatever you want, but the fact remains that more vets leave the system if they have an alternative than stay. In fact, if you read arch’s post at the beginning of this, the reason vets pushed so hard for TRICARE for life is becauses it lets them seek care outside the VA system. That alone underscores my so-called “generalization” and plants an exclamation point behind it.

  • It happened almost entirely at one location by one doctor who no longer works there.  And there are multiple VA hospitals to choose from if so inclined.  But that’s not relevant anyway.  If we had single payer health care, we’d still have all the same doctors, hospitals and choices.

  • If anything government run is automatically to be termed as incompetent why do we trust our basic security to government-run forces?  Aren’t we really risking our well-being by doing this?  Shouldn’t we contract out the entire defense of our country to a corporation or corporations?  Wouldn’t we all feel more secure?  Or is it that, ultimately, government run entities are accountable to the population where as corporate entities are not?
    And how the !@#$ did we ever get to the moon, anyway?  Must have been the Good Lord because the guv’mt shore couldn’t a done it.

  • Answer honestly. When you wrote the original post, did you think that Walter Reed was a VA hospital?

  • you what the funniest thing is about this entirely fallacious argument of yours? The fact that the evidence you provide refutes your own argument! It takes some real cognitive dissonance to miss this. It’s not way down in a part of that NYT article that you cite, but rather it’s what you quote yourself in this post:
    Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records.” (my emphasis)
    So, in order to argue that government health care is the Great Satan, you cite an article saying that the government should be more aggressive in the way it runs health care.

    • The funniest thing is how you’re reduced to flailing around claiming my argument is fallacious without offering anything of substance in rebuttal. I am getting quite a laugh out of that.

      And, to your last point, no I didn’t suggest that at all. I pointed out that it took 6 years to come to light, it only came to light accidentally and that there was no system in place to have caught it in the first place (and as far as I know, there still isn’t a system in place to do so). Most people would deem that a systemic problem, wouldn’t they?

      Do everyone a favor JS – read the article.

  • Guess ya’ll missed the part where Bruce had a choice in the end and elected to go to a private system after feeling improperly handled by the ‘government’ system.
    And of course I’m sure you all feel that choice will still exist as plentifully as it does today when the really cool government run system you all seem clearly in favor of is in place.
    And yes mistakes are made in the private sector too, and in the private sector we can elect NOT to go to those hospitals where the mistakes were made….what a concept.   When the Gov runs all/most of them our choice will be <crickets?>
    Bruce is clearly supposed to chuck his personal experience in favor of evidence your arguments fail to present.  Who’s he gonna believe about VA and Army hospitals?  His own lyin eyes, or your opinions?
    JC be sure and site your overwhelming stats showing other systems are sooo much better – but leave out the dead baby stats, because they’re bogus.

  • So, because a hypothetical action could have solved the problem, the problem isn’t actually a problem. Natch.
    This is the problem with all the defenses in this thread, really. Hypothetically, it may be the case that government health care might not screw up. Hypothetical mechanisms exist that may serve to keep it in check, under some circumstances, if a bureaucrat permits it. Meanwhile, let’s not have the really useful mechanism of being able to go to another entirely separate source with entirely non-hypothetical accountability.

  • 1. No matter how many times people point out that the VA is rated as the highest quality, lowest cost healthcare system in the country or that its patients consistently give it higher marks than private systems, opponents of “government run healthcare” repeat that everything is otherwise. Then they pounce on a single instance of problems — with a private contractor — as proof that government run healthcare doesn’t work.

    2. Not only is Bruce guilty of conflating Army and VA medical systems, he also implies that the VA model is what everyone would have if we as a nation actually achieved reform and had Universal Healthcare. A government option doesn’t mean the government is the provider, any more than for profit insurance companies deliver care.

    3. Why is it that this VA incident got front page play at the NYTimes but they couldn’t be bothered to report about the House hearings that aired on CSPAN about the systematic denial of coverage by private insurers to paying subscribers. Why shouldn’t Robin Beaton have she shouldn’t have an option to have a public insurance program. How could it possibly be worse than what she experienced with Blue Cross?


    • Hey Athena – have you ever been treated in a VA hospital? I have. Guess what? I’ll take the coverage I pay for any day.

      1. And, as I pointed out to one of the other beam-ins, if you’ll bother to read the article, the very VA hospital in question had gotten one of those ratings in the very department that the article cites for that atrocious care.

      2. What I’ve done is talk about government run health care which to any rational person would the systems in both the military and VA. And I got a little laugh out of you telling us how wonderful such a system is in “1” and the implication in ‘2’ that perhaps that’s not what we’d really want.

      3. Take it up with the NYTimes, Athena. What would even be better though is if you actually addressed the topic of the post instead of all this unimpressive hand waving and attempts to change the subject.

      • When were you using the VA? I’m actually dealing with my retired navy uncle’s care in the VA system right now and it is wonderful. He’s happy and it’s been many times easier than dealing with my parent’s prvate coverage.

        If 81% of current participants like it (versus 29% of private insurance patients), I’d certainly say there’s something worth considering.

        As Atur Gwande pointed out in his January article though, the government provider model is only one of several universal care options. It may not be the way we want to go but to discard it based on repeated misrepresentations does everyone a disservice.

        • Well again, given the fact that most vets, when given Tricare For Life went to health care providers outside the VA system, I’d guess that when surveys are done of those in the system its much harder to find those who don’t like it than prior to TFL, huh? It would be much better if the entire veteran population who have been exposed to the VA were surveyed, wouldn’t it?

          And I dealt with the VA system when my father died (he was a 36 year vet, 100% disabled) and my and his experience were anything but “happy”. I bailed when I got TLF and have never regretted the move.

          See article for “misrepresentation”. Then explain to me how a good system doesn’t know for 6 years what was going on in a particular department, why it was accidentally revealed instead of systemically and why, despite these obvious problems in that department, it was rated as “good to go”?

          As I said these are systemic problems indicative of a bureaucratically inept system.

  • Bruce tells us that he paid to avoid the NHS because he heard bad things. In other words, without ever actually having tried it. When I lived in the UK, I was wary of the NHS at first too. The facilities were ulilitarian and they didn’t seem to have a lot of high tech equipment staring me in the face at every turn. After a while though, I realized that the doctors were just as competent and the care just as good as what I got through my Fortune 100, employer-paid plan in the states … and I never paid a dime for care.

    Then I moved to France and experienced care there. The facilities were nicer (the French love high-tech), there was more choice and my company’s private add-on included more extras. It was arranged differently from the UK — private providers with government reimbursement. Again, the quality of the care was every bit as good as here in the US and my net costs were next to nil beyond the 3/4 of one percent (that’s right 0.75%) payroll deduction for healthcare.

    Now I’m back in the US and I pay $5K a year for an individual policy that features skimpier coverage and higher-copays than what my corporate and government employed friends enjoy. I also live with the very real possibility that after almost 8 years, my premiums could be for naught if I were to really get sick and the carrier decide to dig out some bogus justification for “recission”. I read that 62% of bankrupcies were at least partially precipated by medical bills and that that 75% of claimants had medical insurance and I realize that in no other industrialized country could that be possible.

    We don’t need a “public option” to this dysfunctional, broken model, we need a “private option” (which they do have in France and Germany) to single-payer, universal healthcare.

  • And while we’re at it, why don’t we discuss the constantly flogged, and false,  premise that lack of health insurance is exactly the same as inability to receive health care.
    We could even look at what the CBO those, appearantly, lying sacks of government crap, say about the plan being foisted off on us by the administration.
    You know, like the deficits it will cause, or the fact that it still won’t be ‘universal’  a plan that would yield an estimated drop from 50 million un-insured to 36 million.  Where’s the ‘universal’ in that?

    “Once the proposal was fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. At the same time, the number of people who had coverage through an employer would decline by about 16 million … and coverage from other sources would fall by about 8 million,” it said.
    “The net decrease in the number of people uninsured would be about 16 million,” Elmendorf wrote.

    When one branch of the government that’s going to run this thing tells me one thing, and another tells me another, why is it that my level of skepticism about it tends to go vertically ballistic?

  • Why can no one get their facts straight about the health care proposals currently being debated in Congress?  It’s almost like health care reform opponents don’t care about an honest debate and just want to yell “socialism” to scare people.
    1) The CBO did not score the administration plan.  They did not score the house plan.  They scored a partial version of the Senate HELP plan, which did not include a public option.  You can not truthfully claim that the CBO says the administration plan, or a public option, will cost $100B/year because they did not evaluate those things.
    2) No one is proposing making the VA (or army) system a part of the health care system for the general public.  No one is proposing having the government provide health care in this country (single provider.)  No one is proposing having the government be the only insurer in this country (single payer.)  They are proposing having the government run a not-for-profit health insurer that people have the option of joining, having the government subsidize poor people to afford coverage from this or any other private insurer, having minimum standards and rules about the contracts issued by insurers, and providing the means for people to make an informed choice about the insurance marketplace.  That is not socialism, it is not fascism.  
    Do you understand now that I’ve explained it in short simple sentences? 

    • Hey SP – where did we say we were talking about what is being debated in Congress.

      Read the freaking title. It’s about government run health care. As I understand it that’s not what Congress is talking about at the moment.

      However, most of us who can reason and see beyond tomorrow are able to see where what is being debated in Congress might lead. Thus the “cautionary tale”.

      Now that I’ve explained in short simple sentences why you shouldn’t assume what is obviously not in evidence, do you understand?

  • The direct response was to looker, the reply button didn’t thread my comment.  
    As for “cautionary tales,” why don’t you oppose a single provider system when it comes before Congress instead of trying to stop something that could improve the health and finances of the American people?  All these things you’re afraid of can’t come to pass without another proposal (which I posit will never even be proposed)- slippery slopes are usually a ridiculous form of argument when it comes to federal policy because there are so many veto points in our government.

    • Because I think what is coming before Congress is an abomination that will drive out private insurance in favor of “public” or taxpayer subsidized insurance. It is so far outside the charter of legitimate government that it would be inconceivable to those who began this grand experiment. And, as I’ve said, the private sector is a net producer of wealth while the government is always a net consumer of wealth. As you might imagine, that means there is an economic tipping point and governmenteventually devouring 20% of the GDP is a fantastic way to turbo-charge our advance on that point.

      That’s why.

  • When you wrote the article, did you know Walter Reed was not part of the VA or not? I agree with your skepticism of government care, but your post made it sound as though you didn’t know the difference.

    • Of course I knew – the article is about government run health care. Both Walter Reed and the VA fall under that umbrella. Using Reed as another example of mismanagement from the same source was purposeful. It isn’t an article about just about VA – thus the title. Had I been focused only on VA, my title would have reflected that.

  • If you make a mistake – then make a correction. No big deal. People – even smart and informed people –  make mistakes all the time, but if you readily admit it, it might actually strengthen your credibility. Ezra does it here for instance: Not so hard.

    But trying to obscure your blunder with all sorts of smoke-screeens and weird arguments about all government entities being exactly the same – and therefore you made no mistake about a VA hospital, which wasn’t –  that just makes you seem like an ideological hack with no interest in facts or truth.

    You specifically mentioned that Ezra had held up VA as a shining example and then you proceed to use Walter Reed to refute that particular point. This was so obviously a factual mistake and your attempts to explain it away are embarrasing.

    • Yes, Ezra mentioned VA in our interview. He was talking about GOVERNMENT RUN HEALTHCARE for heaven sake. Walter Reed is also government run health care. What part of that don’t you understand?

      • I’m pretty sure we don’t understand the part where you can’t/won’t/are afraid to admit you screwed up, correct the mistake and apologize. That’s all. You’ve decimated your credibility that there’s no reason, at this point, that anyone should bother to read the rest of your post. You’re not a credible source of information, and you’ve arrived there (“beamed in”, I’m sure you prefer) by your own hand. Pathetic.

        • Well I’m pretty sure I really don’t care what you think I did since I actually know what I did and unsurprisingly you’re incorrect.

          I was talking about government health care. I even titled the post that way. I used an interview with Klein as the jumping off point to talk about it. We talked with him about government run health care and he held the VA system up as his example of a good government run system. Then Walter Reed happened (government run, military), colonoscopy problems (government run, VA) and the nuclear seeding (government run, VA) all examples of systemic failures by government run systems. In your rush to play in the weeds you missed the point completely.

          Now my point may be a little too sophisticated for you to grasp, and given your comments, I’d say that’s fairly obvious. But worrying about what you think – uh, no. You apparently aren’t bright enough to read a title and apply it to what is written and thus what you think is of absolutely no importance to me.

          • Wow. You’re like a circus act. Perhaps you could start blogging for The Next Right. They turned into a full on freak show after a promising start, too. It’d be nice if the right could offer an intellectually coherent defense of their arguments but I’m struggling to find anything that fits that description. It’s clear I can cross you off that list and fill you in on the “hack” side of the list. Adios.

          • Well Dean, that’s because you’ve demonstrated you’re dumber than a box of rocks, so the fact that you can’t do anything but beam in and complain, instead of actually addressing the issues in the post surprises no one here. This is merely act II for you. Why in the world would I concern myself with someone acting like a classic troll vs. a person who can actually address the concerns raised in the post and offer a relevant and well-argued counter?

            You’re right, I wouldn’t.


  • These replies are surreal.  Did anyone read the linked article?  It’s not about Walter Reed, but about the Veterans Affairs Hospital of Philadelphia.

  • Karen – the fact that you don’t think you ever paid a dime for care tells me a lot –
    Where did the money COME FROM Karen?  Do the math, figure it out.  THINK.
    It doesn’t just appear in the coffers of the medical facilities, it COMES FROM TAXPAYERS.
    So, Dear Karen, you DID pay a dime, at least, for the care you received, and a dime for the guy next store, and a dime for the guy across the street, and one from the guy in the flat upstairs, etc, etc, etc.  And you were going to pay those dimes even if you NEVER used NHS so long as you were subject to British Tax law.
    Can you people really be that incredibly ignorant of how government MUST derive the funds it hands out in the form of medical care?

  • As a former medical device sales rep, I spent time in the OR of several VA hospitals.  My evidence is purely anectdotal, but it is my own experience.  I would never voluntarily go to a VA hospital.  Decrepid facilities, old equipment, beaten-down staff.  No comparison between those hospitals and every other one I ever worked in.  Do those that tout the VA system as a model have their own personal evidence as to why it is superior?
    The only time I almost passed out doing that job was watching a young guy on the table writhe in pain as the CRNA and staff prepped him for his surgery.  Brutal.

  • When your *direct* response to a post that begins ““Government” is not an amorphous and homogeneous mass.” is “Government is running both of these systems.”, which tacitly assumes that there isn’t and can’t possibly be any significant difference between two different government agencies, or in other words, that government *is* an amorphous and homogeneous mass, it’s hard not to conclude that you have no interest in arguing reasonably or in good faith, but just want to piss on the idea of “government” doing anything, ever.
    Well, it’s your blog.  Piss all you want.  But don’t expect anyone else to watch.

  • Oh, I know – it’s from Fox new, so, it has to be wrong –
    Note “underfunded hospitals” – “overworked doctors”
    Yes you fans of VA!  wow!  impressive!  THIS is what we should aspire to on a national level!  Well Done!

    “[T]here is no question that shoddy standards — systemic across the VA — put veterans at risk and dealt a blow to their trust in the VA,” said Rep. Harry Mitchell, the Arizona Democrat who chairs the House Veterans’ Affairs Subcommittee on Oversight and Investigations.

    Sounds like the anecdotal evidence (of how great is is)  is from you, not from the blog entry.