The VA system of health care Posted by: McQ
on Thursday, March 08, 2007
As is obvious, the Walter Reed debacle is now spreading into an examination of the VA health care system. And the system which the left loves to hold up as the shining example of what government health care can be seems to be severely troubled.
As one might imagine, it is very bureaucratic, and in terms of administrative technology, abysmally backward.
In testimony before Congress today, a VA official confirmed that its current tracking system still depends on paper files and lacks the ability to download Department of Defense records into its computers, a key flaw originally identified as leading to veterans getting lost between the cracks.
Of course that "flaw" has been there for years. Consequence?
Throughout 2004, the new program sat on a shelf while returning veterans struggling with serious brain injuries, psychological trauma, paralysis or worse spent weeks and months fighting the VA bureaucracy to receive the benefits they deserved after being discharged from the armed services, veterans advocates say.
"In that gap...people find themselves not being able to pay for their car, their mortgage, they may have marital problems because they can't pay their bills," said Steve Robinson, director of veterans' affairs for the advocacy group Veterans for America. "You find suicide, alcohol abuse, drug abuse, domestic violence."
And you also find a great example of why a single provider, answerable only occasionally when some huge stink brings it to the attention of the public, most likely isn't the best choice in which to leave the provision of health care.
One of the more persistent excuses heard from those defending Walter Reed has been "well the care we provide in the hospital is first rate". Well great, but if you can't access that care, what real benefit is it? If you're suicidal and 26th in line for a bed, what "benefit" is the system to you?
Well, some argue, look at the oversight now being brought to bear on that system and the flaws it's identifying. As I pointed out, this is ocassional oversight at best. This isn't the first time the VA health care system has been found wanting. And, other than a short 10 year burst where it was touted as among the best, the majority of it's history has been one of being much less than the best.
And how well is that new emphasis on oversight working? Well, here's an example. As you know, Jim Nicholson is the head of the Veterans Affairs Department. These problems have been found on his watch. Consider the reaction of former VA program manager Paul Sullivan at the news that Nicholson was going to head the investigation into the problems of the VA health system:
He reacted with dismay at yesterday's announcement that Nicholson would be leading the new effort to make sure wounded veterans get the care and benefits they deserve.
"I don't think it's a good idea for the people responsible for the problem to be in charge of fixing it," he told ABC News.
Nah ... really?
Oh, and for you that are going to try and argue it's a money problem, save it. There hasn't been a budget year lately in which the VA's budget has been cut. In fact the VA got a +8% overall increase in funding (35.697 billion) and in the very area in which the problem exists (outpatient care), it was plussed up 13% (17.51 billion) within that budget.
Nope, this is a systemic problem inherent is any type of monopoly provision of a product in which a bureaucracy isn't motivated to change by market forces and competition (i.e. choice), but only when there is a scandal it can't duck or ignore. And frankly, I'm not interested in entrusting my health care to that sort of a system.
I have always had good treatment from the VA and and every one of the hospitals and clincs was clean and hygeinic even if old. The beucracie stincks at times like when the 1 ID lamanating machine breaks down or the dip shoot sends you down the wrong hall. Over all I have had a good expierience with the VA.
Just get rid of then dang phone perscrition line that is talking to a machine.
Why must you compare apples to oranges in your efforts to whitewash yet another BushCo. example of incompetence?
Seems I answered my own question.
The VA isn’t a healthcare insurance system, although McQ would apparently have us believe the boogeymen on the Left wish to impose it upon an unsuspected American public. Instead, the VA is its own health system; it has its own buildings, employs its own MDs and staff, purchases its own equipment and infrastructure and the like.
The VA exists for a single purpose: to address the medical issues of US servicemen and veterans. Imagine, in a period where the US is engaged in several ongoing wars, this administration did not anticipate a greater demand on the VA.
Additionally, Walter Reed falls under the purview of DoD, not the VA.
The neglect of medical care for veterans has gone back through many administrations. It is a travesty how we treat those who defend our country. At least not the spotlight is shining on this shameful problem. This country has an obligation to provide the best medical care and facilities to those who serve or have served, to do otherwise is the worst dereliction of duty possible.
This incident should be a warning for those who want Washington to provide medical care for the civilian population. If we can’t provide for those who serve, how can we expect to serve the rest of the population.
The VA isn’t a competitive healthcare insurance system, which is exactly what the Left wish to impose it upon an unsuspecting American public. The VA is its own health system; it has its own buildings, employs its own MDs and staff, purchases its own equipment and infrastructure and the like. Universal health care would result in the same thing.
If universal health insurance was enacted, there are two possible outcomes. Either A)the government would be effectively the sole insurer (like Canada); or B) the country would be divided into two groups, one consisting of people with government insurance, and others that could afford better. Right now roughly 15% of the population has no insurance, but a much larger number are insured at or near whatever the government minimum level will be. Any employer currently providing a basic level of insurance for its low-level employees would immediately drop them on to the government system.
In case A, the government monopsony shifts all hospitals into government oversight, creating a national VA-style system. In terms of quality, there is no difference between a single payer and a single provider. One entity still sets the standard (whether it’s high or low), only those business that accept that standard survive. If the bar is set high (ex: NASA parts supplier) then the buyer pays top dollar for the product. Business that could provide the the part at 85% the quality for half the price get nothing. If the gov’t set the bar that high for health care, hospitals that don’t have the latest equipment would shut down. At the other end of the spectrum you have WAL-MART. Cheapest production only, please. I like WAL-MART, but if it was the only store in town (goodbye mall, goodbye specialty shops) most people would be pretty disappointed. Hospitals at the high end of quality wouldn’t be able to stay in business. Its the same thing at any point in between, its just a matter of what level of service you want to be the standard.
Now case B. In the current U.S. system, health providers have a choice of what insurance they will accept. If that changes and hospitals are mandated to accept gov’t insurance, we are back to case A. If the government payouts are among the highest, we are back to case A. If government payouts are not competitive, then some (or most) hospitals won’t accept that insurance. The only way to ensure that the government insurance actaully leads to access would be for some hospitals to modify their business model to survive on the income from government insurance. Even if the government doesn’t have to run individual hospitals if enough volunteered to accept it, the care at those facilities would still be different than those hospitals still using the current system.
Imagine, in a period where the US is engaged in several ongoing wars, this administration did not anticipate a greater demand on the VA.
Yeah, if they anticipated a greater demand on the VA, they would have given it a larger budget.
There hasn’t been a budget year lately in which the VA’s budget has been cut. In fact the VA got a +8% overall increase in funding (35.697 billion) and in the very area in which the problem exists (outpatient care), it was plussed up 13% (17.51 billion) within that budget.
there is an enormous difference between single payer and single provider.
Remember “The Golden Rule”, he who has the Gold, makes the rules. The medicare program is a good example of this. Washing has continually cut payments to providers. Doctors, unable to survive on the governments parsimony are refusing to accept more medicare patients, or dropping out of the program entirely.
Ted: It’s a red herring to suggest a single payer system would have to look like either of your two choices. As most developed nations have some sort or variation of single payer (with varied options), your only two ’possible outcomes’ scenario isn’t realistic. Additionally, you posit a wild leap to suggest any such system would develop into a VA-like system.
Again, the VA isn’t a healthcare insurer; it is a closed healthcare system.
You also cite the 8% increase in VA funding as evidence this administration anticipated the demands war might place on the VA system. This is misleading as medical inflation is about 12% annually in the US. I’d imagine the VA’s inflation is greater given the increased demands of the wars.
Explain. 12% more for the same exact service, or does that take into account improved procedures or price changes resulting from changes in supply and demand? How much of the price change is based on government intervention in the first place? -=-=-=-=- And I’m still waiting on the explanation for the practical differences between single-payer and single-provider systems.
My scenario isn’t ’realistic’. It’s real. Lets see how other developed nations describe their own health care:
From France: http://www.discoverfrance.net/France/DF_healthcare.shtml
France’s state-subsidized medical system is considered liberal because doctors and dentists establish private practices, and patients, who are free to choose their own providers, are reimbursed by the state for up to 85% of medical costs. Hospital facilities, although greatly expanded since World War II, are still considered inadequate.
Canada: A government insurance system: http://www.canadian-healthcare.org/
Some question the efficiencies of the current system to deliver treatments in a timely fashion, and advocate adopting a private system similar to the United States.
In other words, VA-like problems.
From Germany: http://www.medknowledge.de/germany/index.htm
Health care in Germany Germany today has a comprehensive high-quality health care system covering nearly all costs, even including long-term care. More than 90 percent of the population get health care through the country’s statutory health care insurance programme. In order to avoid excessively high health care insurance payments, new health reforms have been put into effect.
From Japan: http://web-japan.org/factsheet/health/insurance.html
Under Japan’s medical insurance plans, members aged 3 to 74 are required to pay 30% of their medical expenses,
Just as I described if the government set high standards.
Let’s talk about what the practical differences are, Francis. Who makes the decisions, and under what incentives and constraints, in either system?
under single payer systems, doctors are self-employed or work in small groups. much as they do today, they would bargain with the insurer for rates of reimbursement. The insurer (which I would see as a federally chartered not-for-profit corp somewhat like Freddie Mac) would press to keep rates down, but be limited by the need to have doctors not leave certain areas. there are a number of possible compensation systems besides straight fee-for-service between an insurer and a medical group, including capitation, blended capitation and bonus structures.
single provider means that the government hires all the doctors and pays their salaries.
much as they do today, they [doctors] would bargain with the insurer for rates of reimbursement. The insurer (which I would see as a federally chartered not-for-profit corp somewhat like Freddie Mac) would press to keep rates down, but be limited by the need to have doctors not leave certain areas.
But they’d bargain with an insurer who operates as a state-protected monopoly? How are they limited by the "need" to have doctors not leave? They have no profit motive and no chance of being competed out of business. "Bargaining" with a virtually unaccountable force... wonderful.
single provider means that the government hires all the doctors and pays their salaries.
And how is having the doctors negotiate with the government directly for their pay different from having them negotiate with a government-ensured monopoly who plays by the government’s rules?
In both cases, you lose the flexibility of mutual accountability through the price mechanism.
I think that it is fair to beat universal health care supporting liberals with the VA health care system. However, we should not lose sight of the fact that any comprehensive health program for all Americans would be (if not entirely) a different matter.
For just one difference, the Hollywood types would be in the universal system. For those of you who are slow, how many "Hollywood types" are veterans? OK, you pick YOUR group that are NOT VETERANS. See what I mean? OK. The Professor Erbs, for instance. See where this is going?
I can promise you that if this system is adopted, one of two things will happen: Hollywood types will fly to a country where this system isn’t, and/or there will be special hospitals for the favored elite. See nomenklatura.
Explain. 12% more for the same exact service, or does that take into account improved procedures or price changes resulting from changes in supply and demand?
Medical inflation is largely driven by three factors: new technologies, an aging population, and larger profits taken by for-profit health insurers. In the medical world, there is no such thing as the "same exact service" because treatments, technologies and the like are constantly evolving.
Ted: Yes, your scenario is unrealistic. It’s fairly easy to cherry-pick some quotes and attempt to make the case the healthcare systems of other countries are lousy. I could easily find quotes about the US healthcare system that are equally dismal.
But it’s more accurate to make an empirical case. IOW, how much is spent and what are the results. target="new">Ezra Klein has done the heavy lifting in this regard.
If you look through the research, you see the US is spending far more (as a percentage of GDP) and the results are we’re getting less. Plus, we’re not covering a significant portion of our population.
Nowhere in the article is it referred to as a healthcare insurance system. In fact it is referred to as a government provided health care system. Quite a difference.
Understood what it says in the article. However, you tried to compare it to a healthcare insurance program. Apples. Oranges.
When you claim "the left loves to hold up as the shining example of what government health care can be," you are plainly refering to a healthcare insurance program since nobody (at least no prominent lefty) has proposed the Government nationalize all the hospitals, put all MDs and staff into the civil service, take over all the med labs and the like.
But this is a fairly trivial point compared to the overriding issue of letting our wounded servicemen down.
Jadegold; None of my quotes were cherry-picked from parties trying to make any countries’ health system look bad. All were from the front page of those countries’ own health care web sites. In addition, your own source, Ezra Klein agrees with me that Germany, Japan and Canada’s systems are poor choices. As for Britain, he acknowledges:
If you had to decide where to be treated, you definitely want it to be here.
That leaves France as a model. Ezra says:
France is more my speed. Government provided, ceiling without floor.
There are a few problems here. First, as I showed earlier, the French health ministers consider their own hospitals inadequate. Secondly he contradicts his own statement from a few paragraphs earlier:
But if Canada’s problem is that they have a ceiling, our problem is that we don’t have a floor.
So your source agrees with me on three countries out of four, and he doesn’t agree with himself on the fourth. Thanks for the link supporting my case.
As for health insurance versus health system: I showed earlier, the government does not have to nationalize the hospitals to affect the quality of care, just as Wal-Mart does not directly control its suppliers. Any time there is one dominant bill-payer, that entity decides the standards by what they are willing to pay for a certain level of quality product or service.
In addition, your own source, Ezra Klein agrees with me that Germany, Japan and Canada’s systems are poor choices.
To the contrary, Klein is comparing those countries relative to one another. When he compares them to the US, they all show a better bang for the buck:
Japan v. US:
How Do We Stack Up? Japan is 8-11 (three way tie) on fairness of cost distribution and #1(!) on attainment of health care goals. Their system’s performance, overall, puts them at #10. America, to compare, is 54th in fairness(!), 15th in goal attainment, and 37th in overall performance. All that and we only have to spend a bit over twice as much to get it! What a deal!
Germany v. US:
How Do We Stack Up? Due to some concerns over the viability of GDP spending and OECD rankings, I’m going to be changing some of the metrics I use here. Per capita, Germany spends $2,817 on health care for its citizens. America spends $5,267 (which in unbelievably high, by the way — you should really check out how nuts that is, a point well-made by this Excel file comparison). According to the WHO, Germany’s health care system is #6 in fairness of financial burden, #14 in overall goal attainment, and #14 in terms of overall performance. America’s system is 54th in fairness(!), 15th in goal attainment, and 37th in overall performance.
Canada v. US:
How Do We Stack Up? In simple ratings, Canada is 30th while we’re 37th (according to the OECD). So they’re a bit better, but it’s not like the giant disparity we had with France, whose system takes the coveted top slot. As noted above, the Canadian system is significantly cheaper as a percentage of GDP than is the American system, despite the fact that the former covers everyone and the latter leaves a fair chunk of its population out in the cold. On the years of life lost metric, American women lose 3,836 years per 100,000 women and the men give up 6,648. The comparable Canadian figures are 2,768 and 4,698 respectively.
England v. US:
How Do We Stack Up?: As noted above, America’s health care system is much, much more expensive that Britain’s, but also less generous. But does that affect the outcomes?
Yes, but only if compared to a functioning health care system. When stacked up against ours, Britain’s broken system still comes out on top. American women lose 3,836 years of life per 100,000 while our men lose 6,648. By comparison, British women lose 2,947 and their men sacrifice 4,815 (go here to see how this is calculated). On the other hand, they have longer wait times and fewer doctors. The disparity comes because America’s system works okay for most, but not at all for many. Britain’s, by contrast, offers mediocre service but offers it to everyone in the country. If they injected their health care system with the sort of cash we pump into ours — which’d mean spending the equivalent of 7% more of their GDP on it, it’s safe to say we’d be beaten quite handily.
France v. US:
Yes, but are we better? Right, you say, that’s all very not interesting. But how do we stack up with France? Better? Worse?
Yeah, the second one. France’s health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.
So France spends less, gets more, and does so through a public-private hybrid that’s heavily, heavily public. Socialized medicine sure is scary.
When you claim "the left loves to hold up as the shining example of what government health care can be," you are plainly refering to a healthcare insurance program ...
Wrong again. Words mean things and the words I used plainly didn’t refer to "health care insurance programs". The article is about the provision of health care by the VA. As since you cited Ezra Klein, I’d suggest you read who you link. Klein is a big fan of the VA system.
My father was a hospital admin in the Air Force back in the ’80s... The VA (and Walter Reed) both suffer from the same type of problems he encountered back then.
I recall him telling me about coming into a new hospital that was responsible for regional care for 80,000+ military/dependent and retired personnel. As one of his duties, he handled the "CHAMPUS" (Civilian Health and Medical ?Program?... I can’t recall exactly what it stood for - but it was the "insurance" program for military, dependents and retirees who didn’t live near a military hospital)... When he arrived at this particular office, his _first_ day, he received multiple calls from irate retirees. It seems that they had sent in CHAMPUS forms (to the office that my dad had inherited), and they had been rejected _multiple_ times for errors on the forms. A quick investigation turned up that the secretaries/admins handling the forms had been told that their performance would be graded on how many forms they processed in a day. They quickly discovered that if they identified an error on the form, they could reject it and that counted as "1" form processed. Many forms had multiple errors - so they could reject them several times over the course of a couple of months of "sending them back-and-forth" to the poor person who was trying to get reimbursed for medical care.
My dad’s solution - grade the employees on how many people got the reimbursements they deserved.
Bureaucracies thrive on "metrics", but rarely does anyone actually measure stuff that is in-line with the goal of the agency. (That’s usually much harder to measure than something easy like "forms processed".) So they establish poor metrics to measure success, and the employees find short-cuts to make their performance fit the metric. I’d bet money that most bureaucracies’ employees really do "care", but they don’t get performance appraisals on how much they care - so they do what rewards them in their job.
Recall that during the Vietnam war, Robert McNamara was an academic "egghead" who thought wars could be measured like an accounting worksheet. So he judged success by body counts (Army/Marines), and sorties (Air Force/Navy). The consequence was that commanders in the field did everything they could to increase their numbers. There are many reports of Air Force commanders requiring 8 aircraft to fly with 1-bomb each to hit a target that could have been hit with 1 or 2 aircraft having 8 or 4 bombs each. But 8 aircraft = 8 sorties... Of course, you put 4-8 times the crew and equipment at risk to accomplish the same goal...
This same attitude pervades all forms of "government" service. Of course, it fills certain businesses too - but businesses have a difference... If a given process is substantially inefficient, the business either recognizes that the process is costing them money, or they lose profitability and slowly go out of business. Whereas, if a government agency is progressively losing efficiency, they are rewarded with increasingly larger budgets so that they can compensate for their inefficiency and continue to give the same level of service to their target beneficiaries.
As since you cited Ezra Klein, I’d suggest you read who you link. Klein is a big fan of the VA system.
More accurately, Klein is a big fan of certain aspects of the VA system; e.g. the VA bargains with pharmaceutical companies to obtain low prices on drugs and medicines.
This same attitude pervades all forms of "government" service. Of course, it fills certain businesses too - but businesses have a difference... If a given process is substantially inefficient, the business either recognizes that the process is costing them money, or they lose profitability and slowly go out of business.
It’s a nice meme but it has no basis in reality.
The inescapable reality is that some 50M Americans don’t have healthcare insurance. That means we all get to foot the bill when the uninsured shows up at the ER with life-threatening pneumonia when said malady could have been treated as a mere respiratory infection a month ago.
Despite the fact we also pay the most for healthcare, we have poorer outcomes. essentially, we’re paying Mercedes Benz prices for a Kia.
There is nothing in Klein’s first five paragraphs of wrap-up about comparisons, just blanket statements about different countries systems:
Employer-based health care, which Germany and Japan’s universal systems rely on, is a poor choice. There’s no compelling fiscal or policy reason to use it, and employer’s, frankly, should not be in charge of their worker’s health care. It’s just a silly way of organizing it. Canada’s system is too biased against the private sector; some degree of private, supplementary insurance should be allowed.
So there are his thoughts on those systems. I already highlighted the key quote for England: he’d rather be treated here.
So why are the ranking numbers so bad for the U.S.? That requires looking at the data Klein used: World Health system data http://www.photius.com/rankings/world_health_systems.html The U.S. will ranks low in ’Fairness’ because we don’t have a socialized system. Almost everything in the U.S. in ’unfair’, we’re capitalists. Fairness and overall level of health and its distribution (also things that have more variance in the U.S. than in a socialized system) both feed into the ranking for ’Goal Attainment’, so a free market system is dragged down there. ’Goal Attainment’ and expenditure per person both feed into the "Overall ranking". So the three rankings Klein highlights say: 1)The U.S. isn’t socialist 2) The U.S. still isn’t socialist. 3)Not only is the U.S. system not socialist, it costs more than everyone else as a whole. There are two numbers Klein doesn’t bother to mention. Responsiveness of care and it’s distribution. These are the actual goals for the U.S. health system. (Someone’s level of health is determined at least as much by individual choice as it is by the health system) The U.S. is #1 in responsiveness and tied for 3rd in distribution. The only countries ahead of the US in distribution are the UAE (30th in responsiveness) and Bulgaria (161).
#1 and #3 in the categories that matter. By the data Klein uses, we are getting the Mercedes. We fall short in the other categories because we aren’t socialist and the system is expensive. There is no reason to change the system just for the sake of being socialist, so the main problem with the U.S. system, according to this data, is the amount spent.
Klein barely touches on why the health care given / amount paid ratio is so bad for the U.S. in the fifth paragraph. Doctors here get paid a lot more than they do in other countries, and he feels it’s because medical school is so expensive and difficult. He doesn’t touch on the amount of insurance that doctors and hospitals need to carry to survive in our lawsuit happy society. If we want health care to be more affordable, doctors need to be afforded the ability to make an honest mistake without paying through the nose. If we want only the absolute best, with doctors and hospitals paying millions for every mistake, then it’s going to be expensive. Of course the people getting the most money for the least pain are the lawyers. Either way, a large part of the cost of health care in the U.S. is not a straight health care reform issue, but a legal reform question.
Obviously you missed our podcast interview with Ezra where he claims to be much more than a fan of certain aspects of that system.
Obviously. It must have been up against a rerun of "American Idol," so I missed it.
Ted: Ok, we understand you don’t like WHO. They’re a bunch of furriners who will surely steal our precious bodily fluids as soon as we turn our backs. In reality, the "fairness" indices usedby WHO reflect the distribution of healthcare to all rather than a select few. If you wish to argue that the US should confine treatment to the well-off and not to the poor—so be it.
But even if we toss out "fairness" as a non-metric, you still cannot argue the cost and outcomes. We pay the most and we don’t have the best outcomes. And some 15-20% of our citizens have no healthcare insurance.
First, some of us choose not to have healthcare insurance. For example, me. Why? Because I’m young, I live a rather low-risk lifestyle, I have a balanced diet and I exercise, and there are other things I’d rather spend my money on at the moment. The way I figure it, the likelihood is that I’d spend more with insurance than without, over time. It’s a matter of risk management.
Second, many others only go without health insurance for limited periods of time during the year, but are counted as if they don’t have it ever. This is particularly true of the population that’s unemployed temporarily, since employer-provided health insurance is tax-free but mobile, personal insurance is not. In the July ’05 issue of The New Libertarian the QandO guys recommended (start on page 19 and keep reading for all the health stuff) that we do something about that.
In fact, there are a number of reforms that I’d recommend to fix the very real flaws in our health services provision. But all in all, no, most libertarians aren’t going to measure the cost-effectiveness of health services by some arbitrary idea of equality of outcome as "fairness". I mean, this is obvious.
Finally, part of the reason other states might have lower costs than the US is that the US does a highly disproportionate amount of the research and development of which the rest of the world takes advantage.
Jadegold; The WHO says our outcome, based on care and the ditribution of that care, is the best. The U.S. is ranked #1 and #3 in those categories. In reality, ’Fairness’ is based on how much of a discount the poor get for healthcare and how much extra the rich pay, not whether they get care. In case the column headings in the spreadsheet aren’t clear enough for you, this is from the 2000 WHO report:
Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people’s needs. Fairness of financial contribution: When WHO measured the fairness of financial contribution to health systems, countries lined up differently. The measurement is based on the fraction of a household’s capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments). Colombia was the top-rated country in this category, followed by Luxembourg, Belgium, Djibouti, Denmark, Ireland, Germany, Norway, Japan and Finland .
By finishing low in ’Fairness’ it means that the poor have to pay a higher percent of their income for the same care, not that they can’t get care.
As I said earlier, the overall health ranking is not just a function of the system, but also individual health choices (which themselves have a number of factors).The cost can be argued, and I mentioned that in my last post. The cost is not just a function of the health system, but also the education and legal systems.
Neo; Walter Reed is still scheduled to close, as mandated by the authorizations from the 2005 BRAC. All services currently provided there are going to be split between a new facility on Fort Belvoir and an updated Bethesda Medical Center. But seeing as the construction for that part of the BRAC hasn’t started yet, Walter Reed will get more money until they are ready. Reversing the BRAC decision on Walter Reed would lead to lawsuits from every state that has a facility sheduled to close or shrink under BRAC 2005, I doubt Congress would want to start the process over. Barring a lot of backdoor deals, Walter Reed will have to close even if millions are put into updating it.