The Register Citizen (Torrington, CT)
VA provides a model for health care we need
Socialized medicine exists in the United States. Ask a veteran.
We might not call it socialized medicine, but we should give credit where it is due. Within the greater nexus of the American health care landscape exists the Veterans Health Administration, a federally funded, nationwide, integrated and portable health care system that provides more than 9 million veterans a full range of medical services from routine primary care through end-of-life hospice care, while charging minimal copayments and achieving quality metrics that, in most instances, mirror or better those of hospitals in the private sector. I am asking you to consider how a VA-style public health care system presents an alternative to our current health care system.
To do this remove any preconceptions you may have of the VA from the equation and consider the qualities I just mentioned — nationwide availability, integration, portability, low cost to users, a full range of services and high-quality results. They read like the track list from a health care’s “Greatest Hits” album.
Considering all that, maybe I should have started by saying, “High-quality socialized medicine exists in the United States for a relatively few Americans who pay minimal out-of-pocket expenses.” But this statement lacks the same punch. And my intention is to be inclusive, not divisive.
Few would disagree that our health care system needs restructuring. Some of the traditional statistics that accompany the call for restructuring are: Health care is expensive — health expenditures in 2017 totaled $3.6 trillion, an average of about $11,000 per person — when it should be affordable. Health care is exclusive — 27.5 Americans remained uninsured in 2018, up from 25.6 million in 2017 — when it should be accessible. Health care is reactive — hospital admissions for preventable diseases such as congestive heart failure, asthma, hypertension and diabetes occur 37 percent more often in the United States than in comparable countries — when it should be proactive.
Proposed solutions to this dilemma range from allowing the Affordable Care Act to wither away to broadening the eligibility requirements for Medicare. Depending on how you spike your punch, either of these may appeal to you. But however you perceive the problem, I hope your proposed solution is affordable, accessible and efficient.
I perceive the problem as such: Access to our health care system is a luxury when it should be a necessity. My proposed solution is that we build something that avoids the cost prohibitive premiums of the Affordable Care Act. We build something that cannot be subjected to incremental dismantling by future administrations. We replace the system we have. We use the VA as a model to build a national health care system. When I spike my punch, I throw the old punch bowl in the trashcan.
Here is a very simplified explanation of how VA care works. Physical VA facilities exist in every state (as well as in Puerto Rico, Guam and the U.S. Virgin Islands). This includes community-based clinics and large hospitals. Patient records are connected through an electronic medical record, and are accessible to health care providers in all VA facilities no matter the location where a patient receives care. This connectedness enables patients to receive coordinated care at facilities away from their primary site of medical care. Based on income and/or disability rating, VA patients are assigned to a priority group and a payment tier. This system prioritizes care to the sickest veterans while still allowing others to receive the care they need. The VA also has a national formulary of generic medications, which helps keep prescription drug costs down. Private hospital systems are increasingly structured to promote this style of coordinated and continuous care. The VA model shows that it can work on a much larger scale. The VA is already the largest integrated hospital system in the country.
Nationwide availability, an integrated medical record, portable, low cost to users, offering a full range of services, achieving high quality results, a system for prioritizing the sick and disabled that still provides routine care to others, the bargaining power of the federal government, and a blueprint for upscaling coordinated care throughout the country. Where do I sign?
Right here. And you can sign here, too. Email, call or write to your congressional representatives. Tell them that the current health care system is unsustainable. Demand equal access to quality health care. And after you do that, do it again. And then again. Health care workers call receiving a volley of the same message over and over “hammer-paging.” It is so annoying to be on the receiving end of a hammerpage. But when you need to force somebody to act, it works. Hammer-page your congressional representatives. Spike the punch.
Now considering all that, maybe I should have started by saying, “Socialized medicine exists in the United States for a relatively few Americans who pay minimal out-of-pocket expenses, and we can build a health care system that delivers highquality care to all Americans by mimicking and augmenting this pre-existing model of care, but only if we work together to make our needs known.” But this statement lacks the same punch. It meanders on. It’s not an opening statement. So I will finish with it instead.