Single payer means rationed care

The U.S. federal government already operates three single-payer systems, if not more.

Consider the Indian Health System (currently in the news for scandals), the VA system (never free of scandals), and the military system (never covered).

The health care debate has not yet looked closely at how well single payer systems deliver health care. As my retirement from the US Army was not for disability, and not being Native American, I have no personal experience with two of them. My family and I were in the care of the active duty system from 1972-1996.

The following generalizations and anecdotes may help inform a discussion of single payer.

1. Broken promises. When I "won" the draft lottery in 1971, I was told that if I served twenty years I would be entitled to free health care for life. Too many exceptions to note here...

2. Rationing. Preventive care is usually rationed, with the exception of vaccinations. Pap smears, mammograms, dental cleanings, etc. are limited in number. The base clinic accepted requests only on the first day of the month, and if you were not in the first 25 or so callers, you had to try again next month. We sent our kids to the US so Grandma could get their teeth cleaned...

3. No choice of provider. Active duty medical staff are invariably top-notch. But "local hires" made up staffing needs quite often. In 1992 while stationed at EUCOM HQ, a local hire examined my "lump" and told me "in my country we would not worry about this..." Later that year, in the clinic for something else, I casually asked the Army Captain (MD) to take a look at the lump. He was appalled I had not had a biopsy sooner. When I told him that Dr. Bathijah had dismissed it, he looked at me with pity and said, " Colonel, he is from Afghanistan!"

4. No follow-up. When the lump was removed at the military hospital (in Bad Canstadt), they told me to call back in a week for the pathology report. When I called, I was told the tissue had been sent to a different hospital, as the lab was closing...they couldn't tell me where. For a few days I called around Europe looking for it. One amused tech told me, (it didn't come here -- maybe you can grow another one...).

5. No appointments for sick call - you signed in at the clinic and waited indefinitely. Whichever doctor was up next, saw you...there was no history with a specific provider.

6. Highly centralized specialties. Severe injuries were the exception . Treatment for them is the best in the world. However, any burn victims will go to San Antonio, for example...usually far from family and friends. Amputees go to Walter Reed, etc.

7. The military offers a wonderful secondary insurance to Medicare . "Tri-Care for Life" is an outstanding benefit, for which I am very grateful. The pharmaceutical benefit was also exceptionally good, for active duty and retired.

8. I have no idea what any of these health plans actually cost...but with the Canadians having to come to the US for basic diagnostic scans, their system seems similar.