The Medicare prescription drug program, Part D, has enriched pharmaceutical companies beyond all reason while leaving poor elders choosing between drugs and food or cutting their pills in half. This is particularly so now that many are hitting the infamous “doughnut hole” during which time they must pay one hundred percent of their drug costs until they reach the magic expenditure total of $5100 when the program kicks in again.
Not counting Part D, Medicare works pretty well. For a government program. There are some important quibbles to be made which can be addressed in time, and something must be done about disallowing doctors to opt out of taking Medicare patients before 2011, when the leading edge of the baby boomer generation becomes eligible and swamps the program. For now, considering the inefficiency of bureaucracies (and not counting Part D), it is not a disaster and most people get the care they need when they need it.
But there is another government health program that not only beats Medicare in delivering higher quality care, lower mortality rates and much lower cost per patient, it also exceeds private sector healthcare in those benchmarks. It is the Veterans Administration.
Last week, Time magazine published an informative piece on how the VA transformed itself in the past decade from an operation so substandard that Congress nearly shut it down into a space-age, high-tech organization:
“Patient records were transferred to a system-wide computer network, which has made its way into only 3% of private hospitals. When a veteran is treated, the doctor has the vet’s complete medical history on a laptop. In the private sector, 20% of all lab tests are needlessly repeated because the doctor doesn’t have handy the results of the same test performed earlier…
“Another innovation at the VA was a bar-code system, as in the supermarket, for prescriptions. With a handheld laser reader, a nurse scans the bar code on a patient’s wristband, then the one on the bottle of pills. If the pills don’t match the prescription the doctor typed into the computer, the laptop alerts the nurse. The Institute of Medicine estimates that 1.5 million patients are harmed each year by medication errors, but computer records and bar-code scanners have virtually eliminated those problems in VA hospitals.”
- Time, 4 September 2006
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The VA has also invested in heavier preventive care with 300 new community clinics which cuts down on hospital visits.
Time reports that as word of the improved service got around, more vets gave up private healthcare for the VA, overwhelming the new system. So instead of increasing funding, the Bush administration has limited care to the poorest vets and those with service-related injuries and illnesses.
From a social obligation point of view, that last item is shocking. One way America has traditionally honored those who have faced death and injury on the battlefield to protect our way of life is providing for their healthcare until they age into Medicare. It embarrasses me that a soldier or sailor is now required to have suffered a battlefield injury to receive this benefit.
According to Time, American Legion commander Tom Bock has what he describes as a “win-win-win" idea: let elder vets trade in the their Medicare coverage for VA benefits.
“Medicare, which pays more than $6,500 per patient annually for care by private doctors, could save with the VA’s less expensive care, which costs about $5,000.”
And how about this too? Take Mr. Bock’s suggestions and then expand the superior VA service not only to vets currently on Medicare, but to all Medicare recipients, and then to all Americans. But as Time explains, that is not an option in Congress or, rather, the current Congress:
“…conservatives fear [the tradeoff of Medicare for VA care for veterans] would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.”
Trojan horse? Wait a minute. It sounds to me - for lack of any other idea from this administration - like a good horse to ride. But of course, it’s politics as usual. And, the partisan objection falls apart when you consider that the “private sector” conservatives are so concerned with enriching would still be needed: pharmaceutical companies, laboratories, medical equipment and services, assisted living facilities, etc. Even for-profit hospitals for the extremely wealthy who could afford them.
Part of the VA’s success at cost containment is directly due to the fact that they negotiate drug prices with the pharmaceutical companies. When Congress enacted the legislation for Part D, they specifically prohibited Medicare from negotiating with the pharmas.
That’s your Congress at work for you…
Keep that in mind for the next two months. We are in high campaign season now for the November congressional elections and this is the first in a series of political posts from Time Goes By about issues we believe are worth thinking over as you consider your votes for your senators, representatives and governors.