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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2007

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VA system commentary

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I.P. Freely - 28 May 2007 18:28 GMT
A publication solicited my comments on the U.S. VA medical system.
This was my earnest response, posted here as a heads-up for men seeking
prostate medical care.

My 19 years in the VA system produced a thick medical file including
cranial and abdominal surgeries and two cancers. I’ve survived primarily
for three reasons. First, I picked highly regarded teaching hospital
surgeons and oncologists who play VA doctors part time. Second, when the
VA system completely failed me, I hired local specialists for lesser
surgeries such as shoulder reconstruction. Third, I had to learn so much
medicine to protect myself that I [deleted here to help protect my
identity from our resident vengeful child] and many physicians said I
helped them diagnose and treat several problems, some life-threatening.

Upside: I usually got first-rate care at socialized medicine prices.
Downside: I’ve had to to fight, sometimes against gravely serious
errors, in VA recovery wards, which have universally proved in my
experience to be nightmares worthy of a whole page of this publication.

My studied conclusion: Do not rely on any government health care system,
whether it’s the VA system or the national (i.e., socialized) health
care system one of our political parties threatens, unless you have the
time and ability to become your own highly informed medical pit bull and
the acumen, resources, and legal option to take your medical problems
downtown when necessary. “Free” health care costs too much; by delaying
detection by three years, it increased tenfold the likelihood my
prostate cancer will kill me.

I.P.
Leonard Evens - 29 May 2007 17:13 GMT
> A publication solicited my comments on the U.S. VA medical system.
> This was my earnest response, posted here as a heads-up for men seeking
[quoted text clipped - 25 lines]
>
> I.P.

I am sorry you've had troubles with VA medical care.  Most evaluations
of VA care rate it pretty high and better than the care the rest of us
get.  But I gather it has been deteriorating during the past several years.

I should add that private care is often plagued with similar problems.
A lot depends on where you get it and how informed you are.

Finally, let me note that no political party is calling for "socialized
medicine".  That would describe the system in Great Britain where the
physicians are in effect employed by the government.  It might also be
accurate to describe the VA system as socialize medicine.  What many
Democrats and some Republicans such as Schwartzenegger and Romney have
called for (or in some cases implemented) are universal health
insurance.  There are many proposals for achieving such coverage.  The
simplest, to my mind, would be a single payer system.  Under such a
system, physicians would operate much as they do today except that
instead of dealing with a variety of insurers, they would deal with one,
or perhaps one per state or region.   Canada has such a system and the
insurers are by province with arrangments for portability.  The closest
we come in the US to such a system is Medicare, which despite is
drawbacks, is still strongly supported by people using it and also by
their children who otherwise would have to pay for their parents'
medical care.

 Our current system relies primarily on insurance provided by
employers, but that system is clearly breaking down, and something has
to be done to replace it.   The administration and most Republicans seem
to want to rely on private insurers who will be subsidized by the
government.  (That is what they have added to Medicare.)
Unfortunately, there are several fundamental problem with such a system.
 Private insurers make money partly by managing risk, which they do by
excluding people who may cost them a lot.  Any feasible system must
place restriction on the ability of insurers to do that--i.e., they must
be required to employ what are called "community standards".  Without
that, people with medical problems are not going to be covered.   Also,
unless the entire population is covered, we run into the problem of
adverse selection.  Many healthy people will not bother to get coverage
because they figure they don't need it.  That means only people who are
ill will seek medical insurance and that will raise its cost greatly.
Some mechanism must be found to make sure the risk is shared by the
population at large.  Otherwise the market will tend to produce a system
in which sick people can't get insured or in which only the rich can
afford insurance.  Free markets work well for many things, but our past
experience has shown that they don't work well to provide medical care
for everyone.  No policticans. not even Republicans, are calling for an
entirely free market for medical insurance because they know it won't work.

There is not going to be a perfect solution for providing good medical
care for our citizens.  Other developed nations have figured out ways to
do it which their citizens are satisfied with. That includes all of
Western Europe. So it can't be impossible to achieve.  Instead of
talking in generalities such as "socialized medicine" it is more useful
to discuss what we should want to achieve in this country and what the
best ways to go about it are.   Just as with choosing a method to treat
prostate cancer, any choice is going to involve pluses and mi nuses.
The object is to try to be creative in attaining the pluses without also
getting the minuses.
I.P. Freely - 29 May 2007 22:10 GMT
> I am sorry you've had troubles with VA medical care.  Most evaluations
> of VA care rate it pretty high and better than the care the rest of us
> get. But I gather it has been deteriorating during the past several
> years.

I have never seen any study or public forum indicate that. It's cheap to
the user -- unless, of course, one considers how the vet earned the
privilege; other than that it has been heavily criticized for many
decades and has *really* gotten overwhelmed recently despite the current
administration's greatly increased VA funding.

 > Finally, let me note that no political party is calling for "socialized
> medicine". That would describe the system in Great Britain where the
> physicians are in effect employed by the government.  

Socialized medicine, as per American Heritage Dictionary: "health care
regulated by the government and funded by the people".
i.e., Hillarycare, still the primary Democratic party health care system
model.

> It might also be accurate to describe the VA system as socialize medicine.

Absolutely; thus my comparison.

The rest has been beaten to death here and elsewhere.

I.P.
 
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