Re: [OT] I need a reality check

On 25 Jul 2004 at 23:00, KH.Ranitzsch@t-online.de (K.H.Ranitzsch) wrote:

> First, there must be some costs directly associated with the
procedures
> (medicines, implant, disposable equipment...)

True, but that expense is well worth it in order to keep the surgeons in

peak performance.
 
> Second, and probably more important in terms of Dollars, the
government
> hospitals could offer the service of their surgeons to paying
customers,
> bringing in revenue.

Not likely, for several reasons. 

The U.S. health care system is a morass of competing health insurance 
companies. Most health insurance companies have hospitals and doctors 
that are "in system" and those that are not. It costs you, the patient,
a 
lot more of your own money if you go to a hospital that is out of
system. 
In order for the army's surgeons and hospitals to accept money from 
health insurance companies they'd have to add a whole level of 
bureaucratic infrastructure that they don't currently have to worry 
about. This is not insignificant. It's likely, though, that the army 
would still be "out of system". I really can't see the army wanting to 
get into this mess.

You could allow people to walk into an army hospital and pay out of
their 
own pocket. I suspect most people have visions of _MASH_ in their heads 
and wouldn't consider going to an army surgeon if they were paying the 
total cost themselves. If you can afford to have a procedure out of your

own pocket, you can afford to go to the Mayo Clinic, or John Hopkins, 
etc, so why go to the army? The army could charge less for the services,

but if they did that you'd see all sorts of political pressure from the 
large health care lobby, because it would hurt the profitability of 
nearby hospitals.

If you don't let the army surgeons treat soldiers' families, you'd have 
to offer soldiers some form of health care insurance to cover their 
families. This means the soldiers would have to pay for it. (I don't
know 
of any company that pays their employee's health care here in the U.S.; 
usually the best you can hope for is that your employer offers some sort

of insurance that you can buy into.) That means the soldiers would end
up 
being paid less, and thus it would be less of an incentive to join. They

could increase the pay for soldiers to cover the cost of the plan, co-
pays, deductables, etc. but I suspect that it's actually cheaper to give

soldiers and their families free health care from army doctors, plus you

get the benefit of the doctors using the treatment as practice. You also

don't get into the hassle of "pre-existing conditions" and other issues 
where insurance companies try to wiggle out of paying for treatment.

> Indeed, a believer in free-market economy might ask why the long-term
> treatment of military personnel (as opposed to urgent in-theater
cases)
> has to be done by government institutions at all. Why not do it in
private
> hospitals, (with the	government paying the bill), which would be more
> efficient at it ?

Oh, my, you really don't know how expensive U.S. health care is, do you?

Could you imagine the insurance premiums on soldiers? My wife had a
minor 
procedure (removal of a lymph node for a biopsy) and the whole thing 
topped well over $3000. I shudder to think of what it would cost the 
government, at regular hospital prices, to do major reconstructive 
surgery. Probably $500,000 and up. Believe me, it's more efficient for 
the government to do it themselves with army doctors than to go to 
private hospitals. (No, I don't work in the health care industry. My
wife 
does, though. She's a Medicaid Analyst for the State of Louisiana.)

In fact, the U.S. Army would probably be better off using their surgeons

in a charity hospital, giving their services away for free to the under 
privileged. I'm guessing that there aren't enough of them to cover army 
families and help out the poor.

---

Allan Goodall	    http://www.hyperbear.com
agoodall@att.net   agoodall@hyperbear.com

"How can I work with all you peasants kneeling and mumbling?"
  - Michelangelo, while painting the Sistine Chapel (as interpreted
    by Animaniacs)