TCS Daily has an article that points out how a lot of Americans already belong to a socialized medical system.

Their article points out that a lot of people get Medicaid, or Medicare, and that even “private” insurance is subsidized by the government, which allows companies a tax write off for helping employees get medical care.

By using the “private” sector as the template for medicine, it encourages high cost, since there is little to discourage people from using the system: they don’t have to wait, they can see specialists for things a Family Doctor used to do in their office, etc.

TCS is a libertarian blog, oriented toward economics, so you might want to read their analysis.

But as a doctor, I myself have worked in one of America’s “socialized” medical systems. Never heard of them? Well, because most aren’t there any more.

In the past, poor people went to city hospitals for care, often by medical students. Long waits in clinics, few comforts.
Medicaid changed that: now if you saw people for free, and didn’t bill, you could be charged for Medicare fraud, since you didn’t see Medicare patients for free. And the paper work price went up, and if you filed with one wrong code, you didn’t get paid.
Sigh.

But the Federal Government used to have a monopolistic type of socialized medicine for certain populations in the past, and still runs them. I am talking about the Military Hospitals, the VA, and the Public Health Service Hospitals. (PHS).
I’ve worked on and off for the Public Health Service for thirty years. Since Jimmy Carter closed the PHS Hospitals that cared for sailors/merchant Marine, these hospitals now are mainly on Indian reservations. The PHS expanded into the Indian reservations due to the high death rate there, and these hospitals are often in isolated areas and hard to recruit staff. In the past, doctors were drafted, and could choose to do their time at an IHS hospital rather than with the military. That too has changed, and most doctors now are the young and enthusiastic, the missionary types like myself, and the older docs looking for a way to practice without signing their life over to an HMO.

The good thing about these clinics is that people get free care, including free medicine. Specialty clinics and basic specialists are often part of the staff, or available at a nearby hospital in the sytem. Often there are nurse educators, dieticians, and physical therapists.
The bad thing is the rigidity of the system. All cases are prioritized.

The bad news is it takes forever to fix things or upgrade things or hire new staff. Remember Walter Reed? It was a dump because they were going to close it, and when they kept it open they “made do” with the old facility because the paper work to get money to spruce it up would take a years.

Nowadays, the availability of Medicare, Medicaid and the fact that some tribes that are using their casino money to make private insurance available to their people have improved matters. There are loopholes, and if nothing else works, you just get care at a local emergency room and ignore the bill collector.

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But let me describe for you how the “system” worked, and remember if the US gets a “single payer” system there might not be alternatives except paying through the nose for your own treatment (or, if a system similar to the one proposed by President Clinton was installed, paying for your own care would have been forbidden).

Say you have chest pain. That’s priority one: Life or limb. No problem. You get shipped off to the University hospital, air ambulance if needed. Ditto for bad accidents or other live threatening emergencies.

Then you have priority two. Threatening to life or limb, but can wait.

Your kid breaks his arm, and has it splinted. You have to wait a few days until the swelling is down before a cast is applied, but in the system, it means waiting until the committee meets on Tuesday to okay the treatment and then the secretary will make your appointment with the specialist.
Other priority two would be gallstones, non healing diabetic wounds, Rheumatoid Arthritis, lymph node biopsies, routine Obstetric ultrasounds, seeing a Urologist or Gynecologist for things that might be cancer, or seeing your cardiologist, etc.

A small wait, but you get everything paid for.

Then there is class III. Your knee keeps freezing and hurts, and you need to have it fixed. You need a routine colonoscopy for a history of polyps. You have pelvic pain and heavy periods. Severe scarring acne. Your herniated disc is not getting better, and you want to see a specialist, or your specialist wants you to have an MRI.
The committee meets, and after they pay for priority one and two, they check to see how much money is left, and choose a few to see specialists. Eventually you will go but it may take awhile, and a lot of these get turned down and told to resee the doctor to see if the problem is still there, and if so, to put in another request.

Then there is class 4: other treatments available. Most skin diseases fit in here, as do tubes for kid’s ears. A lot of “bad backs” go here, especially those who have chronic back pain for years and no one is going to do surgery on them anyway.

Finally, there is class 5: elective abortions, fertility treatment, most dermatology consultations, and plastic surgery. If Hilary takes over, abortions will go to class one, but most Indian tribes oppose elective abortion for religious reasons, so only pay for theraputic abortions, such as mother with diabetes or a bad heart.

So there you have it.

Free care in a clinic that is ugly, with overworked doctors, and you have to wait for your care, and may have to live with aches and pains.

But if you need an emergency Angioplasty and don’t want to go bankrupt, it’s worth it.

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Nancy Reyes is a retired physician living in the rural Philippines. her website is Finest Kind Clinic and Fishmarket and she writes medical essays at Hey Doc Xanga Blog

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