Healthcare rationing, whether on the supply side (i.e.shortage of specialists or MRI machines) or on the delivery side (i.e. like when the U.S.S.R. would give their elderly populations placebos and not "waste" money on them or when in the U.S., until a few years ago, Medicare would refuse to pay for (or ration) preventative care) needs to be carefully scrutinized and its ethical implications fully understood.
Whatever your view of Obamacare, I want to report a story that occurred yesterday at one of the VA Hospitals here in Chicago, Illinois.
For the past several years, I take an elderly gentlemen, Mr. G, to the VA hospital for his various appointments...including to his GP who monitors his general health, and to the Vascular Surgery Clinic who monitor his aortic aneurism (it sometimes is frustrating to deal with the vascular surgeons because every time we go we see a different resident or fellow who is evaluating the case for the first time...so much for continuity of care.) FYI, 2-4 hour waits at the Vascular Surgery Clinic is the norm, not the exception. Quite frustrating! Also, it frequently takes a relatively long time to receive appointments with specialists even when there is a medical necessity.
In late March or early April he had an eye exam and ordered his new eye-glasses. Those glasses were finally ready this week...over 3 months later. We went yesterday to pick them up. The waiting area was overcrowded with people waiting with much patience for their turn to see the opticians. I sat on the floor due to the overcrowding. Yes, the glasses were very cheap but that is only true if your time has no value and you can live 3 months without your new glasses.
Why can't the VA use a system like the Medicare reimbursement system and allow veterans to go to any optitian, dietican, physician, etc. and just reimburse the practitioners...that way we can chose to go an optician who can deliver the eye-glasses in less than 3 months.
And, more importantly, we can choose to go the Vascular Surgeon of our preference and have one physician following the case over an extended time period.
And now for the good that occurs at the VA...This elderly gentlemen. Mr. G, was declining precipitously a few months ago. His bp was 200 over 140, he was dizzy, filling up with water, having trouble seeing, falling down, and becoming more and more incoherent. His GP, Dr. Caprio, (who just finished up his residency and who we are sorry to lose because he really cared about Mr. G) pulled out all of the resources of the VA to keep him in his own apartment and out of a nursing home (which would be tremendously more expensive to Medicaid or to the VA, whoever would have ended up paying for it.). He ordered a visiting nurse 1-2 times a week and a visiting occupational therapist 1-2 times a week. I contacted the Council for the Jewish Elderly (CJE) who now drop off 5 meals a week and send in a lady who cleans his apartment, does his laundry, and does his chores for him.
The bottom line is this....does the VA offer some good services? Yes. Could a non-VA physician have organized a visiting nurse? Yes. Would Medicare have paid for it? Most probably yes.
I just don't see why veterans cannot receive services under a health plan styled after Medicare and the government can eliminate almost all copays and make the coverage for Veterans even more generous and not age dependent. I also think that veterans would probably receive speedier service and would be able to go to any physician who accepts Medicare and they would not have to schlep out to the VA Hospital for every appointment.
Implications for the implementation and operationalization of the amorphous healthcare bill known as Obamacare? Draw your own conclusions.
I guess at least we are not being forced into VA style healthcare. Yet.
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