"Uniformed" Health Care

As the debate over Universal Health Care or Socialized Medicine (or whatever name you’re currently using to refer to the federal government taking over health care) continues, we seem lost for a decent example of how and whether or not it will work. As European versions seem too far removed, we are constantly being told to take a good, hard look at our national neighbors to the North as anecdotal evidence. But, if Shania Twain, Keanu Reeves and Pamela Anderson are any example of our looking to Canada for informative analogs (of cowgirls, surfers or lifeguards, respectively), perhaps we ought to be looking a little closer to home. As it turns out, there is a significant section of the local population, that we can easily examine to inform our decision on the matter, for whom health care (1) has $0 out-of-pocket cost, (2) is run completely by the federal government, and (3) provides questionable levels of care and care availability, and that is, the military.

During my ten years in the United States Navy, people often told me about how “lucky” I was to have “free” healthcare available to me – as if that were the big upside to the woeful underpayment that they referred to as my “salary” and the opportunity to enter a war zone in defense of my country. Nonetheless, this talisman of a benefit seemed to stand out, to them and to most, amongst the myriad of other perks offered to military members. It was as though it was a “Get Out of Jail Free” card for ever getting sick – the ultimate freedom for a population cowed by the incessant fear mongering of the pharmaceutical and medical industries. But I’m here to tell you, not only is it not what it’s cracked up to be, it’s downright horrible. The policies surrounding military medicine along with anecdotal evidence of its failures leads to one conclusion: it’s a bad idea. I can honestly say, the single best thing about not being in the military anymore is having access real health care, and no matter what it costs me, I’m grateful to pay it.

Policy – Oops, OK.

You don’t have to be an economist to appreciate incentives. In fact, one the most important things I’ve learned in business and in law is to be sure and understand everyone’s incentives to the greatest extent possible before negotiating or dealing with them in any way. Incentives can explain even the most ludicrous behaviors. For example, say you’re the heiress to a global hotel empire, and you’ve got a completely unthinkable amount of money at your disposal. Not only do you not have an incentive to work or create any value whatsoever, you also have little incentive to behave in a polite or even lawful manner. You can see what I’m getting at. Of course, these incentives still can’t explain why such a person would be famous, but hey, it’s not a perfect science.

But, with regard to military medicine, the incentive structure is set up to create mediocre practitioners. One of the first documents you sign when you join the military is an agreement not to sue the Government. That’s right, immediately after signing over your life and freedom, you also give up your Constitutional right to legal redress should they fail to live up to their part of the bargain. This also means you can’t sue anyone else in the military. So, you cannot file a suit for medical malpractice, no matter what happens to you. What’s more, the military’s doctors don’t even need to carry malpractice insurance – they can make as many life-altering mistakes as they would like, and the worst thing that can happen to them is a bad evaluation. How free does that medical care sound now?

Seriously, you’re better protected from the kid serving you ice cream at the 31 flavors than you are from your military doctor. Which is great, except that the ice cream guy isn’t cutting you open.

Practice – Don’t Touch the Sides!

Of course, all of this policy jibber-jabber doesn’t really mean much to you in the abstract. Well, lucky for you, I had a few run-ins with my “free” medical care that went a little south of “good practice.”

When I was stationed in North Charleston, South Carolina, I was assigned to shift work aboard a moored training ship to learn how to operate a naval nuclear power plant. One day I had noticed a lump on my inner thigh and wasn’t feeling well. I went to work anyway and began to feel worse. My head was throbbing; I was sweating and had chills. As my visible condition began to worsen I was allowed to go to the clinic on base. After waiting for over an hour just to have my vitals taken, they noted my fever was 103, at which time they instructed me to go to the local Naval Hospital to be admitted. I never saw a doctor there, and they didn’t offer me a ride. So, nearly delirious, and with my temperature rising, I drove myself to the hospital, over ten miles away, where I waited for another hour to have my vitals taken again. This time an actual doctor saw my temperature and admitted me immediately. Safe, right?

Wrong.

After five days they finally determined that my lymph node was infected and would need to be biopsied to determine what was going on. My fever was still up over 102. They ultimately strapped me to a table under local anesthetic to cut into my groin and remove it. Which sounded like an o.k. idea until I actually felt the scalpel cut my leg, to which “doctor” responded: “You felt that?”

In addition this parade of horrors, I also personally experienced the following medical mishaps:

• Waking up in the middle of my septoplasty (surgery to correct my deviated septum – under general anesthetic);
• Four dry sockets after wisdom tooth removal; and
• Having a root canal done on the wrong tooth!

I’d be better off with a medical student whose only surgical experience was playing Operation while drunk at a frat party than letting these quacks cut into me again. At least for him there was some sort of penalty for screwing up – even if it was only having to take a shot of Jagermeister.

There’s no “u” in “free”

Listen, the idea of universal health care is a fantastic one. The altruism is so pervasive that it even feels good just to talk about it. Pairing common access with the world’s finest medical care seems like a no-brainer. But, just like things you buy after midnight from the Home Shopping Network, the reality is a far cry from the promises (OxyClean, anyone?). When the government takes over health care, and more importantly when it takes over compensation to physicians, the incentives to excel, and even the incentives simply not to suck at your job, simply disappear. Much like teenagers, doctors in a consequence-free environment are bound to do some damage – the difference is that the worst thing teenagers will do is raid your liquor cabinet, make too much noise and maybe ruin a shrub or too.

Uniform Health Care will be much the same as “Uniformed” health care – the doctors will have no reason to be exceptional, and you’ll have no recourse if they aren’t. You don’t need to take my word for it, you likely know someone who’s served – and they’ll be happy to tell you. Of course, it’s true, no one will be turned away, but what makes you think that if we forced to world’s automakers to give everyone a car at a fixed, low price that they’d deliver everyone a Mercedes?