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Frequent lurker, first time poster so please bear with me. I am watching with acute interest the current healthcare debate that has consumed many words and opinions. I by no means claim to be an expert in legislating or policy making or all things political positioning, but as a physician in the Armed Services I would like to comment on some of my experiences and perspective.

One obvious omission in the discussion, both on interwebs and tv tubes to me is the current single payer healthcare system that the government is currently funding—TRICARE!  

Update: My apologies. I initially misquoted the number of Tricare beneficiaries, astutely noted by Cinnamon Rollover. My intent of this diary was certainly not to overstate Tricare numbers. I made the changes to the diary to reflect a more accurate number of beneficiaries (teh damn google). Thanks for the catch Cinnamon. So much for the perfect first post.

According to the GAO website:

TRICARE is the Department of Defense’s (DOD) health care system for active duty
and retired uniformed service members and their families. TRICARE consists of four
separate programs. Three of these programs—TRICARE Prime, a managed care
option; TRICARE Extra, a preferred provider option; and TRICARE Standard, a fee
for service option—cover active duty personnel, their dependents, and retirees under
age 65.

According to the 2008 Tricare Stakeholder's Report:

More than 9 million Americans rely on us for their health care needs

9.2 Million active duty and retired uniformed service member and their families receive their healthcare from the federal government. My family and I receive free healthcare from the federal government. I repeat, over 9 million citizen already receive their healthcare from the federal government. I provide healthcare for the federal government. I'm an active duty obstetrician/gynecologist in a major medical facility on the East Coast. I'd like to share a couple of observations regarding the current single payer healthcare system that I work in and for which my family receives its care.

  1. "Rationing" of healthcare in this single payer system is simply not reality. As a physician in one of the busiest departments (over 4000 deliveries/year) in the military, I practice with the same diagnostic technology, with the same subspecialty support as my civilian colleagues.  If I have a patient who is in preterm labor, I simply walk down the hallway, talk to the maternal fetal medicine specialist (high risk obstetrician), admit her to the hospital. I have the utmost confidence that she will be taken care of in the best way possible and that if she does deliver early, the Neonatal Intensive Care Unit (NICU) will use every available technology to rescucitate and care for the premature baby. If my patient has pre eclampsia or postpartum cardiomyopathy or any other serious conditions, she is cared for in the exact same way as any civilian hospital in the country. Only one caveat- when they get discharged, their bill is always the same: $0.
  1. Single payer healthcare does not eliminate scientific inquiry, research, or the pursuit of evidence based medicine. In fact, quite the opposite. In my department alone, over 90 peer reviewed journal articles have been published since 2002. Research is vital to the medicine and anyone who goes through four years of undergraduate education, followed by four years of medical school, followed by three to six years of specialty residency obviously has an intellectual curiosity which will occur no matter who is "paying" for it. Additionally, some of the best research and scientific breakthroughs, comes from physicians in those "socialized" European countries. To say that progress and research in the field of medicine can only occur in our current system is disingenuous at best and insulting at worst.
  1. Pre existing conditions don't prevent patients from receiving care in our system, rather it is identified and considered in their current medical situation. I'm glad to know if my patient has diabetes or hypertension prior to her pregnancy and it simply allows me to give the best evidence based treatment during the time of her pregnancy.
  1. When a patient sees me, she is my patient. If she wishes to see someone else, she can see one of my colleagues. I believe that is called choice. Physicians, in general, like to see their patients and follow their progress and offer interventions when indicated.
  1. I can prescribe any medications I wish if I believe it is the best for my patient. Sure, there is a DoD formulary that guides many of my decisions, but this formulary if not static. In fact, there are committees who meet regularly to add or subtract drugs based on (I'm hoping I establishing a pattern here) the best available evidence. If a medication is not on the core formulary, I simply put a notation in the prescription that states "nonformulary" and provide a reason that this medication is indicated. While I do not prescribe nonformulary medications often (there is often no need), I have never had a medication prescription not filled in the six years I've practiced medicine.
  1. This system is far from perfect. The administrative bureacracy can be frustrating and often painful and confusing to patients and providers alike. The electronic record that we use as providers called AHLTA is the most nonintuitive, mind numbingly inefficient program I have ever encountered. There are many issues that could make this system better.

The point of this diary is not to suggest that the system I work in that all taxpayers are currently funding is the solution to our nation's healthcare ailments.  I am struck however that nobody has brought up the simple fact that the government already provides free healthcare in a single payer model to over 9 million of its population. While this system is not perfect, I believe I provide that same quality of care, offering empathetic, evidence based (one more time for good measure) care as any other physician who practices at any hospital in the country.

If you spent the time to read this, thanks for your time. This community is vital to the progress of this issue and I value many of the opinions here. After completing this, I also respect all who write diaries way better than my effort. Let's get universal healthcare for all! Peace.

Update:I'd like to thank everyone who commented on this thread. I learned much from many of the comments and it is more than apparent that there are passionate and intelligent people in this community who all have similar goals regarding this topic. This is not an issue that is going to be resolved overnight or without some hiccups. The hard part, I think, is to move in the right direction with substantive legislation while knowing it is only the first step. Frankly, I like our guy in the Office of the Presidency. If anything, he appears to have the ability to distinguish the forest from the trees- a skill vital in this healthcare battle. Again, thanks for the nice words. Peace.

Originally posted to bsmoothmd on Fri Jun 26, 2009 at 08:30 PM PDT.

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    by bsmoothmd on Fri Jun 26, 2009 at 08:30:38 PM PDT

    •  The only concern I have (24+ / 0-)

      is that those who have Tricare, or other care, are able to chose their physicians or specialists. At the moment, there is a problem where those with Tricare can be denied if a provider chooses not to accept them (my example are a pediatrician and a specialist).

      This has to be addressed where a patient in the Govt program can get access to care no matter who they are insured with....

      •  Thanks for the response (30+ / 0-)

        While I don't know the details of your situation, in general, a Tricare beneficiary may get referred to a civilian provider only if a patient cannot be seen within 30 days of a referral. It also depends on which Tricare program one is enrolled in. Usually (again I don't know your specific case) this is not up to the physician or provider. If you do get referred out, the provider has to be one who takes Tricare insurance, which is certainly not universal.

        •  42,000,000 on Medicare, not military/dependents (29+ / 0-)

          Sorry, but the 42,000,000 represents folks on Medicare.

          "Prior to 2001, TRICARE beneficiaries would lose their TRICARE coverage when they reached age 65, and Medicare—the federal health insurance program that provides medical benefits to over 42 million elderly and disabled Americans—would become their primary health insurer."

          •  So how many are on the military plan (8+ / 0-)

            The number may be different, but the Single Payer plan is the same.

            One Nation, One Health Plan. Doctor and Nurse Recommended Single Payer Health Care for All!

            by ludlow on Fri Jun 26, 2009 at 09:37:42 PM PDT

            [ Parent ]

          •  Nice diary. It is all a lot of hoo-ha. (25+ / 0-)

            They know single payer isn't a bogeyman.  This is about money in their pockets as usual.   DC has publicly funded health care, and they need to give us what they have or lose theirs. I'd like to see someone introduce legislation to that effect.

            43 million people were enrolled in Medicare in 2006, 36 million of whom were 65 and older.


            53 million people were enrolled in Medicaid.
            (date unknown)


            "YES WE CAN" doesn't mean he is going to

            by dkmich on Sat Jun 27, 2009 at 03:01:48 AM PDT

            [ Parent ]

            •  Exactly. (12+ / 0-)

              What they DO know is single payer works fantastically.  And that has them afraid.  Extremely afraid.

              I'm sick of GOP SOP!

              by xysea on Sat Jun 27, 2009 at 04:30:05 AM PDT

              [ Parent ]

            •  a couple of things (6+ / 0-)

              not that I disagree with you - but first of all, the federal employees get their insurance mostly through private insurers, although the contracts are paid for by the gubmint. Federal employees may, however, be covered by BC/BS or other private insurers. I'm not sure what is currently on the cafeteria menu of benefits, but I know I've had people who were covered by Aetna, United, and maybe even Cigna through the FEHBP.

              It's a similar issue with Medicaid, which is administered by the states. Many states, including my own, have contracted out to other insurers to manage the Medicaid program for the majority of beneficiaries. SCHIP works the same way in most places. Neither of those is a single payer program - far from it.

              Medicare is certainly a single payer program. So is the VA.

              Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

              by stitchmd on Sat Jun 27, 2009 at 05:15:12 AM PDT

              [ Parent ]

              •  I read there are over 200 plans (7+ / 0-)

                offered by FEHBP, and most employees get to choose from about twelve.  

                One plan is offered by the Catholic Church.  My guess is it needed extra revenue for all the legal fees.

              •  Sorry to burst anyone's bubble but . . . (7+ / 0-)

                Federal healthcare plans are not a public option nor anywhere near a single payer system.  Insurance is purchased from private companies with part of the premiums paid by the employer just like any other healthcare plan provided by a private employer.  Your selection among insurance companies is limited to those operating in your local area and usually tied to whatever corporate health conglomerate operates there as well. Usually no more than 2-3.  They are subject to the same inflationary pressures as any other plan and certainly subject to the same discriminatory practices (e.g. limited 'lifetime' benefits, elimination of services for 'pre-existing conditions, etc, etc).  It's no accident that retired military personnel always, repeat ALWAYS, maintain their health coverage with Tri-Care.  The single complaint I've heard from service retirees is about delays caused by high patient counts because only one of the local healthcare conglomerates accepts Tri-Care patients.  Just to be clear, Federal employee health benefits are not in any way a type of public option or single payer. An equally interesting post would be an examination of the erosion of Federal employee health and retirement benefits since Raygun, just so those benefits couldn't be pointed to as an example of a 'better' system.

                •  Federal healthcare plans are overseen by OPM. (3+ / 0-)

                  OPM negotiates fees and benefits with carriers.  Of course the carriers are negotiating for the highest fees they can get (and the lowest benefits), but because there are so many carriers competing for a large population of insureds, the government can command a better deal than a private employer.  

                  Also, because there are so many plans, an individual insured can get the best possible plan for her situation by shopping around.  For example my son needed orthognathic surgery for a severe overbite that orthodontics could not fix. Most plans would not pay for it at all, but I found one that would if it was severe enough.  Altogether I think it cost almost $20,000 if I remember correctly, and they paid virtually all of it.  My portion of the monthly cost for this plan is $234.  I can change plans in an annual open season if I wish. Of course there is always upward pressure on premiums, but not as bad as in the private sector.

                  It's the same plan your senators and congressmen have.  They have nothing to gain from a single payer plan, especially when you consider how much insurance industry money is going into their campaign chests.

                  You might think with a deal like that, I would be opposed to single payer health insurance, but you'd be wrong.  I do have an excellent health plan, but I'm an American. It is just as wrong for an American to leave his fellow Americans to die without health care as it is for a soldier to leave a wounded comrade on the battlefield to die.

                  I cried with clenched teeth while I watched "Sicko" last night.  I was watching murder being perpetrated, as sure as if a trigger were being pulled.  Because of OPM oversight, insurance companies could not get away with most of that crap in the FEHB.  That's why Congressmen have to hold hearings to find out what's really going on.  They wouldn't know it from their own experience.

                  As far as I'm concerned, those insurance companies who deny coverage and practice recission are worse than any tobacco company.  You can quit smoking.  You can't quit cancer.

                  The money congress (and state legislators) accept from these monsters is blood money.  They have to be stopped if we are to retain any semblance of who we were - who we claim to still be.

                  Would single payer be more inconvenient for me?  Maybe.  Would it cost more?  Maybe.  Do I care? HELL NO!

                  I am an American.  Every American deserves at least what I and your congressmen have.  What is America about- life, liberty and the pursuit of happiness?
                  Well, you can't have life or the pursuit of happiness without adequate health care.  Liberty is worthless without the other two.  Even a stray dog has liberty.

                  Contrary to the way Americans have been treated by the insurance industry, we are not dogs.

                  "A man of true science uses but few hard words, and those only when none other will answer his purpose..." - Melville

                  by ZedMont on Sat Jun 27, 2009 at 03:58:49 PM PDT

                  [ Parent ]

                  •  Zed, You are a most excellent American. If more (0+ / 0-)

                    were like you this would be a better country. You expresses my feelings much better than I could.

                    I love your analogy about leaving a soldier on the battlefield.

                    Thank you.

                    And a thanks to the diarist; both were well written.

                    We are in a time where it is risky NOT to change. Barack Obama 7-30-08

                    by samddobermann on Sun Jun 28, 2009 at 02:19:31 AM PDT

                    [ Parent ]

                  •  Yes. (1+ / 0-)
                    Recommended by:

                    It is just as wrong for an American to leave his fellow Americans to die without health care as it is for a soldier to leave a wounded comrade on the battlefield to die.

                    Thank you.

                    As far as I'm concerned, those insurance companies who deny coverage and practice recission are worse than any tobacco company.  You can quit smoking.  You can't quit cancer.

                    Truer words were never written.

                    Renewable energy brings national security.

                    by Calamity Jean on Sun Jun 28, 2009 at 12:50:54 PM PDT

                    [ Parent ]

              •  Problem with the term "single payer" (3+ / 0-)
                Recommended by:
                SarahLee, stitchmd, whaddaya

                Not all national health systems involve direct payment from government to medical provider--I've heard Germany, among others, has a government funded system administered by private nonprofits. Ultimately, though, the money comes from the government, from taxes of some sort, and those who administer the system are paid for their services, rather than allowed to exploit the system for profit (deciding who gets insured, what gets covered, etc) as with private insurance in the U.S.

                "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                by Alice in Florida on Sat Jun 27, 2009 at 07:10:19 AM PDT

                [ Parent ]

                •  Single Payer and Socialized Not Interchangeable (0+ / 0-)

                  A single payer involves one entity, usually the government, contracting with entities for care. Medicare is a good example of how this works.

                  A socialized model, for lack of a better term involves the government managing both the payment and the medical side. Look at the VA for how this works.

                  This is obviously an oversimplification, but still.

                  The definition of insanity is doing the same thing over and over and expecting different results

                  by political beil on Sat Jun 27, 2009 at 02:10:26 PM PDT

                  [ Parent ]

                  •  Wrong. Gov does not contract with entities for (0+ / 0-)

                    care in Medicare. It sets fees and makes rules. Providers can accept or reject. Only the processing of claims is farmed out.

                    Only in the case of the Advantage plans is there contracting. The gov lets you pick a plan from one of the approved companies who then provide care and have their own plan limits and preferred lists. They are supposed to be value added and to reduce basic Medicare paid costs but they don't

                    We are in a time where it is risky NOT to change. Barack Obama 7-30-08

                    by samddobermann on Sun Jun 28, 2009 at 02:27:49 AM PDT

                    [ Parent ]

              •  private insurers - Tricare (2+ / 0-)
                Recommended by:
                SarahLee, freesia

                Yes -
                "Humana Military Health Services, headquartered in Louisville, Ky., has the managed care contract for the south region. TriWest Healthcare Alliance of Phoenix services the western region. Health Net Federal Services, of Rancho Cordova, Calif., has the north region contract.

                When these current contracts were let, companies were allowed to add millions of dollars to their offers by promising to establish PSAs for beneficiaries living far from any base. Contractors were rewarded, or at least not punished, for such initiatives. Even if they could not claim to be the lowest bidder, they could still win the contract by claiming best value."
                (emphasis added)

                I want a public plan - as the diarist wants - but don't fool yourself some insurance companies are quietly in the background awaiting the spoils.

                If pro and con are opposites, wouldn't the opposite of progress be congress? Unknown

                by leighkidd on Sat Jun 27, 2009 at 09:23:44 AM PDT

                [ Parent ]

                •  Of course they are. Who else would administer (1+ / 0-)
                  Recommended by:

                  the benefits of Tricare?    

                  Yes, insurance companies do the paper shuffling, it is one thing that they are good at.  However, they administer the program under the government guidelines.  Insurance companies do not decide who or what is covered, or for how many dollars.

                  Under any public plan, the actual implementation probably will be done by private companies but those companies will only provide clerical assistance as they do for Tricare.  Yes they will make a profit but it is insignificant compared to the profit they enjoy under the private plans.

                  I have been covered under Tricare since its inception, and prior to that by its predecessor Champus.  I have seen multiple contractors come and go over the years, but the benefits and the service have only increased and that has been due to DOD changes, not contractors like TriWest who, BTW is doing a great job so far.  

                  Their website makes it easy to file claims, check status of same and find participating providers.  Their staff has been outstanding in assisting me to resolve difficulties with civilian physician and medical providers.

                  And the Navy is constantly asking me for feedback on my medical care by phone and by mail.

              •  Medicare, VA two different systems of delivery (3+ / 0-)

                Medicare is a single payer: i.e. government pays the bills but you contract with private doctors.

                The VA is a bit different. You could classify it as the evil socialized medicine. The government is paying the bills, but also providing the care.

                The definition of insanity is doing the same thing over and over and expecting different results

                by political beil on Sat Jun 27, 2009 at 02:05:05 PM PDT

                [ Parent ]

                •  good distinction, thanks (0+ / 0-)

                  my point was more that those systems are ones in which the direct cost of and payment for care rests with one entity, without being contracted out to other intermediate providers.

                  Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                  by stitchmd on Sat Jun 27, 2009 at 06:55:41 PM PDT

                  [ Parent ]

          •  Medicare & Tricar together treat 53 million, yes? (4+ / 0-)

            Between medicare and Tri-care, a whole lot of people have single payer!! (Yes?)

            So what's the problem with Universal healthcare?? Excellent first post!! Thank you!!

          •  My mother and others I know (2+ / 0-)
            Recommended by:
            samddobermann, whaddaya

            had a component called "TRICARE FOR LIFE" as well as Medicare.  Caveat being that Medicare was primary payer followed by "TRICARE FOR LIFE".

            The diarist makes valid points.  While I do not know the "numbers", I do know for a fact that the military provides excellant healthcare and has top notch personel.  I recently emailed similar content to congress critters and everyone I personally know.  

            With both government models ALREADY in place with proven record of being providers for decades and to countless beings, I too am at a loss as to why no one seems to be discussing or looking to utilyze these models.

            Maybe I am naive, but wouldn't something workable and already in place be do-able "for a day one universal healthcare for all"?

            I spent 20 something years as someone's military dependant.  My dad was career military that spanned decades and wars and aerospace mediciene.

            No matter what country or state of residence, healthcare was available, "free" and of the highest quality beit for minor or major medical issues.

            I distinctly recall hanging out where research was conducted and fine tuned for not only the early space program but which also benefited divers, pilots et al.

            The "military" also has one of the premier burn hospitals.  Again, I have distinct memories of witnessing the treatments for not only personnel but Vietnamese refugees.....

            Research and (I surmise) quite alot of technologies before public use were the commonalities back when I was part of the military community.

            While I have not been a user since the mid 70's of the solcialized mediciene that is available for military and the like, my parents, many relatives and friends were until their death.  Never a complaint. Never a problem.

          •  i LOVE medicare... (2+ / 0-)
            Recommended by:
            bustacap, worldlotus

            ...i've been disabled with HIV/AIDS for 13 years and other than the insidious "donut hole" in Part D, Medicare has been a real life saver/extender for me.

            i say this as someone that was diagnosed with 2 t-cells and weighing >110#'s at diagnosis and i'm a robust 150#'s today which was my pre-AIDS weight and because of great care, i'm still on 1st generation cocktail drugs (we don't switch until they stop working to keep the number of options higher).

            "A time comes when silence is betrayal." ~ MLK, Jr...Where has CANDIDATE Obama gone?

            by liberaldemdave on Sat Jun 27, 2009 at 02:11:29 PM PDT

            [ Parent ]

        •  I think what the poster is saying (10+ / 0-)

          is that there are limited providers who accept Tricare. The job I just left did; the job I'm going to at an FQHC does, I believe. However, in my region, pretty much all the specialty care for Tricare recipients has to be done through Johns Hopkins. I don't know if that's because they have a specific contract with Tricare, or if no other specialists take Tricare.

          And for some of my patients, the wait to get in for an initial visit at the Johns has been quite long.

          Btw, thanks for the diary. Tipped and rec'd.

          Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

          by stitchmd on Sat Jun 27, 2009 at 05:10:25 AM PDT

          [ Parent ]

          •  Yes (8+ / 0-)

            My initial post was a bit short on details.

            The examples, not that bad but annoying, were:

            When my son was born we scheduled his 10-day with a pediatrician down the road, about 5 minutes from here. They took the appointment but the day before he was supposed to go the office called and said that they were no longer taking patients with Tricare insurance. Ok. Could understand if they didn't take Tricare at all, somewhat. Or, that the patient load was such that they weren't taking any new patients at all. Just surprised that they no longer took a specific provider's patients. We ended up finding a wonderful pediatrician, but his office is 40 minutes away. Not that far, but should have the choice if they're equal in quality.

            The second was when my wife was referred to a specialist and he wanted her to have a test done. The initial place they sent us didn't take our insurance. So, I had to call the specialist's office and they found one that did.

            My point was: Well, it shouldn't make a difference, but we are, like, at war right? Not that bad at all for me, but what if a husband was overseas and a wife here needed care for their kids and couldn't find a provider? Easy because of where I live, but what about those that don't have as many options because the only doctor within 50 miles doesn't have to take military dependent health care insurance?

            So, I guess what I was asking was if they had anything in the legislation to make it as likely as possible (read: mandatory) that doctors would take Govt-insured patients?

            •  Currently, (3+ / 0-)
              Recommended by:
              SarahLee, Hedwig, bsmoothmd

              it is not mandatory that docs participate with any insurance, including Medicare. Not sure that would fly, frankly.

              And honestly, I'm not sure about Tricare's relationship with Hopkins in our area. It could be that few other docs take it, but it could be that Tricare has an exclusive relationship with Hopkins that is negotiated by both sides. That kind of contract might exclude other providers including those who might want to participate - but I'm not saying that that is the case, mind you. I do not know.

              Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

              by stitchmd on Sat Jun 27, 2009 at 08:45:35 AM PDT

              [ Parent ]

            •  Sounds like a form of cherry-picking. (1+ / 0-)
              Recommended by:

              To maximize the return on their resources, doc's first need to fill up the pages of the appointment book.  Once a doc has come close to doing that, however, he will want to pick and choose the patients that provide the best return.  If he's a sleazy doc, he'll even try to dump patients who don't provide the desired return; if he's an ethical doc, he'll keep existing patients on, even if he no longer accepts patients with their insurance plan.

              Only reason I can think of to turn away those who have a particular insurance plan is (i) the plan doesn't pay as much as others; (ii) it doensn't pay on time, or (iii) it's too much hassle to deal with its paperwork/claims process.  It's been reported, for example, that doc's in some regions have posted signs saying, "CIGNA insurance not accepted."  Don't know what the story is with either Tricare or CIGNA, but my money would be on (i) above.

            •  I almost had to take my newborn to a pedia- (1+ / 0-)
              Recommended by:
              Calamity Jean

              trician 55 miles away with private health insurance. So what else is new?

              We are in a time where it is risky NOT to change. Barack Obama 7-30-08

              by samddobermann on Sun Jun 28, 2009 at 02:36:15 AM PDT

              [ Parent ]

        •  My Husband and I Have Tricare Prime (26+ / 0-)

          We have always gone to the military hospital to see doctors, but this year my husband who is 54 and I am 56 decided to choose a doctor of our choosing so that we will see the same doctor every time.  Sometimes the doctor we were seeing at the base hospital PCSd after a year or two which was not too bad, but we are getting older and wanted more continuity. We pay a $12 co-payment which is not too bad.  If we have an emergency we can still go to the base hospital and get charged nothing.  I still see a podiatrist at the base hospital.  I also get my prescriptions free.  I have the best of all worlds for medical care.  I want the same for my children and for all americans.  The single payer option is the best, but I think that a public option would work.  If everyone had low cost insurance, low co-payments and was able to choose any doctor of their choosing you would have the best care imaginable.  Also, I think the government should put in the health reform bill a clause that says if the insurance does not pay for at least 85% of the healthcare cost the government will pay and the insurance company will forfeit their license.  And no more of this pre-existing bullshit crap.

          •  I Am Also A Government Worker (8+ / 0-)

            I could also purchase low cost insurance thru the Federal Employees Health Insurance Plan which is what our congressmen have.  I could purchase any insurance in the plan at a very low cost. I don't know what the plans are out in the private sector, but I bet it ain't cheap.  Why shouldn't all americans be able to buy insurance at the same rate as our elected officials and federal workers?  The federal government plan could be the model that congress could use for the public option plan.

            •  Ain't cheap (4+ / 0-)

              Why shouldn't all americans be able to buy insurance at the same rate as our elected officials and federal workers?

              Why?...because we taxpayers are heavily subsidizing your medical insurance.  I'm not complaining, I'm just stating that it is not cheap, just cheap to you.

              I'm in favor of Medicare-done-right for everyone, and raise the income tax rates a few percentage points to pay for it.  I'm OK with hiring the insurance companies to push the paperwork for the government much like CMS does now for Medicare, if they do it well.  I'm not OK with paying the insurance companies to do much more.

              Until that comes, we should give our Congress critters a stipend to buy their own insurance on the private market.  Whoa, hear the howls all ready!

              Doesn't Tri-Care basically pay the same amounts that Medicare pays?  That is way too low for some basic services and too high for other services.  A local Coast Guard retiree tells me that he prefers to go to a USPHS (Coast Guard) doctor an hour away at the Coast Guard base rather than be bothered with Tri-Care and local docs.

              •  That is one way of looking at it. (3+ / 0-)
                Recommended by:
                bustacap, Hedwig, Mayken

                Why?...because we taxpayers are heavily subsidizing your medical insurance.  I'm not complaining, I'm just stating that it is not cheap, just cheap to you.

                The other way of looking at it is that my husband spent 27 years in the Marine Corps, covering WWII, Korea and Vietnam.  He was underpaid at the time for an exceedingly hazardous occupation, lived in, at best, substandard housing and was never home for his wife and two daughters.  But when the government begged him to re-enlist it told him that his health care and that of his family would be taken care of for the rest of his life.  (That written promise eventually led to Tricare for Life.)

                The men and women who chose the military as a career, and their spouses make sacrifices the civilian population can't begin to appreciate.  Trust me, these benefits are not entitlements that your tax dollars kindly provide.  They are benefits that this population have earned.  

                These benefits are by no means "cheap" to those who enjoy them.

                What your tax dollars are subsidizing is the military apparatus that protects your nation.

          •  single payer or private option is best but (0+ / 0-)

            not a guarantee of optimal care.

            If everyone had low cost insurance, low co-payments and was able to choose any doctor of their choosing you would have the best care imaginable.

            One of the biggest problems there is bot for cost AND for patient health and comfort is the overuse of medical procedures including surgery and medications.

            Almost every treatment has costs – to the body such as side effects, extra pain, infection, even death. So over treatment which is being done more heavily in some areas than others for the benefit of doctors pocketbooks, is a big problem that universal care won't cure.

            We are in a time where it is risky NOT to change. Barack Obama 7-30-08

            by samddobermann on Sun Jun 28, 2009 at 02:45:12 AM PDT

            [ Parent ]

        •  Thanks for posting (2+ / 0-)
          Recommended by:
          bsmoothmd, whaddaya

          This was the kind of post and response I was hoping to spark with my posthere last week.

          Markos has used this system since he's former military--I'd love to see him follow up with his experiences.

      •  Tricare is the BEST coverage! (14+ / 0-)

        We should all wish we could have it too!

        Poverty does not mean powerless. Unite!

        by War on Error on Fri Jun 26, 2009 at 09:45:27 PM PDT

        [ Parent ]

        •  Yes, we should! (4+ / 0-)
          Recommended by:
          ZZZzzz, OpherGopher, Hedwig, Aquagranny911

          I hadn't heard the name or specifics of this plan before but it does sound like an excellent template for single-payer.

        •  I agree that everyone should have a plan (0+ / 0-)

          like Tricare.  I am also very happy that the people who do have it have earned and deserve it.  Active duty and retired military, you are the greatest, whatever generation.  Bless you all.

          Indict, convict, imprison. "Those who do not learn from the past are condemned to repeat it." George Santayana

          by incognita on Sat Jun 27, 2009 at 09:21:23 AM PDT

          [ Parent ]

        •  I am not sure what crack you have been smoking (1+ / 0-)
          Recommended by:

          but all I hear from tricare patients is nightmares.

          Make a move and plead the fifth 'cause you can't plead the first. He had a lot to say; He had a lot of nothing to say.

          by teleporno on Sat Jun 27, 2009 at 09:22:49 AM PDT

          [ Parent ]

          •  I wonder what the difference in population is??? (0+ / 0-)

            Commenters here and friends swear by TriCare.

            And you know that negative stories spread farther and last longer than positive ones... so what's different about the TriCare experience where you are?

          •  Yeah, I could tell you a bunch of nightmare (0+ / 0-)

            stories relating to TriCare. But the worst was TriCare wanting to move my dying mother out of the hospital 5 miles from her home and all of her family to a nursing home 60 miles away (more than an hour's drive due to it's less than convenient location.) Thank gods for the hospital social worker and the head nurse on the oncology floor who between them decided she was too weak to move and made the doctor go argue with TriCare about it for long enough that she passed away before they could move her. But by all that is holy we should never have to have had that argument in the first damn place. Whoever is running TriCare I want NOWHERE near making health care decisions in the future.

            And do not get me started on "free" military health care. Trust me, it has cost my family plenty over the course of our lives. I started a whole diatribe on it last night but let it go as I am still too emotional about the subject even after all of these years.

            I will just say, I am sure I am not the only one who feels this way. So I don't think military health care and TriCare are good arguments for single payer.

            One will rarely err if extreme actions be ascribed to vanity, ordinary actions to habit, and mean actions to fear. - Nietzsche

            by Mayken on Sat Jun 27, 2009 at 10:28:22 AM PDT

            [ Parent ]

            •  My condolences on the loss of your mother. (1+ / 0-)
              Recommended by:

              I am also sorry that stories such as this still exist.  

              TriCare is not the answer, but like democracy, it is currently better than any other out there.  I have watched the program improve from the bare-bones coverage of the early 80s to what we have today, and am optimistic about the future.

              As for a rant, I answered, perhaps a little heatedly, the suggestion that this benefit was "cheap" here.

              •  I hope it is continuing to get better (0+ / 0-)

                because our service men and women and their families deserve better. Lost Mom over 5 years ago and I am still bitter about how TriCare handled her care from start to finish - the "need" to move her was just the last straw. We even called our Congresscritter toward the end but he didn't get back to us until after it was too late - I try to be generous and believe that he would have helped and she went quicker than we all thought...

                But on the whole I was happy to see the back of TriCare. I'm glad to hear that others have good luck with them and hope that our experiences are not representative but after as many years and as many FUBAR situations as we encountered with them I'm less than positive about it. My private insurance, even the frakin' I was forced into for a while, was a whole lot better but I recognize with a great deal of clarity that I've been lucky on that score (and haven't had a major illness or trauma.)

                And thanks for the condolences as well as your rant. I don't think you were too heated and you were definitely spot on about the true cost to those who serve as well as their families.

                One will rarely err if extreme actions be ascribed to vanity, ordinary actions to habit, and mean actions to fear. - Nietzsche

                by Mayken on Sat Jun 27, 2009 at 06:39:27 PM PDT

                [ Parent ]

          •  Um, my mom before she died. (0+ / 0-)

            You have to be careful to choose Tricare for Life, as it transports throughout the country; otherwise, it used to be that you had Tricare East and/or Tricare West....but that was 5-6 years ago, could have changed.

            Between her Medicare and Tricare my mom never paid a dime for very good health care, even a $160,000 life saving stint after being T boned by a RV going 55 miles per hour.

            Tricare for Life is so good, I am tempted to marry a military guy, but I hear they changed the rules so that you now have to be married to him/her for 10 years before they die to get the benefit.  

            So, see, cutbacks are everywhere.  We will pay more for less on everything if we don't fight this one battle for health care.


            But I am preaching to the choir, of course.

            Poverty does not mean powerless. Unite!

            by War on Error on Sun Jun 28, 2009 at 04:09:23 PM PDT

            [ Parent ]

      •  My mother is covered under Tri-Care. My dad was (8+ / 0-)

        retired military.  She is 85 and sees the best geriatric doctors group in Atlanta (Wesley Woods a part of Emory).  She can see any doctor and it is covered.  Her prescriptions are NEVER more than $9.00.

        "The mind is not a vessel to be filled but a fire to be kindled." -Plutarch

        by DEQ54 on Sat Jun 27, 2009 at 04:53:47 AM PDT

        [ Parent ]

      •  oh have patients pay supplementals. (2+ / 0-)
        Recommended by:
        JanetT in MD, whaddaya

        A primary health care system by the taxpayers should focus on

        1. Primary care physicians.  Get them really decent compensation,

        Cover their reasonable office expenses and provide portable diagnostic
        gear for them (Mini-EKG, Mini Blood test Lab, Portable Digital X Ray.)

        1. Electronic patient Record System Modeled on VA-Vista.
        1. Electronic Pharmacy dispensing and prescription management.

        Doctors should not carry a book for drugs, they should not carry a scrip pad.

        1.  Emergency medicine for crisis and accident management. It's not your

        fault you got hit by a car, but you do need an ER doc right then and now.

        1.  A drug Formulary of Generics and negotiated price patented drugs.
        1. 80% of specialist care.

        If someone wants to see a specialist, they can pay the difference or pay for
        a supplemental insurance plan.

        George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

        by nathguy on Sat Jun 27, 2009 at 07:13:43 AM PDT

        [ Parent ]

        •  I would also add (7+ / 0-)

          Pay for medical training. This would probably increase those who go into less lucrative specialties "to pay off their debt".

          •  honestly (2+ / 0-)
            Recommended by:
            JanetT in MD, Mayken

            If you want to spend 10 years in the medical service corps,
            we should pay the whole ride.

            Think of it.  Offer 4 years of college, plus a guaranteed job
            for Doctors, Nurses, Techs......

            If it's a federal system you can bypass state licensing.
            Treat it as ROTC,  expand, grow, apply it to DoD, Government employees,
            Medicare.  Only the private system would still use state licensing and
            Litigation and insurance.

            George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

            by nathguy on Sat Jun 27, 2009 at 10:20:24 AM PDT

            [ Parent ]

            •  As long as their is some reliable (1+ / 0-)
              Recommended by:
              JanetT in MD

              and effective way for patients to file complaints and have practitioners actually improve their care based on that. One of the worst things about the military health care system is that there is no reliable and effective means for seeking redress against doctors or other practitioners who screw up. In my experience, complaining just gets your sponsor in trouble rather than the practitioner and of course, you cannot sue.

              So any federal medical service needs to address the issue of practitioner malpractice.

              I do think it is a great idea though. Especially to address the nursing and GP shortages we have in this country.

              One will rarely err if extreme actions be ascribed to vanity, ordinary actions to habit, and mean actions to fear. - Nietzsche

              by Mayken on Sat Jun 27, 2009 at 10:42:34 AM PDT

              [ Parent ]

              •  Oh, good grief. "There" not "their" **sigh** n/t (1+ / 0-)
                Recommended by:

                One will rarely err if extreme actions be ascribed to vanity, ordinary actions to habit, and mean actions to fear. - Nietzsche

                by Mayken on Sat Jun 27, 2009 at 10:47:28 AM PDT

                [ Parent ]

              •  It sounds like you had a miserable experience (1+ / 0-)
                Recommended by:

                I guess I would point out that mistakes and/or bad outcomes occur at military health facilities just as much as civilian ones. I would question your assertation that it happens more. If it happens to you or your family it obviously becomes more real and/or devastating.

                The fact is you can sue, just not the individual provider. This is true if he/she is active duty or a civilian contractor. The hierarchy of commands and rank unfortunately can get in the way personal health issues as I've seen many times. Sometimes this is good, sometimes it is quite intrusive to the family that is effected.

                I think your perspective is an important one in this conversation as well and hope you can express it to the community if it is not too emotional.

                Thanks for the response.

                •  you know technically you can't sue under employer (0+ / 0-)

                  health benefits either.

                  if the benefits are denied, it's all ERISA blocked.

                  DoD does not have a safety culture, VA is working to beat one
                  into the system

                  George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

                  by nathguy on Sat Jun 27, 2009 at 02:52:46 PM PDT

                  [ Parent ]

                  •  I'm not sure what you mean by (0+ / 0-)

                    safety culture

                    •  safety culture (0+ / 0-)

                      it's where the point of the organization is always "X"

                      in this case, it's patient care or patient safety.

                      DoD Medical has had a kind of lackadaisical approach to the
                      patients for decades.  

                      Its why they have cruddy patient records, it's why they have
                      cruddy care in the field, it's why they have lots of bad doctors.

                      Chairman of Bethesda Naval Cardiology was not licensed
                      in his field.

                      VA has a safety/quality culture, it occasionally fails but
                      the culture is to improve quality and safety.

                      Navy submariners have a safety culture, it's why they lose so few
                      subs despite the intense hazards.

                      George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

                      by nathguy on Sun Jun 28, 2009 at 12:26:45 PM PDT

                      [ Parent ]

                      •  That might have been (0+ / 0-)

                        in the past.

                        Currently, however you have to have a medical license and have credentialing performed before you can see patients in any hospital in the military system.

                        Regarding patient records, in contrast to 90% of civilian practices and hospitals, the military has an electronic medical record both for outpatient (clinics) and inpatient care. I mentioned in my diary that is is painful for providers because it is not user friendly, but we use it nonetheless and can access all previous appointments a patient has had whether it is in California or Virginia or Japan or Italy or Iraq.

                        Every hospital goes through JCAHO credentialing just like every civilian hospital and this included safety and quality measures that have to be up to standard or you don't get credentialed.

                        I respectfully disagree with your opinion of a lackadaisical approach to patient safety or patient care.

                        At least that has been my experience over the past six years....

                        •  what about the chairman of cardiology (0+ / 0-)

                          at Bethesda Navy.

                          What about the walter reed scandal?

                          that's not a safety culture.

                          that's not a quality culture.

                          George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

                          by nathguy on Sun Jun 28, 2009 at 03:54:34 PM PDT

                          [ Parent ]

                          •  Not sure about the chairman... (0+ / 0-)

                            When was this?
                            This would still be the exception rather than the rule.
                            The Walter Reed scandal did not involve the hospital but the living conditions that the soldier lived in while there for rehab.

                            Your point is well taken, I would just say that there need to be improvements in safety and quality in all of medicine in this country. This is not unique to the military hospitals though.

                          •  the scandal was in (0+ / 0-)

                            2006? maybe 2007,

                            Head of cardiology didn't have  amedical license.

                            George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

                            by nathguy on Mon Jun 29, 2009 at 07:19:53 AM PDT

                            [ Parent ]

                          •  medical safety/quality (0+ / 0-)

                            certainly There are some big cultural improvements that need to be
                            made in medicine.

                            1. All surgical procedures need to be video recorded, audio recorded

                            and the key equipment needs to be instrumented.  That way the
                            procedure can be reviewed after the fact by a panel to improve
                            technique, look for errors and look for near misses.

                            1. Surgery is not done by Crew Resource Management.  Techs, nurses and junior MD's need to be empowered to point out errors, concerns, issues.

                            The Doctor as God issue is as defective as the Pilot as God.

                            1. They need to digitize everything, No Paper, No loose ends.

                            George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

                            by nathguy on Mon Jun 29, 2009 at 07:23:04 AM PDT

                            [ Parent ]

        •  That's stupid as well as callous. Some need the (0+ / 0-)

          type of care a primary can't handle. Which you apparently deem a luxury.  Think about how you would like that if you had a kid with leukemia or some other cancer. Don't you realize it is copays that bankrupt people?

          Even asthma is sometimes better treated by a specialist. Or diabetes. Let your primary deal with people with schizophrenia or bipolar in full manic phase. The doc will have plenty of energy left for you.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Sun Jun 28, 2009 at 03:00:11 AM PDT

          [ Parent ]

      •  Choosing a physician is important (4+ / 0-)

        for women's health especially.  As a Tricare-accepting private physician who also did a couple of medical student/resident rotations in military hospitals, I can tell you that although there are excellent OB and pediatric physicians in active military providing outstanding care for military families, this is not universal.  

        I could tell you some pretty bad stories about what happens when the bureaucracy does not let people have alternative choices available.  In military as in civilian medicine not every small community is going to have the resources needed.  

        Tricare is a nightmare for accepting physicians at times.  My billing people have mostly figured out the system, but any single payer system that seriously wanted to offer free choices would have to make referrals and authorizations better.  At times even though the paperwork gets in early it is necessary to reschedule surgeries because the administrators have just not bothered to look at the referral paperwork yet.

        In spite of these problems I support single payer systems since I think they at least can save us money and we can always work to make systems better and more efficient.  

      •  Hi Hedwig, that is also happening with (1+ / 0-)
        Recommended by:

        Medicare since they cut the payments to the MDs.  If you were not a patient before that, the docs now won't take new patients on Medicare.  They used this same ruse years ago on Medicaid patients when Medicaid payments were cut.  That has to stop.

        Indict, convict, imprison. "Those who do not learn from the past are condemned to repeat it." George Santayana

        by incognita on Sat Jun 27, 2009 at 09:11:23 AM PDT

        [ Parent ]

    •  Congratulations Doctor (38+ / 0-)

      You scored big for a first diary.  Rocketing up the rec list.  And richly deserved.  This is so much the sort of thing that people need to hear.  We on the fron lines of health care get the reality of this stuff.  If only we could get the politicians the see it.  

    •  Tricare (6+ / 0-)

      The only problem I have with Tricare is that I do not automatically get Dental without paying more and vision care does not cover buying a new pair of glasses. Otherwise it works. Also, I have found some issue with getting the best choices with doctors. I live in Seattle and I cannot get any doctor from the University of Washington clinics around here. I thought they had the best doctors.

      •  Agree about dental and vision. (9+ / 0-)

        Likely the reason you can't see any physicians from U fo W is because they don't accept Tricare insurance. They probably don't accept Medicaid or Medicare as well- all within their rights in the current system

        Thanks for your response

        •  Tricare (0+ / 0-)

          I am not sure, I would have to blame the State of Washington, as they are a "land grant university".  I received a letter from tricare not liking the UW Physicians and later a solicitation from UW Physicians for support like any "non-profit". I want to know what is the issue although my current provider, Swedish Physicians is a good alternative.

      •  You just wouldn't believe how this sounds to me. (9+ / 0-)

        I am self-employed and have been for years. I pay nearly $300 a month for a policy that covers basically nothing with a $5000 deductible. Dental? Vision? Out of the question. There are a list of providers from which I can choose and I abide by it just in case there is a major problem. I still want to be in the system.

        If I could get access to dental coverage, I'd be thrilled. Same with vision. I'd be thrilled if I could get a prescription filled for a copay instead of footing the entire bill myself. I'd love to be able to get an annual mammogram without writing a check for $600. It just seems as though the nearly $4,000 I spend on health insurance a year should buy something.

        I realize Tricare may have issues. But, at this point in time for me it sounds like heaven.

        Always be sincere, even if you don't mean it. - Harry S Truman

        by parker parrot on Sat Jun 27, 2009 at 06:05:28 AM PDT

        [ Parent ]

    •  OOOHHHH...don't me started (25+ / 0-)

      I am a veteran....and recently got into it bigtime with an active duty 'friend' of mine.  He and his wife..who use TriCare.. want to deny the same taxpayers who FUND THEIR Tricare to same option.  I think their POV is disgusting and said so.

      Recently the wife posted a FB entry about her son having to wait two weeks to see a pediatric gastroenterologist.  The fact that she got that referral so goddamn quickly and automatically has that OPPORTUNITY she wants to deny others is completely lost on her.


      ~Call it what it is, not domestic terrorism, but RIGHT WING Domestic Terrorism.~

      by CWalter on Sat Jun 27, 2009 at 03:49:21 AM PDT

      [ Parent ]

    •  never heard of TRICARE (1+ / 0-)
      Recommended by:

      thanks for the information

    •  add the tricare numbers to those on medicare and (0+ / 0-)

      medicaid.  medicare and medicaid provide the end of life care to millions of Americans.  they are all single payer programs.

      and read the new yorker article on comparisons of cost for medicare in US.  that is a real eye opener.

      •  Medicaid is NOT single payer. It is at least 51 (0+ / 0-)

        different systems. each is run by a state. Most have been contracted out to private organizations. Profit sucking organizations.

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Sun Jun 28, 2009 at 03:10:08 AM PDT

        [ Parent ]

    •  husssh... (1+ / 0-)
      Recommended by:

      If the right wing and insurance industry morons realize this is in fact a socialistic program existing in their midst they will demand it end post haste. End it or privatize it will be the cry and we the taxpayers will get the enlarged bill.

      The young man who has not wept is a savage, and the old man who will not laugh is a fool. George Santayana

      by Bobjack23 on Sat Jun 27, 2009 at 12:00:59 PM PDT

      [ Parent ]

    •  Well, start right at the top, why don't you :) (0+ / 0-)

      Terrific diary, well worthy of its trip to the reclist - a very valuable contribution to the discussion. Thanks immensely for your perspective. I hope to read more of your thoughts here!

      Our system of law is premised on the idea that an unfettered government - rather than criminals - is the greatest danger to our lives and liberty.

      by pixxer on Sat Jun 27, 2009 at 04:15:13 PM PDT

      [ Parent ]

  •  Tweaking the software (18+ / 0-)

    The software exists, all that is missing is the political will.. (and thanks for an informative diary too)

    With a year or so for enrolments to be done..there is no reason Obama couldn't get the job done before the end of his term.

    Are there still as many lobbyists for the health care and insurance industries as before?

    With unemployment as high as it is it seems feasible that the number of uninsureds will rise and doing nothing is not an option.  Go to where software exists that works because consultants will break the bank coming up with something completely new.

    Think Tank. "A place where people are paid to think by the makers of tanks" Naomi Klein.

    by ohcanada on Fri Jun 26, 2009 at 08:43:19 PM PDT

  •  Great Diary!! (20+ / 0-)

    I wish more people inside the system would speak up like you have done!

    Religion gives men the strength to do what should not be done.

    by bobtmn on Fri Jun 26, 2009 at 08:44:10 PM PDT

  •  Terrific Diary! (18+ / 0-)

    Hope many see this and further understand that we don't have to re-invent the wheel.We just need to expand it.

  •  Excellent first diary.. (19+ / 0-)

    very informative and very clear.

    Thanks..hope to read more from you.

    YES WE DID! November 4th, 2008

    by Esjaydee on Fri Jun 26, 2009 at 08:47:07 PM PDT

  •  Yes we can! And we already are... (11+ / 0-)

    I love it. I hope this gets more publicity.

    Nice job.

    "Mankind must remember that peace is not God's gift to his creatures; peace is our gift to each other." -Elie Wiesel

    by zesty grapher on Fri Jun 26, 2009 at 08:50:54 PM PDT

  •  As a recipient of military medical care, (65+ / 0-)

    I can echo your comments from a patient's perspective.

    My preferred provider under Tricare Prime is the local naval hospital.  I can say that my care is superior to that received by many, if not most, of my civilian peers.

    When I have a medical problem, I call an appointment desk, briefly describe my concerns and an appointment is scheduled with my family care physician, usually within a couple of days.

    I arrive 15 minutes before my appointment and rarely have to wait past the scheduled appointment time to be seen by my doctor (I now hate being referred to a civilian specialist whose scheduling never seems to work out properly, resulting in waits of up to 45 minutes.)  Tests are ordered and prescriptions issued as needed by computer.

    I walk down the hall, stop at the lab or at radiology and then to the pharmacy to collect my medications, carrying no paper documents.  

    When my husband was diagnosed with prostate cancer, the urologist at the San Diego Naval Medical Center talked to us about his options, either surgery or radiation (1996).  Then he reached across his desk and called one of the radiation oncologists who suggested we come down for a brief explanation of the risks and potential of radiation therapy.  

    I can't imagine this ever occurring in the office of a civilian doctor.  They can't afford to practice medicine the way they would probably prefer.

    When available, my medications are generic.  I don't receive unnecessary tests or procedures, but have never felt that needed steps were not taken.  Should I choose to see another provider, I am free to do so.  But mostly I feel that my doctor is acting in my best interest, not in the interest of his bottom line.

    And I only wish that all Americans could have access to the type and quality that I enjoy.

    Thank you for your service.

  •  But, but, I thought all our enlisted men (19+ / 0-)

    and women were fighting to prevent this sort of evil socialism!

    Mark Sanford's mistress has access to a public health insurance option. Why can't I have one?

    by jazzmaniac on Fri Jun 26, 2009 at 09:03:43 PM PDT

  •  Recommended...Recommended...Recommended... (19+ / 0-)

    Thank you for this diary!

    "We are a Plutocracy, we ought to face it. We need, desperately, to find new ways to hear independent voices & points of view" Ramsey Clark, US AG

    by Mr SeeMore on Fri Jun 26, 2009 at 09:04:20 PM PDT

  •  Great diary, great information! Recommended. (9+ / 0-)

    I doubt I am alone in having never heard of this!

    Thank you so much for posting. Rec's in hopes more people will read and know about this.

  •  Excellent post. Glad to hear from you. (11+ / 0-)

    One of the things the lobbyists for the insurance companies always say is that government programs don't work, are poorly administered, mistreat claimants and patients, and so on. Not a drop of truth in any of it.

    In another age, we could just say they are lying and people would understand us. But, now people are so used to lies they don't know the truth when they hear it. You know, 42 million people ain't chopped liver. And, there is not a single private insurance plan that does the same thing. Not one. People should know about the Tricare system, Medicare, Medicaid, and for that matter, Social Security.

    We all have work to do in getting the word out. But, your excellent diary goes a long way toward that end. Thanks for your service. And thanks for this post.

  •  superb! thank you (8+ / 0-)

    This is the kind of insight that is so lacking in the current debate.

    If you happen to read this, perhaps you can point to an analysis of this system (x hospitals, y clinics, z clinicians)?

    And thank you for serving our country

    •  Thanks for your response (7+ / 0-)

      Your suggestion is an excellent one. I'll see what I can do.
      In general, though there are several large military treatment facilities (MTFs) in the larger military dense areas with clinics in virtually all area both nationally and internationally that have military personnel. The army, air force and navy (which provide healthcare to the marines) all have their own respective facilities.
      There are residency training programs and subspecialty training fellowships in every major medical field.

      •  Thanks! (4+ / 0-)

        Please stop by our poster at ATACCC if you're attending this year.  Targeted Glucocorticoids for Chronic Pain.

        We're very concerned about the use of opiates treating our OEF/OIF returnees.  The Tampa VA has done an absolutely outstanding job developing new protocols for signature pain [my words]. We know that 1.9 million have deployed.  Statistically we expect that ~50% will present for some form of pain in their lives, and 44% will be given opiates.  

        Doesn't take a rocket scientist to realize that's 500,000 men and women on potentially addictive painkillers.  The brass know that veterans are selling VA-prescribed opiates on the street.

        Please ask your Congressional representative to hold hearings on better treatment for pain, and to fund research into new therapies for pain therapies.

        •  Thanks for the response (0+ / 0-)

          More evidence that scientific inquiry does not depend on the insurance of its individuals.

          I won't be at the ATACCC conference but best wishes!

        •  DLPA - reduces pain and its natural (1+ / 0-)
          Recommended by:

          dl-phenylalanine is a supplement available for extremely low cost. The D isomer is a natural enkephalinase inhibitor.

          It has analgesic activity, its non addictive (because the painkillers are your own bodys')

          However, it should not be given in high doses by itself because that could result in low serotonin.

          Add a small amount of l-tryptophan or whey protein to prevent competitive loading of the transporter and an artificially induced lack of serotonin by precursor manipulation.

          Health insurance is 450000 people or 0.145% of the 310000000 people in America. Change is easier, though, if you don't have to worry about health insurance

          by Andiamo on Fri Jun 26, 2009 at 10:52:56 PM PDT

          [ Parent ]

  •  Excellent framing besides the (3+ / 0-)
    Recommended by:
    WisVoter, bthespoon, antooo

    great points! Thanks for this very helpful diary.

  •  thanks, Doctor (3+ / 0-)
    Recommended by:
    WisVoter, bthespoon, antooo

    very informative. Please spread the word.

  •  Do you know why the VA medical (2+ / 0-)
    Recommended by:
    WisVoter, antooo

    facilities aren't simply folded into Tricare?  Wouldn't that expand access and cut out a separately run administrative operation?

    What FDR giveth; GWB taketh away.

    by Marie on Fri Jun 26, 2009 at 09:15:08 PM PDT

  •  Peace right back atcha, bsmoothmd! And (6+ / 0-)

    thanks for this!  Why isn't this brought up by anyone to throw back in the faces of Baucus, Grassley, et al?

  •  That Was a Huge Help (3+ / 0-)
    Recommended by:
    Rogneid, bthespoon, antooo

    Thank you!

  •  Yes! Yes! yes! - great diary! (6+ / 0-)

    This is the kind of thing people need to hear and hear again.  And again.
    It really is simple, but the powers that be are so determined to make it complicated.

  •  Now we have to kill foreigners to get socialized (4+ / 0-)
    Recommended by:
    Rogneid, 4Freedom, Calamity Jean, antooo

    medicine. Tsk.

    Any government that robs juveniles to pay Jamie Dimon, can always expect the support of Jamie Dimon

    by JerichoJ8 on Fri Jun 26, 2009 at 09:28:57 PM PDT

  •  Exeplary first diary. (3+ / 0-)
    Recommended by:
    Rogneid, Calamity Jean, IL JimP

    Thank you for your service and for the information you have provided.

  •  The Va would be moot (4+ / 0-)
    Recommended by:
    raatz, gaff98, Lusty, antooo

    with single payer.  People would not have to travel great distances to to a VA hospital for care, they could go to a local doctor in their community.

    So much of the objection to single payer makes little sense.  There would be bureaucracies that could be eliminated and consolidated.

    •  I agree (2+ / 0-)
      Recommended by:
      trinityfly, antooo

      to a point.

      I do appreciate Obama's desire to work within the system we currently have in this country- insurance companies, big pharma, physicians, etc.

      I think the ultimate goal of a single payer system is desired, but that is A LOT of consolidation that will definitely not happen overnight.

      Thanks for your response

    •  No, veterans want and need to see military (0+ / 0-)

      .... doctors because a civilian doctor may not understand their needs as well.

      "Toads of Glory, slugs of joy... as he trotted down the path before a dragon ate him"-Alex Hall/ Stop McClintock

      by AmericanRiverCanyon on Sat Jun 27, 2009 at 12:26:23 PM PDT

      [ Parent ]

  •  Ummm, there is a serious flaw with this diary (4+ / 0-)


    This statement is completely false - "42 Million active duty and retired uniformed service member and their families receive their healthcare from the federal government."

    42,000,000 represents the number of people covered by Medicare.

    Quoting from the shaded area - "Prior to 2001, TRICARE beneficiaries would lose their TRICARE coverage when they reached age 65, and Medicare—the federal health insurance program that provides medical benefits to over 42 million elderly and disabled Americans—would become their primary health insurer."

    I recommend that the diarist delete this diary.


  •  Like DUH!.... glad someone finally pointed it out (2+ / 0-)
    Recommended by:
    Rogneid, bthespoon

    Excellent diary, very clearly points out the idiocy and illogic (Obama's words) of the current system and of the friggin morons who are trying to stop reform to rationalize the entire mess.

    What do these people think? As with other aspects of the comeplete ass fucking of the people, eventually WE will have no money left, and the FilthyRich (tm) will have ALL the money.... then what?

    I tell you what, we'll finally wake up, build guillotines, and put them out of our misery.

    1789... either thier bank accounts get it in the neck, or eventually THEY will. Consider taxing the fuck out of the rich the humane choice, otherwise, people are going to die.

  •  Hooray for Socialized Medicine! Hooray for the (6+ / 0-)

    care available to our troops and veterans!

    Take that you silly republicans! Take that you weak-kneed Democrats!

    One Nation, One Health Plan. Doctor and Nurse Recommended Single Payer Health Care for All!

    by ludlow on Fri Jun 26, 2009 at 09:35:59 PM PDT

  •  Actually 1/3 of Americans are (10+ / 0-)

    receiving health care from the government when you combine sChip, medicare, medicaid, federal employees, and military (of which Tricare is part).

    By 2016 it is projected that 1/2 of Americans will be insured by  these federally sponsored programs.

    That leaves the other half, or 150 million, of which only 50 million are not covered at all.

    So, the budgeting of the cost of health care comparatively needs to be carefully watched.

    Where are the numbers?  Don't let them get away with playing the numbers, K?

    Poverty does not mean powerless. Unite!

    by War on Error on Fri Jun 26, 2009 at 09:44:57 PM PDT

    •  You have a great list, maybe there are more (1+ / 0-)
      Recommended by:

      federally paid for systems.

      It would be nice to have a list with numbers for all of the government-paid health programs.

      I have a couple:

      * This is a hidden transfer of money from the public to private but written in almost every employer-sponsored disability plan.
      A disability qualified employee MUST apply for Social Security disability.  Why?
      Because the policy states that any other awards are to be automatically sent to  the private disability insurer.  
       If the qualified insured does not apply for Social Security on their own, the insurance company will send a "helpful" representative to the sick person's home to fill the paperwork, to assure Social Security acceptance.  I have a friend whose husband   was diagnosed with Glioblastoma (similar to Senator Kennedy's cancer).  As soon as his employer's disability kicked in because he could no longer work, they got the phone call.  They never saw a dime of the taxpayer-supported disability, which they truly needed.

      This is a common practice for those disabled from work and eligible for SS.

      * A little-known and good program sponsored by Medicare, is the funding of residencies for soon-to-be physicians. While it doesn't relieve the greatest part of the education burden, it prevents yet another debt.

      Thank you to this diarist for writing.  Some of the most innovative research in cancer and environmental illness have come from Navy doctors and the DOD.

      I'm new here; lurking since before '08 election. I'll try to find something pithy from William Wilburforce.

      by Regina in a Sears Kit House on Sat Jun 27, 2009 at 12:03:29 PM PDT

      [ Parent ]

  •  My pop swears by Tricare (5+ / 0-)
    Recommended by:
    Chi, Technowitch, Ozzie, bthespoon, antooo

    And with the medical problems both he and my ma have...
    Thank you.
    Nice job!

  •  Some questions: (3+ / 0-)
    Recommended by:
    Rogneid, CatJab, shortgirl

    Are the physicians and medical staff in the Tricare system active military staff or a mix of military and civilian personel?

    Is salary for the Tricare physicians and staff comparable to that which is available in civilian practice?

    Is the system able to retain staff, or do doctors tend to migrate to civilian practice after their term of service is complete?

    •  Thanks for your response, good questions. (11+ / 0-)
      1. There are a combination of active duty staff and civilian personnel. Most facilities do not have enough active duty physicians to cover the workload and hire additional staff. This is true for nurses and other ancillary staff as well.
      1. Salaries for physicians is a tough one. Salary wise, the pay is significantly less than civilian counterparts. This is somewhat made up by the fact that many active duty physicians (myself included) signed up to have their medical school paid for in return for a certain amount of time required to serve.
      1. Retention is definitely an issue for the above reason. Physicians can usually at least double their income in the civilian world when there obligation to service is completed.
      •  Yes, but (2+ / 0-)
        Recommended by:
        samddobermann, antooo

        It's not such a bad deal like you said, if your education is covered.  I mean, starting off as an O3 is not a bad base salary, then monthly Basic Housing and grocery Allowances, not too mention additional pays like hazard pay if you're in an airbone unit or what not.

        Then world class experience, especially if you are a trauma surgeon or something.  Then there is, depending on specialty, those great annual bonuses meant to retain docs.

        So in the end, it seems to me, if you can live comfortably like your other non-medical officer peers on a military salary, and if you are wise and save the annual bonuses, then when you do eventually fulfill your obligation (and for others, it depends not only on the length of med school itself but also how many years of residency as to how long obligations are: I recall two years for every one year of education or something like that), then a military doctor can get out with years of top notch experience, no debt, and probably enough savings to start a private practice.

        And if a doc stays in for 20, which I imagine is a consideration because by the time you finish your obligation it may be worthwhile just to do the few additional years to get the retirement, just add the retirement benefits and pension on to the above.

        I've always thought the military had a great program for its doctors that, in the long run, maybe puts them in a better position than their civilian peers.

        "First, we take Manhattan! Then we take Berlin!" -Leonard Cohen

        by Jeffersonian Democrat on Sat Jun 27, 2009 at 05:50:39 AM PDT

        [ Parent ]

        •  Thanks for the response (2+ / 0-)
          Recommended by:
          Jeffersonian Democrat, antooo

          Financially speaking, it also depends on which medical school you go to. If you go to a private medical school, the average debt upon graduation is in the range of 200K to 300K. If you go to a state medical school (for which I did) it is a much more "realistic" 100K to 200K.

          It also depends on your specialty. Family practice, pediatrics, Internal medicine physicians in the military make less but much similar to their civilian counterparts. Surgical specialties make one half to one third the amount.

          In my personal example, if owe one year for every one year of medical school they paid for, this does not include residency (4yrs for ob/gyn). I will complete a total of 8 yrs. I plan on getting out when if complete this obligation, mostly for personal family reasons.

          •  I always thought (1+ / 0-)
            Recommended by:

            Uniformed Services University of the Health Sciences was the best deal because you got your commission and got paid as a 2LT while attending rather than the AMEDD (?) med school scholarship which seemed to be like an ROTC type for med school with a minimal monthly stipend.

            I got a Green to Gold, enlisted to officer, ROTC scholarship for pre-med in 1992, I remember the anesthesiologist had the highest annual bonus at the time around 183k.  General Practitioner down near the bottom of the bonus scale, no wonder there is a shortage of GPs.

            I guess some docs go to private schools, but there are so many great state schools like U Michigan, Berkely, UCLA or UVA, but I'm not sure why they would as the prestige seems more expensive to buy and not a lot more prestigious.

            Anyway, it took a semester to find out that I had no aptitude for science but did pretty well with Russian.  So I ended up dropping the scholarship and switching to the Navy and OCS upon graduation.

            "First, we take Manhattan! Then we take Berlin!" -Leonard Cohen

            by Jeffersonian Democrat on Sat Jun 27, 2009 at 06:43:49 AM PDT

            [ Parent ]

    •  Also, don't forget that Tricare recipients are (9+ / 0-)

      free to select their provider from any who participate in the plan, just like Medicare recipients.

      Many retirees do not live within the 30 mile radius of a MTF that the DOD is now enforcing, so they have to seek medical care from civilian physicians.  (Which is as it should be, the active duty military and their families deserve first call on the available care at military facilities.)

      I have received care from active duty military and civilian contractors at the military hospital over the last 15 years.

      And I mentioned in another diary tonight the story of a friend who decided to stay in the Navy as a doctor of internal medicine, pursued a fellowship in endocrinology and is now a Captain and approaching retirement.  

      One thing that went into his decision was the prospect of trying to practice medicine in an era that increasingly requires a doctor to spend so much time arguing with insurance companies.

      Also, the Navy offered him the opportunity and paid for him to pursue his interest in endocrinology.

  •  Unbelievable!! And it has CHOICE built in.... (4+ / 0-)
    Recommended by:
    Chi, Blissing, a small quiet voice, CatJab

    for all those who need that in their lives.

  •  TRICARE isn't single payer as normally understood (10+ / 0-)

    It's much more left-wing than that: it's government funded, government provided health care. I'd call it "single provider" or "fully socialized".

    There are many millions happily using a single payer system in this country, though, probably more than the diary title says. It's called Medicare.

    They tortured people to get false confessions to fraudulently justify our invading Iraq.

    by sullivanst on Fri Jun 26, 2009 at 10:11:28 PM PDT

  •  My brother had Tricare. It was considered the (4+ / 0-)
    Recommended by:
    Big Tex, Blissing, Cleopatra, LeftyAce

    cadillac of health care plans.  Providers loved to see him.  He got the best and most expensive health care options.  

    •  Different Experience (1+ / 0-)
      Recommended by:

      "Providers loved to see him."

      I've experienced the exact opposite -- many private providers don't accept Tricare.  The ones I've talked to state that Tricare pays less than civilian providers, Tricare requires twice as much paperwork, and Tricare is very slow to pay.

      Tricare works great as long as you seek treatment at a military facility.  Luckily, I live near one.  When I've sought treatment from a civilian provider, I've had nothing but hassles.

      •  Exact opposite experience....he never had a (0+ / 0-)

        problem with being able to see who he wanted and he never went to military facilities after he retired.  He did however live in area's with a high percentage of retired military, maybe that makes a difference.  

      •  We have had the same thing (0+ / 0-)

        happen. After retiring from the US Navy, we are now living far from any military medical facilities. TriCare Prime, administered by Humana, is so slow to pay that there is only one GP left in the whole county who accepts TriCare. My SIL, who is a nurse, echoes the dislike for TriCare that exists in the local health care provider circles.
        True single payer would eliminate this problem, since medical providers would have no other option than to deal with the one system available. I believe it would eleminate a lot of hassle and wasted time at medical offices as well.

  •  THANK YOU! (2+ / 0-)
    Recommended by:
    Big Tex, Rogneid

    You make so many good points that I can't begin to acknowledge them all.

    I have a question for you, where can somebody who has an idea that might help with a specific aspect of military medicine suggest it?

    Health insurance is 450000 people or 0.145% of the 310000000 people in America. Change is easier, though, if you don't have to worry about health insurance

    by Andiamo on Fri Jun 26, 2009 at 10:29:24 PM PDT

  •  I don't know what your original numbers were... (2+ / 0-)
    Recommended by:
    tmo, Rogneid

    but if you add medicare recipients... the number grows vastly...

    Tipped. Wrecked (our health care "system," that is, LOL).

  •  I am a Tricare provider (20+ / 0-)

    also, though in a far different context.

    For me, a private practitioner who runs his own business, a small family practice in the San Francisco suburbs, there is no nearby base and Tricare is a tiny part of my practice.  I signed up simply because I wanted to make myself available to military dependents who happen to live in the vicinity.  

    The program works for me as just another preferred provider organization (PPO), but one which has never given me any administrative headaches. As such, Tricare shows just how a national single payer program would work:  publicly financed health care, privately delivered. Simple, comprehensive....

    Dr. Aaron Roland is a family physician in Burlingame, CA. Follow him on Twitter @doctoraaron

    by doctoraaron on Fri Jun 26, 2009 at 10:51:14 PM PDT

  •   Not true! (2+ / 0-)
    Recommended by:
    tmo, Rogneid

    Only one caveat- when they get discharged, their bill is always the same: $0.

    We have to pay for our meals!

    I have tricare prime - The only complaint I have is... you are assigned a prime doctor but basically you cannot get an appointment with them because of how they book - but you do get an appointment with a "team member".   Standard appointments do take a little coordination - but they do have urgent and other care for illiness.

    Takin it to the streets....Doobie Brothers

    by totallynext on Fri Jun 26, 2009 at 11:16:44 PM PDT

    •  Can you order out where you are? (3+ / 0-)
      Recommended by:
      melo, Sherri in TX, shortgirl

      The last time my father was in a VA hospital, the food was horrid. The nurses had menus from local restaurants, so every day he ordered dinner from a different restaurant. That's how he got hooked on Thai food.

      His breakfasts were very good, but lunch and dinner were really bad. Shimmering green meat bad.

      The only thing that helps me maintain my slender grip on reality is the friendship I share with my collection of singing potatoes. -5.75, -7.18

      by Rogneid on Sat Jun 27, 2009 at 01:01:31 AM PDT

      [ Parent ]

  •  I am in a Medical University setting (5+ / 0-)

    and we provide pediatic endocrinology services which the military bases close to us don't provide. We see families from Whiteman Air Force Base, Fort Leavenworth, Fort Riley Military Base and families of Recruiters in the area.

    Tricare has always been so easy to work with and have approved any and all complicated endocrine testing that we might need to perform on children.

    The system works very smooth at no cost to the patients. I wish all Insurances were as easy as Tricare.

  •  Tricare, Medicare, the VA ... why don't the Dems (4+ / 0-)
    Recommended by:
    tmo, Justina, Blissing, Calamity Jean

    point this out?  The government ALREADY covers lots of people.  Why is this splitting the atom?  It is absolutely insane that the Dems would give up the public option for any reason.  

  •  and don't forget the Indian Health Service (7+ / 0-) in Alaska, the Alaska Native Tribal Health Consortium and the Alaska Native Hospital are something that, while not flawless, would be great for all of us.  I've been through several long-term experiences with friends there, one with cancer and one with major health issues, and the difference is just incredible.  Nationally the IHS has its issues but again, is a single-payer system serving many people.  

    •  someone was recently knocking a congressional (0+ / 0-)

      set aside for the Indian Health Service because they said it was an attempt to keep the traditionally underfunded IHS out of the national health care system (!!???!!! assuming there will ever be such a thing.)

      The point they were making was that IHS was notoriously underfunded and shouldn't be ghettoized in this health care discussion.

      So many smaller programs and out of the mainstream programs that it's quite difficult to get an overall picture of US health care.

      I guess that's the point that someone else made down thread.

  •  Great Diary! (5+ / 0-)

    My father, mother, and - come to think of it - myself, all got excellent care while the old man served in the Air Force.

    After retirement, he and Mom were covered by Champus, and then got kicked out after turning 65. They signed up with a civilian HMO, and got crappy care until "Tricare for life" came back in the 90's, and gave them PPO coverage.

    No complaints, no denials, no fuss, no premiums. SS paid it's share, Tricare paid the rest.

    But... won't the critics say that Tricare is a "special case", subsidized by exorbitant Pentagon spending?

    And... aren't military personnel "healthier" by virtue of selection, physical exercise, supervised diet, disciplined attitude, etc?

    BushCheney Inc. - They lied to me, they lied to you, they lied to our troops.

    by jjohnjj on Sat Jun 27, 2009 at 12:22:32 AM PDT

    •  That's what I'm wondering too n/t (0+ / 0-)

      corporations interpret "loyalty" the way a prisoner might interpret "dropping the soap"

      by Johnny Venom on Sat Jun 27, 2009 at 01:46:05 AM PDT

      [ Parent ]

      •  I bet Tricare is far more cost effective (4+ / 0-)

        per patient than private insurance.  

        And Medicare works on 3-4% overhead while private insurers use 30-40 (according to Elizabeth Edwards on C-SPAN yesterday.

        And Tri-Care covers a very high number of extremely disabled (therefore high cost) veterans.

        Remember the brouhaha inthe news over Walter Reed not taking good care of our returning soldiers?  What what vastly under-reported about that story is that the Bush administration had turned the management of Walter over to a subsidiary of Halliburton in a fat-cat government contract.  Costs skyrocketed and quality of care plummeted.  

        •  That and the VA got unfairly hammered (2+ / 0-)
          Recommended by:
          fhcec, Calamity Jean

          while it was actually the military and not the VA as those troops were still on active duty going through physical therapy or waiting medical discharges.  It was mostly on living conditions, too, but the health care part got the most scape-goating.

          So now, everyone is under the impression that VA health care sucks.

          "First, we take Manhattan! Then we take Berlin!" -Leonard Cohen

          by Jeffersonian Democrat on Sat Jun 27, 2009 at 06:06:24 AM PDT

          [ Parent ]

    •  you may be surprised (1+ / 0-)
      Recommended by:
      Calamity Jean

      about the healthier.  I recall research back in the early 90s that dealt with recent retirees and heart attacks.  I think the gist of it was, after 20 years of big omelet and fried potato breakfasts, that after retirement, when the exercise stops, the diet catches up with a lot of folks and there was a higher incidence of cardiac problems.

      "First, we take Manhattan! Then we take Berlin!" -Leonard Cohen

      by Jeffersonian Democrat on Sat Jun 27, 2009 at 06:03:05 AM PDT

      [ Parent ]

  •  No one wants VA style health care (0+ / 1-)
    Recommended by:
    Hidden by:
    Ann T Bush

    While I was in the Navy, I was treated almost exclusively by barely trained enlisted corpsmen. These people worked hard and meant well, but had only a few weeks training before seeing patients.

    If you were not pregnant or suffering from a STD, they had no idea what it was.

    This physician may be highly trained, but only a small percentage of sick call actually gets to see a real doctor. Most are shuffled off to someone with a few weeks training and then sent back to work without any real understanding of their illness.

    No civilian would let someone with less than 6 months training play doctor on them. 1/2 my family is in the military and several are medics/corpsmen. I know how poorly they are trained and how little real instruction they have before being turned lose in a clinic and treating patients.

    Again, these people work hard and mean well, but they have less training than a second semester nursing student.

    This is an absurd diary. No one wants this crap for their family.

    •  If ALL Americans were in the same plan, then (8+ / 0-)

      ALL Americans would have total freedom to choose any licensed health care provider...and health care providers could not discriminate against us based on what health coverage we have.  ALL providers would have to be in the plan because there would only be one plan: if you are sick and need medical care, you get it.

      TriCare is a government-run health care and insurance program.  Medicare is a public insurance program utilizing private providers.

      If all Americans had the right to join the largest, most reliably protective and efficiently run health insurance plan available, we would all join Medicare.

      Expanding and improving Medicare for All would save Medicare, Social Security, and our economy for generations to come....not to mention millons of unnecessary deaths, illnesses, disablings, home foreclosures, bankruptcies, lawsuits over who has to pay the medical bills, tens of millions of terrorized Americans, and trillions of currently wasted health care dolllars.

      Only when we are all in one non-discriminatory coverage plan, will we be able to achieve the strength and transparency we need to be able to start solving the other problems in health care.  Nothing involving humans will ever be perfect.

    •  Speak for yourself (10+ / 0-)

      As a CAT I vet disabled at 60%, I love my VA care.

      But this isn't about Veterans Administration care, it's about military Tricare.  In my 18 years, if you were sick, you went to battalion level sick-call, where if it wasn't something that the medics couldn't handle with a cold pack or Motrin, you saw the Battalion PA.  More often than not, he refers you to the Troop Medical Clinic at the division level where you see a doctor.  That doctor in turn either solves the problem or sends you to the hospital for specialists, exams or x-rays.

      But it's moot anyway, because this is a matter of internal military organization and would have nothing to do with civilians.  It has nothing to do with how insurance is paid or what's covered.  Those retirees and dependents don't see the "barely trained" enlisted unless they go to a military facility and then it is for administrative screening and taking temperature and blood pressure before they see a medical professional.

      "First, we take Manhattan! Then we take Berlin!" -Leonard Cohen

      by Jeffersonian Democrat on Sat Jun 27, 2009 at 05:13:24 AM PDT

      [ Parent ]

    •  Was that on Ship or in the field? (4+ / 0-)

      Yes field medical is a problem,  A friend of mine was a freshly minted
      officer,  had been stationed on a remote caribbean island and got
      pregnant and had to leave the navy because there was no
      medical care at her duty station.  She was flying all day to Key West
      to see a doctor and she didn't want to try being 9 months pregnant
      and facing a corpsman.

      certainly in WW2, a pharmacists mate had to conduct an appendectomy
      on a sailor in a submarine.   And soldiers stuck out in the Sinai as part
      of UN Task forces get a medic for their medical care and need a medevac
      if they get seriously hurt. Sure.

      But if you are at a major facility, San Diego, Pearl Harbor, Norfolk,
      That shouldn't be happening....

      George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

      by nathguy on Sat Jun 27, 2009 at 07:04:15 AM PDT

      [ Parent ]

      •  The "doctor" in the WWII appendectomy (1+ / 0-)
        Recommended by:

        certainly in WW2, a pharmacists mate had to conduct an appendectomy on a sailor in a submarine.

        may have been only a pharmacist's mate, but by golly, the operation was a success and the patient lived!  And this was at a time when in civilian life a case of  appendicitis was virtually a death sentance.

        Renewable energy brings national security.

        by Calamity Jean on Sun Jun 28, 2009 at 12:26:29 PM PDT

        [ Parent ]

    •  When was this? (6+ / 0-)

      The only time corpsmen (who have more than a few weeks of training, btw) treat patients is either in the field with the Marines, or occasionally will work in a school situation where they take care of minor issues - but there is always either a Physicians Assistant, Nurse Practitioner, or Physician available! I worked in Navy medicine for 40 years and would have preferred to get my healthcare at the facility where I worked. The entire staff works very hard, were JCAHO surveyed and certified, and have access, if not possession of, state of the art equipment. The people who usually do all of the complaining are the ones who think that somehow military healthcare professionals are somehow second rate! They attend the same universities as civilians, get the best kind of fellowships and residencies, and have the added experience of combat medicine. I resent comments being made like this that have no basis. Of course, if you prefer no healthcare, you do have that option, but I, for one, wouldn't hesitate to go to a Navy clinic or hospital. I do know that our Navy Corpsmen are highly regarded by the Army and Ntional Guard when they've worked with them as they have much more hands on training.

      •  best medicine I ever had (2+ / 0-)
        Recommended by:
        bustacap, Ozzie

        not that I needed much, was while active duty AF Officer during Vietnam era. My girlfriend at the time was a Captain OR nurse, and most of our friends were medical corps people, so I got the inside scoop on how things worked. She was pissed at the military because she wanted to be sent to Vietnam to work on the front lines, but they wouldn't let her go. We got out of the AF within months of each other.

        My son is Army Special Forces, and got his preferred MOS - Combat medic. It will take a (taxpayer-funded) year to train him. Not exactly an ignorant corpsman.

        "red hair and black leather, my favorite colour scheme" - Richard Thompson

        by blindcynic on Sat Jun 27, 2009 at 11:36:55 AM PDT

        [ Parent ]

    •  I am sorry for you. (2+ / 0-)
      Recommended by:
      bustacap, dmh44

      You are totally off base in your comment.

      I served on destroyers and carriers and a nuclear sub in the Vietnam era Navy. Sure, the typical Fram II destroyer would only have a corpsman aboard, but to say that petty officer has little or no training is bull. Serious cases would be transferred to carrier or other facility with adequate medical personnel as soon as possible, faster than your wife or mother could get you to any hospital in the states. Christ, the carrier even has dentists with latest equipment and technologies. If they cannot take care of you there, you get transfered to a land based facility. Anyway that is not TriCare or the VA.

      Oh Barry, they are turning Health Care into an Actuary's wet dream.

      by fredlonsdale on Sat Jun 27, 2009 at 12:00:01 PM PDT

      [ Parent ]

  •  My sister and nephew have TriCare (3+ / 0-)

    through her active-duty husband; and from the years of ad-hoc anecdotal stories from her, TriCare is all that the diarist claims.

    And let us not forget the Single Payer Gov't Provided system that covers the lawmakers themselves.

  •  My grandfather, a retired Major, has Tricare (4+ / 0-)

    He likes it. He sees private doctors, his several medications are covered. As is the wheelchair needed due to his recent knee replacement.
    Tricare combined with Medicare means he pays very little.

  •  More like 28 percent. (2+ / 0-)
    Recommended by:
    maybeeso in michigan, 4Freedom

    You have to add in Medicare, Medicaid, VA and other programs like SCHIP.

    Government programs directly cover 27.8% of the population (83 million),[37] including the elderly, disabled, children, veterans, and some of the poor, and federal law mandates public access to emergency services regardless of ability to pay. Public spending accounts for between 45% and 56.1% of U.S. health care spending.[44

      •  fun with apples and oranges math? (3+ / 0-)

        S-CHIP (coverage for children and some of their parents as long as they stay poor enough) is almost always private insurance funded with taxpayer dollars, as are federal, state and local government employee plans (AKA corporate welfare for the health unsurance industry).  "They" are making the situation so convoluted (on purpose?) what with mixing up private plans into Medicare and all, that the public/private numbers are really hard to sort out.  

        I was hoping this diary did that for me (us).

        But here's one (I think really good) reason why SOMEBODY should take the time to find out (with documentation to back up the numbers).  

        Our 16% uninsured rate compares privately insured apples to publicly insured oranges.  

        In other words, IF (and I'm not saying 28% is the figure) 28% of Americans are not in the private market, then 72% are.  In that case, 16% uninsured should be compared to 72 (not 100) percent.  16 is to 72 as 22 is to 100.

        That would mean 22% of Americans in the private (apples to apples) market are uninsured, while 16% of ALL (apples to oranges) Americans are....and so 22% should be the uninsured figure we use, not 16.

        We really should not allow our opposition to dupe us into using apples to oranges comparisons.  

  •  Not to be the "Dr. Pooper" here but (0+ / 0-)

    just one question, something that wasn't really detailed.  How is this funded?  Is there information on the financial "health" of this program?  Are there budgetary problems?  

    Don't get me wrong, I say let's have Tricare tomorrow!  If there is one thing this nation needs, it's a universal health insurance operator for the masses.  We hear all this talking, though, about Medicare going bankrupt in Year such-and-such.  I'm sure you've all heard it before.  

    Once more, I hope no one thinks I'm against expanding or cloning Tricare for the rest of us.  But I'm an econ/accounting geek, and would like to know the numbers end of this.  

    corporations interpret "loyalty" the way a prisoner might interpret "dropping the soap"

    by Johnny Venom on Sat Jun 27, 2009 at 01:44:20 AM PDT

    •  BTW, almost forgot (1+ / 0-)
      Recommended by:

      fantastic diary.   You sound like the kinda doctor I would appreciate to have.  Thank you for your service, and of course...this diary post!  Please write again.

      corporations interpret "loyalty" the way a prisoner might interpret "dropping the soap"

      by Johnny Venom on Sat Jun 27, 2009 at 01:51:58 AM PDT

      [ Parent ]

    •  There is some information out there. (1+ / 0-)
      Recommended by:

      It indicates -- no surprise -- that Tricare is a system that is under significant financial pressure. The subject of the portion of the "military" budget that goes to other than direct military expenditures has been a long-standing DoD concern. According to a 2005 GAO report, DoD expenditure for Tricare doubled in just 5 years, 2000-2005, from $17.4 billion in 2000 to $35.4 billion in 2005.  DoD cited several reasons:

      The factors DOD identified as the largest contributors were medical care inflation and benefit enhancements required by law, including TRICARE for Life, which supplements Medicare coverage for TRICARE beneficiaries, generally after age 65. DOD also identified other factors, including an increased number of beneficiaries who have chosen to use TRICARE and health care costs for mobilized reservists and their families due to the Global War on Terrorism.

      To lower the increasing cost, the Bush administration proposed to increase charges to beneficiaries, under a proposal called "Sustain the Benefit."  It estimated that the proposal would reduce expenses by $11 billion over a 4-year period.  Most of these savings would be achieved through what DoD called "avoided users," which is the term used to describe people "persuaded" not to enroll due to the higher costs.  

      DOD's savings estimate depends largely on the assumption that the increased fees and deductibles will result in approximately 500,000 retirees and dependents under age 65 either leaving or choosing not to enroll in TRICARE--collectively referred to as avoided users--and on the assumption that each avoided user will save DOD the equivalent of the cost of providing health care to the average TRICARE beneficiary.

      GAO strongly doubted these savings levels would be achieved.

      In any event, looks like dividing 35.4 billion by the 9 million beneficiaries in Tricare yields an annual cost to the taxpayer of $4000 per beneficiary in 2005.

      •  .... (3+ / 0-)
        Recommended by:
        dmh44, Calamity Jean, Johnny Venom

        In any event, looks like dividing 35.4 billion by the 9 million beneficiaries in Tricare yields an annual cost to the taxpayer of $4000 per beneficiary in 2005.

        That includes, I would imagine, complete funding of all the associated facilities (including all medicines, supplies, logistics, etc) for every serviceman, their dependents and other eligible beneficiaries as well.  Considering that, $4K per person is cheap, especially when the following is taken into account:

        The Office of the Actuary (OACT) of the Centers for Medicare and Medicaid Services publishes data on total health care spending in the United States, including both historical levels and future projections.[24] In 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person, up from $2.1 trillion, or $7,026 per capita, the previous year.[25] Spending in 2006 represented 16% of GDP, an increase of 6.7% over 2004 spending. Growth in spending is projected to average 6.7% annually over the period 2007 through 2017. Health insurance costs are rising faster than wages or inflation, and medical causes were cited by about half of bankruptcy filers in the United States in 2001.[26]

        ... and we have seen the black suns | pouring forth the night. -- Clark Ashton Smith

        by bustacap on Sat Jun 27, 2009 at 02:28:27 PM PDT

        [ Parent ]

        •  Can't say one way or the other. (1+ / 0-)
          Recommended by:
          Johnny Venom

          Maybe the DoD budget writers have pumped up the $35B number by including things they shouldn't have; maybe they kept it low by hiding real costs somewhere else in the budget.  

          I keep my copy of the federal budget on the "fiction" shelf.

        •  It should also be noted (1+ / 0-)
          Recommended by:
          Johnny Venom

          that, if we've calculated it right, $4K is the cost to the taxpayer.  I've seen mention in the comments that beneficiaries have expenses (co-pays, deductibles, etc.) which would have to be factored in to get the bottom-line expenditure per person. No way to even guess what an average out-of-pocket would be.

          All in all, though, the cost per beneficiary doesn't strike me as unreasonable.

  •  Thank you for this very informative Diary (n/t) (1+ / 0-)
    Recommended by:

    An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it. Mohandas Gandhi

    by msmacgyver on Sat Jun 27, 2009 at 02:58:15 AM PDT

  •  If republicans support the troops... (9+ / 0-)

    ...why do they inflict "socialized medicine" on them?

    If republicans love their mothers and fathers, why are they content to leave them with the inferior, socialized medicine of the Medicare system?

    If republicans revere our veterans, why do they tolerate the socialized medical care provided by the Veterans Administration?

    Answer: it's good enough for our troops, veterans and parents, but it's not good enough for the rest of us.

    You'd think this level of coruscating hypocrisy on the part of our republican friends would be noticed by Charles Gibson and the rest of our lapdog media.

  •  Government-paid medicine (1+ / 0-)
    Recommended by:
    Calamity Jean

    actually is the norm in this country taking all programs like Medicare, S-Chip,.. into account.  And those are most satisfied customers. Private insurance is a minority and they are just trying to hang onto a diminishing share.

  •  Every day (2+ / 0-)
    Recommended by:
    fhcec, dewley notid

    progressives make points that counter the prevailing right wing fear mongering.  These need to be inserted in comment threads that run ideologically right.

    For some reason I've been blocked at AOL and my comments on health care won't post.  Someone else needs to take up the slack there.  We need to do it all over the net.

    Just getting the salient points out so they can be talked about is prime.

  •  Medicare , Medicaid, and VA also (5+ / 0-)

    In effect these are single payor entities for the beneficiaries they serve (seniors/disabled, low-income, veterans).

    And to answer arguments that a public option would create a large bureaucracy making our health care decisions for us, let's not forgot that there is a large private bureaucracy (health insurance companies) doing that now. I'm not sure why reformists rarely point that out.

  •  And -- there's TRICARE For Life (6+ / 0-)

    I am a retired Army officer.  Upon my retirement, my wife and I went under TRICARE Standard -- we paid a monthly premium and got medical care.  

    When a military retiree or retiree spouse reaches age 65, he/she goes onto Medicare.  However, most people on Medicare carry a back-up policy that pays (almost) everything Medicare does not cover.  TRICARE For Life is the military's Medicare gap policy.  My wife is over 65 -- she has Medicare primary and TFL as secondary -- we pay monthly premiums, deducted from her Social Security annuity and my miltary pension.  I turn 65 later this year and will move from TRICARE Standard to the same combination she has -- Medicare and TFL.

    We are VERY pleased with our coverage -- no problem finding physicians who take the insurance, no problem with payments to physicians, and the premiums are affordable.

    As for medication, we had the option -- go under Medicare Pharmacy or stay with TRICARE Pharmacy -- we stayed with TRICARE -- mail-order pharmacy, or, our local pharmacies all accept TRICARE Pharmacy insurance.

  •  Tricare simply works (3+ / 0-)
    Recommended by:
    danmac, 4Freedom, dewley notid

    It should be noted that the Tricare program is managed by PGBA LLC, which is a subsidiary of BlueCross BlueShield of South Carolina. From their web site

    PGBA, LLC provides fiscal intermediary and management information services to the Department of Defense (DoD) under TRICARE Managed Care Support (MCS) Program subcontracts. The Company’s major customers are prime contractors for DoD, Humana Military Healthcare Services, Inc.and Health Net Federal Services, Inc

    Love should be everything or not at all

    by kansasr on Sat Jun 27, 2009 at 04:46:28 AM PDT

  •  a local physician cited Tri Care (0+ / 0-)

    in a solicited opinion piece for our local paper as the number one reason NOT to support a government run plan.  He trashed it and talked about how he hated dealing with it and how awful it was for the people enrolled in it.  So this won't be an easy argument to win either.

    •  Thats because (0+ / 0-)

      of the paperwork and the backend of it I think.

      I wrote a comment further down the thread.

      I would be curious to read that article and find out what specifically he was unhappy with.

      Get It Done With Fifty-One! Healthcare Rights are not subject to compromise. Period.

      by karma13612 on Sat Jun 27, 2009 at 06:06:24 AM PDT

      [ Parent ]

      •  here is the relevant quote (1+ / 0-)
        Recommended by:
        dewley notid

        Another falsehood is that people enjoy having government-provided healthcare. They only enjoy it relative to having no coverage at all. The insurance plan for military families (TRICARE) is so bureaucracy laden that it is difficult for the doctor to do anything for the patient. Medicare, likewise, is burdened by too much paperwork for the doctor, ostensibly to prevent fraud (it does nothing of the sort).  Medicaid pays doctors so little, that if you just saw patients with Medicaid, you would have to see about 40 to 45 patients a day just to make a living.  The Veterans Administration provision of health care to veterans for non-service related illness is the biggest waste of money in our system today.  

        This is from Monday June 15, 20009 Paducah Sun (online by subscription only) and the author was Dr. Chris Dobrose, a family practitioner in Mayfield Kentucky.  

        and btw, his only suggestion for reform was to reform malpractice liability.

        •  I disagree with Obama (0+ / 0-)

          that reforming malpractice liability is a must in order to get the medical community on board. Whether real or not, this issue is a major concern for may providers of healthcare

          •  Dr. Dobrose... (3+ / 0-)
            Recommended by:
            bustacap, fhcec, dmh44

            ...seems primarily concerned with his bank account, and sounds like the worst type of greedy republican I can think of.

            Veterans Administration provision of health care to veterans for non-service related illness is the biggest waste of money in our system today.  

          •  Malpractice -less of a problem (0+ / 0-)

            with universal care, for two reasons.

            1. Increased standards of care are part of the package. These have been shown to reduce costly errors that cause families to go into bankruptcy...
            1. If health costs are shared, then individuals and families will not be exposed to bankruptcy in an effort to pay individually for the medical costs due to unexpected accidents/illness.
    •  One-off experiences like Dr. Dobrose's (0+ / 0-)

      don't provide a lot of insight in themselves. Like beneficiary reviews -- some very positive, some very negative, and it's easy to understand how that can happen.  E.g., one got a good doc, the other got a jerk.

      However, GAO has also criticized Tricare for many of the same reasons cited by both providers and users.  Like here, and here.  And probably elsewhere.

      I think the lesson is, no system is perfect, no system will please 100% of its users, and we'll just have to accept the fact that, when you want improvements, you can expect to have to work for them.

  •  Thanks bsmooth; terrific diary n/t (3+ / 0-)
    Recommended by:
    Justina, bustacap, bthespoon

    Obama is a tool; and I mean that in the nicest way.

    by hoipolloi on Sat Jun 27, 2009 at 05:00:05 AM PDT

  •  Interesting and Thoughtful Post... (8+ / 0-)

    It's well thought out and considered -- and best of all, devoid of the hysterics surrounding this health care debate.

    A few thoughts from a vet on the other end of the stethoscope :

    "Rationing" of healthcare in this single payer system is simply not reality.

    Pre existing conditions don't prevent patients from receiving care in our system...

    There is a rationing of healthcare in the military system.  Those who are medically unfit to join the military will, obviously, never receive the benefits of military healthcare.  Nor will their family members, again obviously.

    Single payer healthcare does not eliminate scientific inquiry....

    Certainly not. Research of all flavors by military entities has been around the American landscape for a couple hundred years.  Not everything the military does is angry, malicious, deadly, and anti-life, as some loonies seem to think (as they trash recruiting stations or shoot up soldiers).

    When a patient sees me, she is my patient.

    True in principle, and a good principle, but organizational and personnel stresses can make this more fantasy than reality.  My experience tells me that this is a problem, or not a problem, depending on where the TriCare service is offered.  Some areas have low turnover of staff; some areas have high turnover; some areas will not accept a patient's desire to be treated off-base, and some areas have staff who cheer when you walk in with a list of civilian doctors with whom you'd rather deal.  It is what it is.  I think in earnestness and effort, it trumps the British national health system as I experienced them.  In speed of treatment, there is no competition from the Brits.  In speed of getting one in and out (in order to deal with the next patient), the plodding Brits have the advantage.  And British A&E (our ER equivalent), I thought, was world-class, in large part because there was no paperwork to be filled out before one was seen and stabilized by staff.

    From commenter War on Error:  Tricare is the BEST coverage! We should all wish we could have it too!

    Careful what you wish for.  There's no such thing as a perfect rose.  We just have to decide which rose we want.

    wildweasels' comment is worth noting:  The only problem I have with Tricare is that I do not automatically get Dental without paying more and vision care does not cover buying a new pair of glasses.

    These services do require additional payment.  When the Delta Dental program first came out (I've never need the vision program so can't comment on it), everyone raved about it.  It's become degraded over the years.  Now it (and I presume the vision program) is a bureaucratic lake of molasses through which GIs, vets and their families must row, to receive anything more than basic care.

    NMDad refers to Those socialists at the DoD.  That's been a joke around the military for decades.  Depending on one's personal/political orientation, it can be a good thing or not.  Some of the most right-wing, apple-pie chomping nutcases readily and eagerly use programs like medical care, and subsidized (or at least tax free) commissary and Exchange privileges.  Some patchouli-sniffing left-wingers (they do exist in DoD, despite public perception) can't stand lining up in the lobby of a military facility to receive same.  (The military is larger tent than many Americans want to give it credit for.)

    Marie thinks that the US government is running a large and excellent socialized medical system at much lower cost than what we civilian schmucks pay for our "best medical system in the world."

    I don't know about the relative cost of the military system compared to the US civilian "system of systems."  But I might think that the relative costs are more comparable now than three or four decades ago, because of the dramatic increase of civil service and contract staff.  'Back in the day,' there seemed to be more uniformed medical personnel working in clinics and hosptials than there are today.

    Susan states that Tricare recipients are free to select their provider from any who participate in the plan, just like Medicare recipients.

    That's not true.  Depending on the load at a military facility, patients may or may not be referred off-base.  I've been in three TriCare regions.  Two of them didn't care if I was seen on-base or off.  One refused to provide off-base referrals.  In any case, TriCare members must be referred to an off-base provider.  They may not simply pick and choose who to see (both for the reason stated above and because [as noted in diary and comments] not all off-base medical personnel choose to participate].

    Yellow Catering Van caters to an anti-VA attitude not uncommon among vets:  No one wants VA style health care:  While I was in the Navy, I was treated almost exclusively by barely trained enlisted corpsmen. These people worked hard and meant well, but had only a few weeks training before seeing patients.  If you were not pregnant or suffering from a STD, they had no idea what it was.

    PA and corpsman training is intense and not as characterized here.  There is some validity to the feedback patients receive before being sent back to their units -- seen it myself.  I always took it as an expression of workload by the attending physician, PA or corpsman/NCO.

    Perhaps the yello catering van could drive 'round to the relatives' homes and deliver a catered menu of competent medical training for those medics/corpsmen with "less training than a second semester nursing student."  Me, I'd take a corpsman in the field who can treat a trauma wound on the spot.  Tens of thousands of GIs have benefited from them.  Some of them tear up when describing their experiences with a corpsman; some of them speak of medics in tones normally reserved for their apple-pie baking (OK, snark off from now on) mothers.

    Yellow Catering Van thinks this diary is absurd; I think the Van's comment is.

    Getting to the end of my rant, I promise.  Go check out Old Redneck's comment for a perspective of this system for older folks.  It's a good (and IMO, accurate, view).

    One more thing:  I've been cattle-herded through sick calls 'back in the day,' I've used TriCare both on- and off-base, and now I used a civilian HMO, though I'm still eligible for TriCare.  My bottom line is that both the civilian insurance program and the military system can work, and can work very well.  Both are expensive and both fare better and worse compared to foreign systems, depending on what slice of the pie you're looking at eating (apple, anyone?).  There is world-class medical work within the military (granted, the military system wasn't set up to deal with delivering babies, but they do it now and succeed), and world-class healthcare provided by private doctors.  So to me it's about commitment to access.  And the commitment means $$$ and nothing else.  "If you fund it, they will come."

    Lookin' for an exit strategy, from stupidity, that is.

    by 4 Borders Pundit on Sat Jun 27, 2009 at 05:04:01 AM PDT

    •  Thanks for your response (3+ / 0-)
      Recommended by:
      Justina, dmh44, dewley notid

      Your points are very well taken.

      I guess the impetus for my diary was two fold. One is simple. I haven't heard much chatter about Tricare as a model to emulate nor a model to eliminate and I find this interesting as many, many Americans receive their care through it. Second is more personal. It bothers me when I hear how a government run healthcare organization will stymie all medical progress and scientific inquiry. I hear this from my civilian physician friends as well. It is simply not true.

      I agree with you that this system can be a frustrating one for patients. My wife even says she may write a rebuttal to my diary ;) My intent was to verbalize the points above from a personal perspective.

      •  Two of my friends have TriCare (1+ / 0-)
        Recommended by:

        as a result of his being retired Navy. I am envious of their coverage. They have an excellent private doctor in their community for their care.

        As you can imagine, they are strong advocates for universal, single payer care - since that is how they experience their medical care.

        As for Delta Dental, I wonder if anyone negotiates rates with them. As a retiree from a large public institution, I get Medicare as part of my retirement. I know rates are negotiated with providers, but I don't know about Dental - and I wonder if the dentists don't just raise their rates for patients with insurance???

        In contrast to medical, for which I currently have a quite affordable $15 co-pay for every visit (including surgery), except labs ordered by my Doctor and drop-in services such as blood pressure checks, Delta Dental provides semi-annual cleaning and check ups for free (to me), but pays only 50% of costs for crowns, endodontist exams, etc. That can be steep - and for my friend whose retirement from a county government position is less generous than mine, a large disincentive to treatment that she needs.

  •  Perhaps this can be condensed into an op-ed? (8+ / 0-)

    and submitted to some newspapers?

    "I'm not a member of an organized political party - I'm a Democrat." Will Rogers

    by newjeffct on Sat Jun 27, 2009 at 05:16:42 AM PDT

    •  My thoughts exactly.... (0+ / 0-)

      Our local paper has an article this morning, written by a retired surgeon, titled "Doctor: HealthCare Overhaul Won't Work". This diary is a better response than  I could possibly write.

      Love is the lasting legacy of our lives

      by princesspat on Sat Jun 27, 2009 at 09:39:36 AM PDT

      [ Parent ]

  •  So glad (3+ / 0-)

    you posted this.  Excellent, excellent diary.

    I would not normally pimp my own postings elsewhere in a comment, but this recent post on my own blog is so closely related, I can't help myself.

    It's sort of close up view of the system from a user-standpoint.  

    Thank you for this diary - great work!

  •  Send this diary link to Obama (1+ / 0-)
    Recommended by:

    Also, send to the usual call/fax list.  Expanding/improving Tricare would be a good suggestion.

    Watching Pete Sessions and reporting from the Taliban-controlled 32nd Congressional District of Texas.

    by CoolOnion on Sat Jun 27, 2009 at 05:20:36 AM PDT

  •  By the way, we own AIG, right? (2+ / 0-)
    Recommended by:
    fhcec, bthespoon
    If we implement Tricare for All, maybe we could use their stuff to streamline administration and electronic records...y'know, since the taxpayers own AIG now.

    Watching Pete Sessions and reporting from the Taliban-controlled 32nd Congressional District of Texas.

    by CoolOnion on Sat Jun 27, 2009 at 05:23:00 AM PDT

  •  Thanks bsmoothmd. I love it (4+ / 0-)

    when a lurker unlurks themselves with such clarity.

  •  Wonderful diary! (8+ / 0-)

    I just am cautious about the backend of things with Tricare.

    I am a medical coder and Tricare came to visit our hospital recently since we were beginning to get patients with Tricare. We are near Fort Drum in Northern New York.

    Beautiful coverage. Totally impressed.

    Just wasn't too impressed with all the red-tape ins and outs of the billing end of things. I came away from the meeting reminding myself of why I chose to be a coder, not a biller.

    I know that we can get the paperwork involved in medical coverage streamlined, it will help so much, and save lots of money. But, it is absolutely true that administrative costs are not helping medical care at the moment. The paperwork and regulations are mind-boggling. Too cumbersome and need to be streamlined.

    I suspect that if we do get more patients over onto existing systems like Medicare and Tri-Care, it would get better. We could look at paper/processing, and see where we can improve the reimbursement/billing side of things. And I bet more docs would come on board with Medicare/Tricare if the system was made easy for them. They don't want more paperwork/processing. They want less.

    I am all for single payer, or a robust public option. And I truely believe that Medicare/Tri-care could be a great model.

    as an aside, I am just heart broken that Thursday turned out to be such a news day that there didn't seem to be any coverage on DFA going to Washington to represent America's desire for healthcare reform. The losses of two entertainment icons, and a politician's indiscretions trumped the efforts of our cause.

    sigh, get up, dust off, start all over again.

    Get It Done With Fifty-One! Healthcare Rights are not subject to compromise. Period.

    by karma13612 on Sat Jun 27, 2009 at 05:58:17 AM PDT

  •  I have tricare too (7+ / 0-)

    I've been on Tricare for 7 years and have been extremely happy. I've had experiences with both military and civilian care here in New Mexico.
    2 1/2 years ago, had total knee replacement at a military/VA hospital, good care (except for one tech, but we won't go there!) and 6 months ago thought I was having a heart attack (I wasn't) and went to a civilian hospital. Also had good care there.  Total bill for my knee replacement, $0. Total bill for my heart incident -- $25.00.  
    Until this month, my doctor(s) were active duty military, but changed every couple of years as they rotated out of this duty station. They were all great, but had a conflict with the latest one I was assigned to, and chose to go to a civilian. WHen I called Tricare to ask about this, I gave the name of the person I wanted, they looked it up, and said she was available. So now I have a civilian Dr., copay is $12.  
    I'm a very happy Tricare customer.
    Thanks bsmoothmd for your service, and for your diary. I just wish we could all have this kind of care.

  •  Yet this isn't "free" health care by any means (2+ / 0-)
    Recommended by:
    josephk, bustacap

    And let's face it, when you talk universal health care, what you mean is health care for those who currently cannot afford health insurance.

    Tricare is paid for by a tremendous sacrifice of freedom and rights while on duty in the armed forces. It is paid for by being separated from one's family for years at a time and repeatedly.

    If you do this honorably for 20+ years, you can continue with Tricare.

    Far from free.

    The Bill of Rights is universal.

    by Paul Goodman on Sat Jun 27, 2009 at 06:23:42 AM PDT

    •  socialized medicine is NEVER free (0+ / 0-)

      and in the same context as it is provided in this diary ... there ARE sacrifices made, but imo -- those sacrifices lead to a larger social compact and shared responsibility -- shared sacrifice for the broader social good is the result, no matter the social organization that "socialized medicine" resides ...

      "I want to keep them alive long enough that I can win them to Christ," - Rick Warren, Professional Greed Driven Scumbag

      by josephk on Sat Jun 27, 2009 at 07:05:55 AM PDT

      [ Parent ]

  •  Excellent diary (1+ / 0-)
    Recommended by:

    Only one question, why have you only lurked till now?  


  •  wait until you get VA-VISTA for a patient record (0+ / 0-)

    that's an Obama priority.

    It will help out  alot.

    George Bush is Living proof of the axiom "Never send a boy to do a man's job" E -2.25 S -4.10

    by nathguy on Sat Jun 27, 2009 at 06:57:20 AM PDT

  •  Recently offered to reservists as well (1+ / 0-)
    Recommended by:
    dewley notid

    I just got out but before I did I received a letter informing me Tricare was to be offered to reservists as well.

    That may make 9.2 million an outdated number as I know many reservists were interested in this. I certainly would have signed up had I stuck around longer.

  •  the best DR I ever had was retired military (0+ / 0-)

    Republicans are walking the socio Path.

    by 88kathy on Sat Jun 27, 2009 at 07:09:31 AM PDT

  •  Might be great, but dad a vet and they fucked (5+ / 0-)

    him over under bush. Guy worked day after day for years around nukes and Cold War security and they shit on him by taking away his Rx benefits.

    Just isn't right what the Neos did to our military and vets. They don't mind theorizing about sending them off to die and get maimed, but they basically gave them the finger when it came to taking care of them. Another reason why I worked for Obama.

    Bullshit is the glue that binds us as a nation. George Carlin

    by gereiztkind on Sat Jun 27, 2009 at 07:13:49 AM PDT

    •  "We Support the Troops." (2+ / 0-)
      Recommended by:
      Wildthumb, Calamity Jean

      One of the biggest lies in human history.

    •  I am sorry to hear about your father's experience (0+ / 0-)

      I don't understand the gaps in coverage that has some Vets going to TriCare and others to VA and others to ....

      I wish someone would explain that, and also compare how these systems differ in costs per person and how they are funded....

      Although I am solidly in the Single Payer camp and realize that so-called private insurance has myriad of its own funding problems, I do worry about the reliability of funding streams for universal, single payer programs. Budget cutters, like our esteemed Governor, go after the big ticket items to find "savings", and our single payer system will likely be the biggest of all.

      I wonder if similar budget cutting might have been at the root of your father's problems in obtaining the high quality care that he needed?

    •  You Lost Me At... (0+ / 0-)

      ...Bush and neocons.

      There have been complaints about vet care since Vietnam.  Probably before that too,  but Vietnam's the earliest I remember hearing.

      /tired of "Chimpy McBushitler" ties to every goddamn thought expressed on this web site

      Lookin' for an exit strategy, from stupidity, that is.

      by 4 Borders Pundit on Sat Jun 27, 2009 at 09:11:38 AM PDT

      [ Parent ]

  •  Thanks for this important diary. I am (3+ / 0-)
    Recommended by:
    Justina, Wildthumb, dewley notid

    a single-payer advocate and I hadn't even heard of Tricare before (I don't know anyone in the military). Great ammunition in the debate. This would make a great commercial if single-payer wasn't being totally dismissed by the corporate whores in congress.

  •  Not to mention the fastest growing group (1+ / 0-)
    Recommended by:

    in America signing on to Medicare.  This is Dr. Howard Dean's constant mantra, Amereica already has a single payopr sytem it is called Medicare.

    I would have thought all Americans would have wanted what the military has, what anyone over 65 (62) has if they want it, what all govenment and state employess have abd so on.

    By enlarging the pool you create a bargaining position for premiums in the private sector. this is exactly what the private companies are terrified of, that they will have to be comptetitive to match the existing public options already in play.

    And, that is absolutely anti-captalist, anti-American.  Shame.

  •  I've used Tricare for 30 years (3+ / 0-)

    (once known as Champus)

    Since I've never lived close to a military facility, I've always chosen my own providers. I remember one instance years ago when I needed to see a specialist and my doc mentioned that I may have a problem finding someone that accepted the medicare rate paid.  The referral ended up being in the next office building.

     I don't pay any premiums

     My deductible is $150.00 @ year

     My coverage is 80% of the allowable rate (set by Medicare)

    I've been screaming from the housetops for some time, "Why can't every one have the health insurance I do?!"

  •  Employees vs Self-employed (0+ / 0-)

    The DOD system relies on full-time employees to provide care. There are other systems in the US that have employee physicians, like Kaiser, but most US doctors are self-employed often in group practices. The countries with single payer programs have both, in England most physicians are government employees, in Canada most are not. The overwhelming majority of US physicians do not want to be government employees so it is hard to take the DOD system and extrapolate it here in the US. One of the challenges we have here in the US is that our physicians make 2-5 times what physicians in single payer systems earn. I don't have a problem with that, but it is one reason our system is so much more expensive. When the physicians are salaried government employees it is much easier to control compensation.

    "let's talk about that"

    by VClib on Sat Jun 27, 2009 at 08:18:55 AM PDT

    •  if patients need to be mindful of costs.. (0+ / 0-)

      doctors need to be mindful of who is paying their fees.

      One of the problems of employer based health insurance is that fees are hidden and for many plans, no one monitors or negotiates them. Companies don't negotiate that much since the insurance payments reduce their tax burden substantially. Workers don't monitor because their premiums are not taxed either. Finally, doctors apparently work with insurance companies to obtain favorable fees, and the system for paying fees favors those who do many procedures, thus creating incentives to do more procedures than necessary for good care. (Research apparently shows an inverse relationship between number of procedures and health outcomes.)

      If costs are hidden, it is very hard to find a leverage point to reduce them. In addition, some Docs have figured out how to take advantage of the current reimbursement systems. I'm sure you saw the recent New Yorker article that showed why McAllen TX had the second highest Medicare costs in the nation.

      Specialists sometimes assert they deserve high fees because of the cost of medical school. Some systems, like TriCare, reimburse Docs for training costs in return for service and hire Docs based on need. That approach may work more broadly in the civilian sector to ensure adequate supplies. Likewise, re-calibrating the reimbursement system will change incentives that produce too many highly specialized Docs and too few Family Practice Docs.

  •  August Consumer Reports featured Tricare (7+ / 0-)

    As part of a 7-page Viewpoint. Consumer Reports included the case of a retired vet and his wife on Tricare. In calling for a choice of a public insurance plan, the article said programs like Tricare "demonstrate that public insurance can work."

  •  Plus Medicare (1+ / 0-)
    Recommended by:

    I don['t count Medicade, 'cause that's a matter of private HMOs -- at least in IL.

    "I'm not opposed to all wars; I'm opposed to dumb wars." -- Obama in 2002

    by Frank Palmer on Sat Jun 27, 2009 at 08:44:42 AM PDT

  •  My 82 yr old mother just had knee replacement (1+ / 0-)
    Recommended by:
    polar bear

    with little out of pocket thanks to Tricare (and Medicare), she pays almost nothing for the medication she must take - so it's been a life saver for her.

    Of course, we've had to pay $135 / month to keep access to her primary care physician (it was either that or go out of business - he couldn't keep seeing 5,000 patients a month!), so the rest of it stinks.

    "Curiouser and curiouser..."

    by TechBob on Sat Jun 27, 2009 at 08:54:27 AM PDT

  •  as a retired DOD employee (1+ / 0-)
    Recommended by:

    I've worked with Tricare and, as you say, while it's not perfect (and AHLTA is as bad as you say it is!)it is a perfectly workable system. I always felt that it should have been offered to DOD civilian employees.

  •  Thanks! Hope you can get this out to as many (1+ / 0-)
    Recommended by:

    people as possible.  It would be nice if the media would recognize these facts, instead of fear mongering.

  •  Please disseminate this blog!! (1+ / 0-)
    Recommended by:

    Dear All,

    Please  post / send the link to this blog to everyone you know, to your legislators, and to newspaper and media outlets.

    We need to get the word out, to counteract the scare tactics of those fighting against single payer!

  •  Choosing your own doctors... (5+ / 0-)

    I am confused by those who use this as an excuse. My family has private insurance through my husband's employer. Its pretty good insurance..but we are still limited on what doctors we can choose unless we wish to pay a huge premium. My step-father has Medicare with a private AARP supplement and he could not choose his own doctors but had to wait for them to find one locally on his plan. I have a friend whose husband works for Disney and they provide great insurance but when her son was suffering from tick disorders, she had to fight to get him help from a good doctor specializing in this area because he was not on their plan.

    So even with private insurance, you are limited on what doctors you can choose. And often the doctors are removed from the private plans so you have to find a new doctor mid-stream. This is after you or your employer pays hundreds of dollars each month to the insurance company.

    The ability to obtain good medical care is important and the argument regarding choosing your own doctor doesn't even apply here since it doesn't appear to be any different in the current public systems than in the private. When my kids were still foster kids, we had to use medicaid for them since they did not qualify for our insurance. It was difficult to find doctors but not impossible..and its not any different with the private insurance. In the 'old' days, yes, most doctors took most private plans but that is not true anymore. This is an argument that really holds no water unless you have the best, most expensive private plan out there.

    •  you can choose your own doctor.... (2+ / 0-)
      Recommended by:
      Justina, boofdah

      on straight Medicare.  it doesn't sound like your step-father has straight Medicare.

      i have been able to choose any doctor when it comes to my healthcare needs as long as the doctor accepts Medicare.  that has included my general physician, a gastroenterologist, a nephrologist, a cardiologist and an inner ear surgeon.

      opting into a Medicare Advantage plan or supplemental may limit your options in choosing a physicians.  it is my understanding that these are privately managed arms of Medicare so they will have more say about your healthcare.  you may not pay as much out of pocket but i prefer being able to keep the doctors i have.  i just have to pay my 20%.

      I'm a blue drop in a red bucket.

      by blue drop on Sat Jun 27, 2009 at 10:54:41 AM PDT

      [ Parent ]

      •  Possibly (1+ / 0-)
        Recommended by:

        you can choose your own doctor on straight Medicare.  it doesn't sound like your step-father has straight Medicare.

        Possibly it was the AARP supplement that was restricting the choice of doctors.  

        Renewable energy brings national security.

        by Calamity Jean on Sun Jun 28, 2009 at 12:38:33 PM PDT

        [ Parent ]

  •  Politically...well... (0+ / 0-)

    Hopefully, you're aware of the politics and constituency involved here. We're not just talking about a single-payer system, but one that has a constituency that is protective of their system. If you wanted single payer you'd have to burn everything down--so to speak--and start from scratch.


    The definition of insanity is doing the same thing over and over and expecting different results

    by political beil on Sat Jun 27, 2009 at 11:45:22 AM PDT

  •  From my personal perspective, (4+ / 0-)
    Recommended by:
    Justina, fumie, dmh44, political beil

    the military provided the best healthcare service I have ever received in the USA. I have experienced the Canadian single payer systems and the US military's healthcare system is comparable. Right now and compared to most civilians, my private insurance is pretty close to Cadillac care on the private side. And it sucks compared to single payer.

    Minor notes: For myself, having been the soldier, there was absolutely ZERO for me to pay for any healthcare service or medication provided while I was serving. For the rest of my dependent family? They had small 10$ co-pays here and there for the same service.

    Most Americans really do not have a clue how bad their private insurance system is.

  •  t&r for catching lightening in a bottle! (1+ / 0-)
    Recommended by:

    first diary, incredibly relevant, on the rec list!


    we have more than one "single-payer" option: TRICARE and Medicare come to mind.

    Now, why can't our government not see that we already have two WORKING MODELS from which to choose and expand? (rhetorical question, the obvious answer is that it would be widely and vocally opposed by repubs, blue dogs, and the healthcare/pharma lobbies).

    "A time comes when silence is betrayal." ~ MLK, Jr...Where has CANDIDATE Obama gone?

    by liberaldemdave on Sat Jun 27, 2009 at 02:04:53 PM PDT

  •  I have Medicare/Tricare.... (0+ / 0-)

    having reached the requisite age for Medicare.  To date I have no complaints.

    Thus far I have only had to copay a VERY reasonable price for drugs plus my Medicare deducted from ss.  Tricare pays the 20% of Medicare approved amount that Medicare doesn't pay.

    The only problem in our area is a dearth of docs willing to take on new patients with Medicare as their primary.  I called a few thinking it would be nice to find a doc a little closer to home than my current one... some were closed to new patients...but others were just closed to Medicare patients.

  •  Question: does your total include those of us (0+ / 0-)

    with Medicare/Tricare?

  •  I'm a former Military Dependent (2+ / 0-)

    I grew up with healthcare that I think everyone should have. If I had a cold I could walk into the adolescent clinic and get treated. Free prescriptions. If I needed an x ray. I got it. When I needed anything it was free and didn't feel like the free clinic. I got to go to a real hospital, not a band-aid station. I had real doctors. My experience with civilian insurance has been less than stellar. Years ago I had a sinus infection, and ear infection and strep throat all at once. My primary care doctor wouldn't see me for two weeks despite my symptoms. I ended up in the emergency room and my insurance refused to cover it.

  •  As a prior participant (1+ / 0-)
    Recommended by:
    Calamity Jean

    in military healthcare, I vouch for everything the Doc has said.  My first child was born in a military hospital, my second in a civilian.  the difference was the bill.  My husband was a schoolteacher when the second was born, and I stayed home when the children were small, so paying for everything was hard to do.

    There was also a huge difference in getting care for the children, too - the difference in not worrying if you had enough in the bank to take the kid to the doctor or not.  In the military, if your kid is sick, you take him in.  Period.  There was always room, there was always time, and the medical care was just fine, thank you.

    It's so obvious it works.  It's so obvious that what we civilians who aren't on Medicare or Medicaid have does not - unless, of course, you're a fat cat CEO of one of the insurance robber barons.  Works fine for them.

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