Health care. Is this issue just a shoving contest between leviathan monetary interests, or are there some real numbers and experiences to work from, and most of all some image or meme of decency and kindness and humaneness that can trump the money stuff?
I don't know the "answer" to getting universal, open access health care to everyone in America. I work as a nurse in a rehab doctors' office, so I get to see a little of the complexity, wastefulness and unfairness of the present hodge-podge that bureaucrats and greedy insurers and for-profit instititions produce, every day.
I am also a Viet vet with a small disability, and thus qualify for health care through the VA system of clinics and hospitals. My sense is that the VA system is a very efficient model,
even though like any human-managed system, particularly one open to fairly direct political manipulation, it has its problems. My sense, without having enough time myself to really study the subject, is that the VA model would, if widely extended, prove to be one hell of a lot cheaper than Medicare as implemented currently and probably even than the mixed plans under consideration. "The economy" needs help, and if the POTUS is right that "fixing health care costs" is a linchpin of "fixing the economy," I would hope this model is getting some serious look-see and consideration. It sure doesn’t look to me like an "opt-in public option," once it has run the sausage-making gamut in Congress and past the phalanxes of lobbyists for the various interests, would be producing ANY savings – much the opposite, human greed being what it is.
And as an aside, why do people now go to Venezuela and other foreign lands, with the travel costs involved, to get the inexpensive care they don’t "qualify" for and can’t afford in the US?
VA facilities generally have a healthy ratio of providers and staff to patients. The pay for nurses and the various benefits like vacation and such seem to keep people in place for long careers (argue that how you will; the staff underpay and overwork, and consequent poor care and medical errors rates in private facilities, speak their own truths.) The doctors may not be the brightest of the bright, and English is often a second language (like in most present-public-system facilities, of course.) And they are on salary, not having to fart around with negotiating contracts with dozens to hundreds of private insurers, and worrying about the latest cuts to Medicare and Medicaid reimbursement made to allow "us" to buy a shitload of F-22 and F-37 Flying Black Holes and such.
The VA has had its share of problems with some of its computer systems (acquired through the usual Beltway Bandit scamming processes) but it has a fully-functioning if not geeky-whizbang "Electronic Medical Record" system that lets every provider know what meds and treatments and history go along with every patient that's seen. The VA has also had its share of problems with how badly damaged returning vets have been treated (horribly, in may instances), but that seems largely to have been thanks to the war-wimp, chicken-hawk SOB neocons who went on and on about stay-the-course and support-our-troops while playing tin soldier and robbing the public blind ... but don't let me get started on that subject.
I get to hear every day about and from people who can't get care because they either don't have "good" insurance or are in the middle of some forced transition from one carrier to another under our capitalist-socialism Medicare system. Which of course is the product of private for-profit insurers lobbying very profitable niches for themselves in the bosom of the taxpayer-funded "National-socialized-medicine" Medicare program.
Is this chance to show a human face to the rest of the world, where health care is less expensive, generally as good, and usually more accessible than it is here, going to devolve to an argument about "relative efficiency" and "marginal costs?"
If so, my bet is that the VA system's economics would show a significant, maybe even massively significant savings over the present system and the interest- (rather than wisdom-) driven proposed changes that "everyone assumes" are what "the art of the possible" has to be based on. VA can negotiate drug prices. It can refer people with needs for specialized treatment out to expert resources. The VA does a lot of "wellness teaching" and while it's hard to prove the negative, my bet is that a lot of individual health disasters are avoided by that fully institutionalized emphasis. There’s loads of other advantages there, where some people, starting with a simple "mission" to provide good health care to their patients, without the burden of "making a profit," have done things that the rest of the "health care" (actually "illness-treating and money-making") system have not.
It ain't perfect, but from the view of a person "in the business" and actually having received "care" from the private-pay side as well as through the VA, my vote is for the VA as a model every time.