For a while now I’ve been thinking about what a nationalized health care system would mean for the military community and, the truth is, I don’t have any answers, just a lot of predictions and questions.
When I was the health reporter for The Fayetteville Observer, I was definitely in favor of a nationalized health care systen. I argued many times that, because uninsured people get treatment for basic ailments via costly hospital emergency rooms and then often do not pay those bills and hospitals write off the losses, we already had a nationalized health care system. So it made sense to me that we should just organize it better.
But lately I’ve been thinking more about what it will mean to me as a military wife if the whole country has access to the same health care that we in the military community have. For starters, the access to and quality of health care for military dependents would almost certainly drop. The best thing about Tricare now is that it’s there and we don’t have a co-pay.
In exchange for that accessibility and affordability, we already have a hard time getting appointments for certain services. When my son was enrolled at Clark Clinic on-post I had to lie several times just to get him seen by a doctor. When I tried to make an appointment for a child I was often told that there were no appointments available and that the schedule for the next month had not yet been made. I was told to call back at a certain time on a certain day when the new schedule would be up to make an appointment. But when I tried to do that I would be on hold for an hour or more because everyone else was calling for an appointment then, too.
So I just started making appointments for myself with a family doctor and then playing dumb when I arrived and saying that someone must have messed up and made the appointment for me instead of for my son. Since we were already there and already had an appointment slot, the doctors were always willing to see my son. Nowadays he and I both go to civilian providers off-post. We pay a little out of pocket but have no trouble being seen.
However, a lot of civilian doctors choose to not accept Tricare, Medicare or Medicaid because these government payor plans reimburse the doctors at a lower rate. Doctors don’t even break even on some services with what they receive from the government payors. Throw a couple of hundred million more people into the system and you’ll find fewer people wanting to be doctors, more “boutique” doctors who choose to treat only people who pay in cash and an even more overburdened health care system. It will take longer to get an appointment and the doctors available to the masses will likely be those who didn’t finish in the top half of their medical school classes.
When I had a miscarriage almost two years ago it took eight months for me to get an appointment with an OB/GYN on-post so that I could find out why I had lost the baby. My baby was already dead and I wasn’t pregnant anymore, so I wasn’t a priority. By the time I was seen there was no way a doctor could have determined why I miscarried. Fortunately, I was able to get pregnant again. Now imagine that same scenario in a health care system that is even more crowded and less profitable for providers. It’s a scary thought.
A nationalized system would definitely help the millions of Americans who cannot afford any type of health care, so I feel a little guilty and greedy for arguing against it. And it is obvious that the country’s current system of employer-based insurance is broken and needs to be fixed.
But when I reported on healthcare, I interviewed a lot of people who entered military service, re-enlisted or returned after getting out because someone in their family had significant health problems and needed the insurance to pay for often costly and frequent services. If there was a national health care system that provided the same access and quality of care available to members of the military, there would be no incentive for many of the people in the military now to stay in or for future service members to choose to have a military career. Enlistments would almost certainly fall during this precarious time for national security. We would be more vulnerable to terrorist attacks and the government would have to find another way to entice people into military service or would have to re-instate the draft. A column in the New York Times in June addressed this issue at length.
Finally, nationalized health care just seems kind of unfair to me, personally. My husband and I have made a lot of sacrifices for this country and one of the ways we have been compensated for all that we’ve given is with the promise of available and affordable health care. If the same system is made available to all the people in the country, people who have not made these same sacrifices, then I think the government should provide some other form of compensation to troops to make up for the difference. Replacing our current health care system with one that would most likely be of poorer quality would essentially be an enormous pay cut to service members during a time of unprecedented demands being made on troops and their families.
In the military community we are often reminded that, though there is a significant gap between what service members are paid and what they would earn in the civilian world, the shortfall is made up for with all of the other benefits we receive. The most significant of these benefits is health care. No one is going to sign up for or stay in the military just so they can shop at the PX and the Commissary and patriotism will only take us so far for so long.
Some sort of new system for the uninsured is necessary. Maybe we just need to expand the parameters of Medicaid so that more people are covered. I’m not an expert on Medicaid, so I don’t know. But allowing everyone in the U.S. access to the same system now available to military families would almost certainly be more costly to the country, both in terms of dollars spent and security lost.