Academic journal article The Hastings Center Report

The U.S. Department of Medicine

Academic journal article The Hastings Center Report

The U.S. Department of Medicine

Article excerpt

To the Editor: I was amused by Daniel Callahan's "proposal" to privatize the Department of Defense (November-December 2006) and its implication for universal health care, quality of care, and economic outcomes. Actually, DOD would be the model if the United States goes to a single-payer "universal" health care system. With our new "Department of Medicine" we could look forward to having many copies of thousand-dollar toilet seats in every clinic and hospital. We would have resource allocation by Congressional flat (a.k.a. earmark). We would have a fickle procurement system that runs off all competitors, degrades to a single supplier with requisite skills to apply and conform to federal policies, and eventually works on a cost plus basis. Finally, the theoretical administrative savings from a single party payer model will be just theoretical given the bureaucratic need to "fine tune" multiple layers of service and oversight, and the redundant and unclear chains of command that are prevalent in most government agencies, including the DOD. The federal tax code would be the model for administrative simplicity in the DOM.

In terms of quality of care, the DOD has experience with providing a universal health care system. From approximately the post-World War II era until the early1980s it promised (and provided) cradle (newborn dependents of active duty military members) to grave (retirees) universal health care at "no cost" to the members. This became too expensive (generals and admirals like to spend money on buying and operating tanks, planes, and boats, not hospitals and clinics). The DOD then reneged on this promise, with the support of Congress and the judiciary. The current plan in the DOD is to farm out as much health care as it can for active duty, dependents, and retirees at below-cost rates to the private sector. The private sector is faced with either subsidizing this care from other sources, reducing quality of service for either these or all of their patients, or refusing to accept DOD-sponsored patients and risk being seen as unpatriotic.

There would, however, be a boon to the bioethics community from our new DOM. There would be a need for legions of bioethicists to explain that for reasons of "social justice," our "universal" health care system was providing for all the medical needs of some of the population, while others would not have their medical needs addressed because they have an unpopular or expensive illness; because there was no funding to provide the service required in a timely fashion (in other words, the queue where you never quite make it to the front of the line); or because some citizens are just less equal than others. …

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