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Health & Wellness

We Already Have a Popular Single-Payer Health Care System -- It's for Active Military and Veterans

By Chris Kromm, Facing South. Posted July 2, 2009.


Oddly the states with the most people enrolled are down South -- where political leadership has been most opposed to single-payer.
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In this year's health reform debate, congressional Democrats quickly took proposals for a single-payer system off the table, claiming it was "unrealistic."

But more than 9 million people in the U.S. have already signed on to a single-payer system that has proved both workable and popular: TRICARE, the Department of Defense's program for active-duty military and retirees.

Even more interesting: According to a Facing South analysis, nearly half of TRICARE beneficiaries live in the South -- states where congressional leadership has been most vocal in opposing public involvement in health care.

Last week, a top-rated diary at DailyKos by a person claiming to be "an active duty obstetrician/ gynecologist in a major medical facility on the East Coast" noted that:

9.2 million active-duty and retired uniformed service member and their families receive their health care from the federal government. My family and I receive free health care from the federal government ...  I am struck however that nobody has brought up the simple fact that the government already provides free health care in a single-payer model to over 9 million of its population.

 

I decided to look into where TRICARE beneficiaries were located. According to my analysis of TRICARE data, 47 percent of the 9.2 million using TRICARE live in 13 Southern states:

TRICARE South.jpg

Overall, 6 of the 10 states with highest number of TRICARE beneficiaries are in the South. This makes sense given the high number of military bases in Southern states, as well as the concentration of active-duty and retired military in states like Virginia.

The high Southern enrollment in government-run TRICARE, where the military pays private doctors in a single-payer system, seems at odds with the vocal opposition of Southern lawmakers to anything smacking of public involvement in health care.

South Carolina:

The Palmetto State has the eighth-highest TRICARE enrollment in the nation, nearly a quarter-million people. But South Carolina's overall population ranks only 24th nationally -- meaning that the share of South Carolinians using TRICARE's single-payer government option is one of the largest in the country.

Contrast TRICARE's popularity in South Carolina with these words last week from Sen. Jim DeMint, R-S.C., who has led the Republican Party's attempts to torpedo health proposals that involve the government: 

"[Democrats] think we're stupid," said DeMint. "They think that you don't know that government does not work well, that the same people who cleaned up after Hurricane Katrina are the ones who can really run our health care system with that personal touch that we all want ... They're talking about a government plan that can do things that no government plan has ever done."

 

The 233,725 people who chose to use TRICARE in DeMint's home state probably disagree.


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See more stories tagged with: health care, single payer

Chris Kromm works with Southern Exposure magazine and the Institute for Southern Studies in Durham, N.C.

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To keep the war machine going, locking single payer to the military is the plan.
Posted by: maxpayne on Jul 2, 2009 3:29 AM   
Current rating: 4    [1 = poor; 5 = excellent]
And with pols like these, you don't need the Taliban.

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We Need To Raise the Visibility/Volume on This
Posted by: drricklippin on Jul 2, 2009 3:34 AM   
Current rating: 2    [1 = poor; 5 = excellent]
Thanks- What you say is true. Yet we hear little about it?

However TRICARE,like all health care systems, is not without its problems.

Also active duty miltary often get their healthcare directly from miltary treatment facilities located on miltary installations.

Still we need to raise the visibity and volume of what you are reporting here.

Dr. Rick Lippin
Southampton,Pa

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What about members of Congress?
Posted by: Dominic369 on Jul 2, 2009 5:20 AM   
Current rating: 5    [1 = poor; 5 = excellent]
What program are members of Congress covered under? I've always been bothered knowing that they have favored treatment themselves [not just for health care] and that favored treatment insulates them from the experience of the rest of us.

I could be wrong. Yet that is my perception.

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» Rolls Royce Plan Posted by: james108
Head Cornerstone
Posted by: james108 on Jul 2, 2009 6:18 AM   
Current rating: 4    [1 = poor; 5 = excellent]
No public health insurance or single payer system will work without a reasonable fee schedule.

If we did a fee schedule, we'd all be better off whether we had insurance or not.

Providers cannot continue to charge individuals many times the costs of services for life or death situations, even if they plan to negotiate later or just use it for a write off.

One reason I've heard is that the medicare fee schedule is too low, so they have to raise prices for everybody else. That's also based on overcharging everyone else and exaggerating losses though.

I say it as sure as night and day. If providers can charge unprotected individuals whatever they want for life and death situations, insurance will continue to be expensive for everybody else, whether it's a public health option with hidden expenses taxed out of us, private options or even a single payer system. My hope of a single payer system is it actually addresses the fee schedule and gouging for EVERYONE. As long as they can fleece other people, and we lack collective bargaining power as a people, even tricare members can be SOL.

1. UPMC rejection of Tricare Patients.

2. There's help finding a doctor that will accept Tricare though.

3. TC trying to deal with funding like everyone else.

Our greedy corporate run system has us without a clue what health care should even cost anymore. Life or death situations should not always be subject to supply and demand fleecing.

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It's About Payoffs, Not Principles
Posted by: FoonTheElder on Jul 2, 2009 6:42 AM   
Current rating: 5    [1 = poor; 5 = excellent]
The politicians (especially Southern ones) aren't really against single payer health care, they are against saying no to the special interests that pay them. This BS about individual rights and deficits would disappear if there were no insurance companies and other price gougers paying for their votes.

They seem to have no problem with deficits when the money is spent on projects in their states. They have no problem with huge wastes of billions of dollars if they are receiving campaign contributions to vote for that waste.

The health care debate, if you can call it that, is just another example of why our political system does not work for the majority of Americans. It was set up to benefit the wealthy and influetial people of the country and continues to do.

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Sorry TRICARE is hated
Posted by: muzunguhowru on Jul 2, 2009 7:09 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Sorry folks, but I have a little history with TRICARE. Despite having the widest scope of benefits of any health plan in the world and lowest share of cost..actually no share of cost for active duty & their family members TRICARE should get rave reviews right?

Guess what?

Beneficiaries hate it:
1. Because it forces them to go to military hospitals first for care where the care is discontinuous (different doc every time despite the titular assignment of a "primary care provider") and quality is generally viewed as inferior even when it's really not.

2. There are utilization controls that although quite lax compared to a civilian HMO result in some services and procedures being limited. In the the "I'm a hero & you owe me" entitlement mentality of today's military (even those that have not and will never see combat) this is an affront. Ironically in my personal experience it was the combat vets and particularly the wounded who were the least demanding.

Providers hate it because:
1. They are reluctant to see them because of low reimbursement and the difficulty of working with poorly compliant demanding military families

It is a cost management disaster because every time someone gets told know they write to their congressman and get a new benefit legislated into existence. DOD maintains an office in Aurora Colorado that does nothing but churn out change orders at the rate of 1-2 a week. Virtually every change raises program cost. For all the outrage about the F22 and wasteful procurement by the military, DOD's largest single expenditure will be on health Care

Who wins? the Contractors: Humana, Healthnet and TRIwest. Every change order rings the cash register and because controlling costs (i.e. occasionally saying )brings down the wrath of congress.. they make little effort to do it. They save that energy for their commercial health plans.

To be fair TRICARE gets a whole lot of folks cared for and pretty darned well. There are lessons that can be learned from TRICARE but it's hardly the model

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» RE: Where do you start? Posted by: kettleblack
» a fee schedule Posted by: james108
» RE: Where do you start? Posted by: seaoftears
Ever Visited a VA Hospital?
Posted by: lsmart on Jul 2, 2009 7:24 AM   
Current rating: 3    [1 = poor; 5 = excellent]
VA hospitals are filthy & disgusting. Veterans have to wait months and months to get treatment, get lost in the system, and some die because they haven't been treated.

If this is what the new healthcare plan means, I'm certainly not looking forward to it.

The UK may have a better system to glean from, but the US has yet to prove its prowess.

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» true Posted by: Gabba_Gabba_Hey
» reality Posted by: james108
Patently false jibber jabber.
Posted by: ABetterFuture on Jul 2, 2009 8:30 AM   
Current rating: 1    [1 = poor; 5 = excellent]
No, the military health system is NOT single payer. It is funded by Americans and American companies that pay taxes, or by our Congress assuming debt that these people and institutions are supposed to pay off...someday.

Taxpayers: the word is plural, not singular.

Learn English first and the source of federal funds second. Then work on ways to make your gimme, gimme, gimme-limited lexicon sound like anything but.

"Single payer".

What utter bullshattery.

Pfft.

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Lies.....
Posted by: Spiritgirl on Jul 2, 2009 8:52 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
The Senators that are blocking care need to be pimp-slapped! These people are aware that they are the ones that have installed incompetent political operatives in charge of many of the government agencies whose sole purpose has been to undermine the very agencies they are in control of! Congress has taken many of the "teeth" out of these agencies, and underfunded many others in their attempt to portray "government as non functioning"!

I think that if more people really understood that their Congress person isn't really representing "their" interest, but the interest of the Corporate oligarchy they would make the connection between why agencies are not able to regulate big polluters, really level fines on those businesses that hire illegal immigrants, regulate and inspect Agri-business, really check into the claims of Big PHARMA and the drugs they produce, really regulate BIG BANKS, truly protect our wildlife and national parks, and why when there is a disaster we no longer can count on FEMA!!!

We are told that private Health-Insurance is the way to go! What we are not aware of is how many people that thought they had health insurance got sick, and ended up going into bankruptcy! What we are not aware of is how many people are denied treatment, because some bean-counter at the insurance company - denied you the care you needed! We are not aware of how much money the "Industry" has supplied to the Candidates (you pick a name), and the quid pro quo involved! This fight about health care and the obstructionists in Congress that are blocking the path of true reform need to be outed NOW!

Americans have been duped and deceived! We believe that we have a "democracy and choice", yet the truth is we do not! What we have are the choices that the Corporate Oligarchy will allow! Maybe now is the time to demand true public financing of elections and term limits for Congress, because until we can get the private money out of Congress, we cannot claim that "WE HAVE A DEMOCRACY"!!!

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As a military dependant
Posted by: willbjett on Jul 2, 2009 9:38 AM   
Current rating: 5    [1 = poor; 5 = excellent]
I never had to worry about health care until I was 21. I was well taken care of, including fixing a double compound fracture. We had great doctors.

If it's not so great these days, maybe there has been some serious neglect over the last 8 years. I don't know. For me though, it was a sample of how single payer works.

Now, I'm stuck in a marriage I don't want because she'd lose coverage if I divorced and I can't afford it. If I lose my job, I can no longer afford health insurance. Really, having insurance companies hauling in the money and employers with so much control over your life is not the way to go.

People who are "happy" with their current insurance should consider how happy they'd be with it if they got laid off.

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As a Navy retiree
Posted by: willymack on Jul 2, 2009 10:05 AM   
Current rating: 5    [1 = poor; 5 = excellent]
And a Vietnam vet, I'm entitled to Tricare for Life, and access to VA hospitals.
As for the latter, this is based on income "catagories" from one to eight, with one being at the front of the line, and eight the rear. I'm an eight, so, needless to say, I've never used their services.
I'm also covered through Medicare and my wife's government health care plan.
I had to be treated for prostate cancer at age 62 (before Medicare), and used the Cancer Center at Klamath Falls, Or.
The entire range of treatment would've cost me $44,000 if I had to pay for it myself, and would have certainly forced me into bankrupcy. As it was my share of the cost was $1800, which I still consider steep, but a damn sight better than 44K.
The facility and quality of treatment was first-rate,and I have no complaints.
This is the way it should be for EVERYBODY, and is a measure of the criminal aspect of the "health care" rackets. Enough, already; let's get good health care for everyone.

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Know-nothings
Posted by: Ahimsa on Jul 2, 2009 1:48 PM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Ignorance and adherence to rigid dogmas will do it for ya.

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The VA hospitals are doing well
Posted by: Gabba_Gabba_Hey on Jul 2, 2009 3:53 PM   
Current rating: 3    [1 = poor; 5 = excellent]
As one of the 83% of satisfied patients cited below, I disagree with a poster above about the VA, which is much improved and doing a good job in most respects. AlterNet ran a story on 8/20/07 (by Ezra Klein of the American Prospect - excerpt):

Over the last decade or two, the VHA [Veterans Health Admin.] system has become a worldwide leader in both the adoption and the invention of health-information technology, and it has leveraged its innovations into quantifiable gains in quality of care. As Harvard's Kennedy School noted when awarding the VHA its prestigious Innovations in American Government prize:

[The] VHA's complete adoption of electronic health records and performance measures have resulted in high-quality, low-cost health care with high patient satisfaction. A recent RAND study found that VHA outperforms all other sectors of American health care across the spectrum of 294 measures of quality in disease prevention and treatment. For six straight years, VHA has led private-sector health care in the independent American Customer Satisfaction Index.

Indeed, the VHA's lead in care quality isn't disputed. A New England Journal of Medicine study from 2003 compared the VHA with fee-for-service Medicare on 11 measures of quality. The VHA came out "significantly better" on every single one. The Annals of Internal Medicine pitted the VHA against an array of managed-care systems to see which offered the best treatment for diabetics. The VHA triumphed in all seven of the tested metrics. The National Committee for Quality Assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments. As Phillip Longman, the author of Best Care Anywhere, a book chronicling the VHA's remarkable transformation, explains: "Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals."

What makes this such an explosive story is that the VHA is a truly socialized medical system. The unquestioned leader in American health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction. Eighty-three percent of VHA hospital patients say they are satisfied with their care, 69 percent report being seen within 20 minutes of scheduled appointments, and 93 percent see a specialist within 30 days.

Critics will say that the VHA is not significantly cheaper than other American health care, but that's misleading. In fact, the VHA is also proving far better than the private sector at controlling costs. As Longman explains, "Veterans enrolled in [the VHA] are, as a group, older, sicker, poorer, and more prone to mental illness, homelessness, and substance abuse than the population as a whole. Half of all VHA enrollees are over age 65. More than a third smoke. One in five veterans has diabetes, compared with one in 14 U.S. residents in general." Yet the VHA's spending per patient in 2004 was $540 less than the national average, and the average American is healthier and younger (the nation includes children; the VHA doesn't).

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Convoluted thoughts
Posted by: GAYF on Jul 3, 2009 9:38 AM   
Current rating: 2    [1 = poor; 5 = excellent]
I am the former wife of a career military man and have access to Tricare. I have a theory that allows me to understand the inability to think coherently, critically and compassionately by the people most people elect to public office. The system is a round-robin of continuous ignorance: communities elect schoolboard members, mayors, councilpersons, etc. who have no clue. These public "officials" set up and control schools and universities that perpetuate the same ignorance. Those few students who do think have the hardest time in these institutions. Those who finish, go into the community, work at "respectable" occupations, get elected to school boards, as mayors, representative...YIKES--a closed loop of ignorance. The influences on these drones are corporate types with one idea--greed.

The creationists concept rules. This process makes intelligent thought and action impossible. The only hope is evolution--quickly, please.

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sex
Posted by: sex on Jul 6, 2009 2:52 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
TALKING SENSIBLE.
Posted by: ruruben on Jul 7, 2009 1:46 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
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