The American Spectator

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Such simple estimates suggest to a lot of persons: Why not just give eligible veterans and their families vouchers for the same health insurance coverage available to federal employees? It appears this would be more cost-effective than maintaining the archaic and not-user-friendly VA health care system. The veterans would be free to seek care anywhere they wished. Patient satisfaction would increase. Quality of care would depend on where the patient decided to go. But he would be free to go where the quality (as he perceived it) was acceptable.

Note that I am not advocating doing away with the VA, just that part of it dealing with providing health care. The other half of the VA budget involves administering death and disability benefits to veterans and their families and providing and maintaining military cemeteries. The VA would continue its work in these areas.

What would happen to all the health care and administrative personnel currently employed in the VA system? Shortages exist for almost all health care personnel nationwide. No group of professionals is better suited to find alternative employment within a matter of weeks. Definitely do not worry about this.

Second topic: The mission of military hospitals such as Walter Reed is separate and distinct from anything found in the private health care world. The scope of what they do includes providing specialized mobile care in war zones and patient transport in similar circumstances. There is nothing remotely like it in civilian medicine. Of course military hospitals need to survive and evolve as they are doing.

But active-duty patients, for example those with severe neurological injuries, once back in the United States, should be allowed to avail themselves of the best care around. Especially when the military health care system is overwhelmed, as it is now. They could easily (but for bureaucratic, authoritarian, and turf considerations) be treated in one of several superb medical centers located in the Baltimore-Washington area or nearby in New York or Boston. Or for that matter, anywhere in the country. There is no reason why such an injured patient on active duty could not be given a similar "voucher" for care outside the military hospital system, one similar to that which I have suggested above for the veteran patient.

In fact, doesn't the VA have such a system in place already in the form of TRICARE? Doesn't TRICARE pay for treatment in a civilian setting when such care is unavailable or unsuitable in the VA system? Well, why not make a TRICARE for active duty personnel? This is essentially what I have in mind.

The first impression many would have of such a notion is that it would be the demise of military hospitals and that it would be a disgrace. Quite the opposite: It would allow a lot of cross-connecting between military hospitals and excellent civilian medical centers, and there would be a lot of informal learning going in both directions. It would alleviate the shortage of military physicians. It would allow the military hospital to focus more on the specialized things that make it unique, and allow the civilian hospital do what it does best: Deliver complex care. In medicine, this specialization of mission is the name of the game.

p>We should face the reality that health care is a highly modernized, extremely specialized, technology-intensive, rapidly changing, and competitive field. It requires constant, ongoing adaptation to change. It is therefore unrealistic to expect isolated, antiquated and highly bureaucratized divisions of the federal government to do this mission well, in either the active duty (military hospitals) or civilian (VA) settings. This in spite of their best efforts to do so. br> -- Francis Dillon, MD br> Indianapolis, Indiana /p>

May I respectfully request that Mr. Reiland be assigned to write an article of equal or greater detail and specificity on this particular problem once per week, every week, until at least a small dent is made in the problem? This problem has been with us since at least WWII. It would have been a problem before, but in 1919 our society did not think that government had the duty to our wounded warriors that we demand today.

This is a problem of bureaucracy, and those that "demand" government provided health care and/or health insurance better hope that they do NOT get what they claim to want. Regardless, whatever the problem, it must be fixed once and for all, right now. This is another "Katrina," and it is also on the watch of George Bush. He needs to worry more about getting this fixed and less about whether some Mexican national is allowed to come to America illegally, get on welfare, sire some kids to be instant citizens, and accept a blanket amnesty so that they can register and vote for Democrats.

I would, however, like to suggest that there is another source of the problem. On Sept. 12, 2001, George Bush chose NOT to put the American citizenry on a war time footing. He told us to just go about our business and he would handle everything. So we have. As a result, taxes have been cut and the military budget is now below the budgets of the 1970s and '80s in terms of real inflation adjusted dollars, and in terms of percentage of the overall discretionary budget. Now I am always for tax cuts as a means of downsizing government, in every area except national defense and the military.

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