sunset from behind the wire

sunset from behind the wire

Tuesday, May 9, 2017

The Common Thread

I was at a family event this past weekend that "Grandpa Carl" also attended. Carl served with UDT 11 (which became SEAL Team Five) roughly at the same time that I was born. He was with MacArthur doing beach recon at Inchon. Whenever we get together, there are discussions of the evolution of Naval Special Warfare. 

Grandpa Carl is a shirt-tail relative (my son-in-law's step-grandfather). There are a handful of old amphibians in the extended family tree and as is usually the case, he and I stood in the buffet line at my daughter's house, holding all of the other (starving) attendees up who wanted to assemble a sandwich, while we chatted. But they didn't want to tick off the old amphibians.

There are a lot of arcane things that old sailors talk about. The demise of Olongapo, P. I. (the devil lived in Olongapo - so no serious loss there), Laos during the secret war, and Thailand when it was wild. -- File it under "the mysterious East". Then there are the politics of SPECWAR, which is very personality driven. And I'm not even going to touch that in this blog.

One topic that came up was the fact that there are women serving afloat (not just nurses on a hospital ship) now. We lamented that the Shellback ceremony that documents the crossing of the Equator has been watered down to accommodate the fairer gender - the snowflakes and trannies, etc. 

There are still official entries indicating date, time, latitude and longitude recorded in individuals service record. So for the time being, King Neptune still holds court. Neither of us could predict how long that would last. 

Because he was at UDT11 and I was at ST5 (it was still the same old building at the Coronado Amphib Base - seaside when I was there), there were a lot of discussions of throwing people into the dip tank (where outboard motors were tested) for this or that promotion, transfer, somebody got married, etc. Then we discussed various people we knew who were killed or maimed in training accidents - helocasting, limp ducks gone wrong, parachute canopy failures and partial failures, screwing up the demo train, and many O2 hits on Draegers. Then there are the medical problems in the field - sometimes fatal and sometimes non fatal. I told of cutting out a hot appendix during an exercise in Korea when it was too socked in to do a casevac. He spoke of a medivac in Japan after one of his platoon fell off a cliff. It's not always a bullet or an IED that gets you.

And things have changed a lot since we worked there. Times always change, but there is a common thread that doesn't. 

Thoughts on National Health Care

America set up a single-payer health plan a long time ago. It's what the Democrat Party wants for the country. It's called the Veteran's Administration. While some VA offices worked well, the system as a whole was a train wreck. I don't think that there is anyone in Washington that would dispute it.

Reform of the VA (and its labor unions) has become a cliche for a lot of politicians. The current move is to allow patients who need care immediately to step out of the system and go to healthcare providers in the open market. 

However if all healthcare in America was a much larger version of the VA, there would not be an open market to resort to. Sure, there'd be some independent providers catering to elites and those wealthy enough to pay for them. But the really good healthcare would be far beyond the means of 95% of the nation.

Is that what we want?

I realize that the "free cheese"/"Obamaphone" crowd want somebody else to pay for their needs, and they ALL want Cadillac care, but that won't be happening in a country of 330 million people where 48% pay no federal income tax. 

The Market

The market for health insurance should look like the market for auto insurance or homeowner’s insurance: coverage you buy on your own, instead of depending on the government or your employer to buy it for you. Supplement that market with financial assistance for the poor and the chronically ill, and you’ll have achieved market-based universal coverage, along the lines of Switzerland’s health care system.

In order to make the U.S. health care system as free and efficient as Switzerland’s, we’d need to do four things: (1) establish a functioning individual health insurance market by replacing Obamacare’s exchanges; (2) gradually raise Medicare’s eligibility age for future retirees so that more people in their sixties would buy individual coverage that is subsidized where needed; (3) gradually migrate certain populations out of Medicaid and into the individual market; (4) address the grab-bag of other health-reform problems like medical malpractice, hospital consolidation, drug pricing, and veterans’ health care.

The American Health Care Act passed by the House was focused on problems (1) and (3). Legislative rules bar Republicans from using the reconciliation process to change Medicare. 

The Onion

Medicare is the elephant in the room that nobody wants to talk about. It's a $600 billion/year problem that is headed toward a trillion (see figures below). Because old people tend to vote, politicians don't want to bite the onion and change the eligibility age. But it needs to be nudged upward - possibly to 70, to make room for all of the younger (newly entitled) sick, those chronically dependent on others for their sustenance and so forth.

Ideally any government insurance/welfare program would deal with chronic and catastrophic problems, requiring patients to cover the cost of incidental doctor's visits and elective care. Catastrophic plans are far less expensive but that's where the greatest need is.

Though it may seem impossibly unfair to some of this blog's readers, discounts and preferential treatment for federally subsidized healthcare should be given to people who don't voluntarily engage in activities (smoking, abuse of alcohol and drugs, obesity, etc) that put themselves more at risk. This may sound cruel, but incentivizing good habits may increase lifespan, the quality of that life and the expense of medical care paid for by public dime.

At least that's how I see it.