Friday, March 16, 2007

TANSTAAFL

Well, the grout is sealed and between that, planting my palm tree and cleaning the garage I'm thinking about this Walter Reed problem.

I'd like to qualify what I'm about to say with full disclosure: I have no idea how real hospitals are run. What you are about to read is largely anecdotal, constructed of my own opinions and philosophy... kind of like everything else I write.

Since I earned my commission in 1998, I've been part of the military heath care system. I've handled the inefficiencies and frustrations by not being sick, though that doesn't always work. I've been lucky enough to never have been hospitalized for anything, but Red started dealing with them during her pregnancy and now Jack's got pediatric appointments. The bureaucracy is no different from any other administrative machine the Navy concocts, as far as I'm concerned.

There is a running gag that a corpsman treats everything with Motrin. To be fair, they're 800mg Motrin tablets, so they'll cure what ails you, as long as it's not a sucking chest wound or something. I've had a corpsman operate on an ingrown toenail during a deployment, but it grew back just as bad. Sick call is quite different from the type of treatment you get if you go to an actual Naval Hospital. When I did, a doctor took care of that toenail and it hasn't bothered me since.

Of the two Naval Hospitals I remember dealing with, only one had a campus full of old buildings, but there weren't any patients living in them as far as I knew. I suspect there are many military hospitals like this - they've been updated and remodeled, but still have old buildings that have not yet been taken care of and that aren't normally used. Heck, most military bases are like that.

I imagine a place like Walter Reed is bursting at the seams and the staff are trying their best to keep up with demand.

From the original Washington Post article:
Vera Heron spent 15 frustrating months living on post to help care for her son. "It just absolutely took forever to get anything done," Heron said. "They do the paperwork, they lose the paperwork. Then they have to redo the paperwork. You are talking about guys and girls whose lives are disrupted for the rest of their lives, and they don't put any priority on it."
Welcome to socialized medicine, Mrs. Heron. I've lost count of the number of times I've needed to reproduce documentation that's been lost by administrators, updated information that was subsequently not updated in the "system" or changed to something entirely different from the information I gave them. It's frustrating and a part of life when you allow the government control of it. What I've described here are minor annoyances - the military health care system only has to provide for members are retirees of the U.S. military. Imagine the magnitude of problems a system required to provide for 300 million Americans would have. Universal health care, indeed.

Now, I've received decent care most of the time. Jack's pediatric visits go well, though we've had issues with his doctor being available and have been seeing a nurse practitioner alternately. The hospital and the doctor keep telling us that he doesn't need a nine-month "well baby" appointment (whatever that is, Red was expecting to have one), while the nurse practitioner says that he should have one. Well, there's nothing wrong with the boy, but I'll go along with having one.

When Red was pregnant, she had to see all the pre-natal physicians because most of them were being deployed to Iraq and there was no telling which one would be available when she had the baby. As it turned out, a civilian doctor at the Newport Hospital delivered Jack and was there while Red was in labor, the Navy doctor got there right when she was ready to go into the delivery room.

Based on my experience, I'm inclined to believe Lt. Gen. Kevin C. Kiley, chief of the Army Medical Command:
While acknowledging "pretty distressing" conditions in some rooms at Building 18, Kiley said the problems were neither widespread nor symptoms of a system that allows soldiers to languish. The building is not "emblematic of a process of Walter Reed that has abandoned soldiers and their families," said Kiley, who was commander at the hospital before becoming surgeon general in 2004.

"I want to reset the thinking . . .," Kiley said. "While we have some issues here, this is not a horrific, catastrophic failure at Walter Reed."


I have no idea how this compares to private medicine, since this is the only experience I have. I'd venture to assume that other than being able to pick your doctor, and being much better at managing processes and capacity, it's probably not much different.

The key is process and capacity management and the ability (or lack thereof) to handle it. I would argue that a privately run hospital, operating as a business would have the ability to use cash flow to add to capacity and invest in process improvement as it benefits the hospital. Military hospitals are run using tax dollars, and let me tell you, things are tough all over, if you're not on the ground in a combat zone. From the second story in the Washington Post series:
The conflict in Iraq has hatched a virtual town of desperation and dysfunction, clinging to the pilings of Walter Reed. The wounded are socked away for months and years in random buildings and barracks in and around this military post.

The luckiest stay at Mologne House, a four-story hotel on a grassy slope behind the hospital. Mologne House opened 10 years ago as a short-term lodging facility for military personnel, retirees and their family members. Then came Sept. 11 and five years of sustained warfare. Now, the silver walkers of retired generals convalescing from hip surgery have been replaced by prosthetics propped against Xbox games and Jessica Simpson posters smiling down on brain-rattled grunts.
The point is that Walter Reed ran out of capacity to accommodate demand 10 years ago, and has been deteriorating ever since. Now that its been put on the chopping block by BRAC, do you suppose it was on the top of the list for expenditure of your tax dollars? Not until the Washington Post story. None of the repair that Building 18 needs are free, just like none of the health care my family and I receive is free. The money has to come from somewhere.

I'm not defending anyone involved here. I think the conditions that some of the soldiers and marines lived in were deplorable and the fact that it took the Washington Post, the resignation of the Secretary of Army and... was there a General?... just ridiculous. If there's one thing I've learned in my eight-and-a-half years in the military, it's that if you make a mistake, or if you know of a problem, do not be the senior man with a secret. Tell your boss, try to resolve it, have a plan. It's clear that someone did not follow that rule.

More:
Michelle Malkin: Milbloggers on WaPo Series: Broken System, Biased Report
Bloviating Zeppelin: What We Want
Smash @ Michelle Malkin: Healing Walter Reed - The Rest of the Story
BlackFive @ Michelle Malkin: @WR

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2 Comments:

Blogger Bloviating Zeppelin bloody well said...

The civilian equivalent of the military system is Kaiser. In Fornicalia, where I live, a massive amount of persons belong to Kaiser Permanente -- yes, the same Henry Kaiser who whacked out all those Liberty Ships in 2.35 seconds when mandated.

I haven't been that terribly sick yet, under the Kaiser system, and I can say I haven't died of my cancers. They've generally treated me kinda acceptably. But I hear and read of countless horror stories revolving around Kaiser. I guess I'll have to deal with that when I contract a massive mycardial infarction which, I sense, is closer than I care to acknowledge. In any event, I'd rather have ONE vertical incision in my chest than the "Y" - incision. If you get my drift.

On the other hand, I was absolutely disgusted with the way Walter Reed treats our military personnel and posted about it here.

How our VA system treats its veterans is simply and completely UNACCEPTABLE.

BZ

17 March, 2007 21:05  
Blogger Gyrobo bloody well said...

The problem doesn't seem to be the fact that the government is running the facility, but that the people in charge have no idea how to run the thing.

Whatever happened to our lunar colonies?! Where are they?!

18 March, 2007 23:03  

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