NOVEMBER 27, 2010 11:21PM

Without health care, the U.S. will lose the perpetual war

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Figure 1



Health care reform (and its potential repeal) is back on the front page. The most recent, and unfortunate, news about health care shows that there are now 50,000,000 people in America who don't have any medical insurance at all. One can only wonder how many of these people will end up dying because they can't afford to get help.

A few weeks ago I watched the season finale of Real Time with Bill Maher. That night one of Maher's guests was Rep. Joe Sestak (D-PA), a former US Navy Vice Admiral and the highest-ranking former military officer to serve in Congress, who was sadly defeated in the latest Democrat debacle (the 2010 mid-term election). This was the first time I heard of this guy, but he made some points that really hit home. I'd like to share them with you here.

As expected, the possibility of the current version of the health care law being repealed was a major topic of the show. During the discussion, Rep. Sestak mentioned something that I've touched on in my posts on health care reform (see here, and here, among others), but in a way that I hadn't thought of before.

It's common knowledge that all military personnel and their immediate families get full medical coverage (paid for by the American public, which no one seems to mind). But I'm sure that, like me, a lot of people just assumed that it was an incentive to get men and women to volunteer for the possibility of being blown up in foreign countries. But Rep. Sestak showed that it was a lot more than that:


  • By providing medical insurance, the soldiers are more likely to be in better health when they are called for duty. Basically, the United States armed forces want to ensure that their soldiers are in the best possible health even when they are not in combat situations.


  • By providing medical insurance to the soldiers' immediate family, the soldiers who are on tours of duty here and abroad have one less worry about the health and well-being of their loved ones, and can therefore devote that much more energy towards the objective.


Now, I'll admit that the second point might seem a little nebulous and touchy-feely, but there's a lot of official support for Sestak's first point. The Military Health System, which is part of the US Department of Defense, has to say about the first point:


The MHS identifies, develops, and sustains critical military capability and readiness in support of resource management and the operational planning process. Medical readiness ensures service members are free of health-related conditions that limit ability to actively fulfill an assigned mission.

The goals of Medical Readiness include:

  • Managing warfighter fatigue is the ability to evaluate fatigue and monitor its effects on warfighter performance. Fatigue management is a proactive initiative in predicting warfighter performance and counter the effects of fatigue.


  • Enhancing warfighter sensory cognitive and motor capabilities is the ability to enhance and sustain human performance within three domains: sensory, cognitive, and physical activities. Addressing these abilities in individual warfighters aids in commanders' decision making.


  • Enhancing physiological capability is the ability to improve success of the warfighter within the physiological domain: neuroprotection (to decrease brain injury), manipulation of metabolic processes (related to water intake, nutrition, and waste production), enhanced ability to withstand trauma, and maintained/enhanced performance despite the stressors of military operations.


  • Providing/maintaining ability to operate across the full range of environments is the ability to perform in flight environments, kinetic and highly-explosive environments, extreme climates, space, underwater environments, chemical/biological/radiological/nuclear (CBRN) environments, and directed-energy environments.


  • Providing a healthy and fit force is the ability to provide and enhance a healthy and fit force throughout the continuum from accession to veteran. This includes optimizing health/fitness of peacetime forces, maintaining health/fitness of deployed forces, and ensuring the physical and mental health of redeployed Service members to original optimal levels.


If you take out the sci-fi movie vocabulary, the US government believes that providing cutting edge health care for military personnel around the world (their words) ensure the productivity of the members of the armed forces. Good idea.

And yet, this is the same US government that believes providing health care of any kind for the rest of the population--which would allow everyone the same opportunity to be as productive as a "warfighter"--would damage the country! What's up with that?

As I've discussed in previous posts, all other industrialized countries have understood that providing medical insurance to everyone improves the likelihood that everyone will be able to contribute to society. My colleagues in Scandinavia and Europe certainly attest to this, as do my relatives in Canada. And since the American military gets it, one would think that the government as a whole might catch a clue.

Given the fact that the US is now a country in a perpetual war, as some have recently claimed (see here, here, and here), how can we, as citizens (young and old), be prepared--or even able--to defend our country* when so many of us have inadequate health care or no health care at all?

*Some have proposed the re-introduction of the mandatory military service (aka draft). Would everybody be able to fulfill their duties in short order?


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IQ: I agree completely. The US military health care system seems to be very good before the soldiers are sent abroad, but not so good when they come back. This is very sad actually. Maybe this will be the subject of another post in the near future.
Miliatarists, and I mean that in a totally non-perjorative terms, just those who believe that since there is no world government, war is a part of reality, and so therefore as a matter of survival, you can't lose wars, don't usually totally like capitalists completely on a point like that.
Now of course, every organization will butter its own members bread, but, they worry about what the military calls "the generating force," in English, where do we grow the soldiers?
They also have their own views on economics, which are not totally free trade or totally laise faire either, and my bet is, we here more of them, because beyond health, social cohesion is mandatory for optimal military performance, and too much laisse faire, which doesn't mean socialism either, would undermine that potentially by spreading out the income distribution too much, although that seems to happen a lot anyway.
Interesting piece.
Don: Very good points! I know you are very knowledgeable in this area, as shown in your comment. Thanks for dropping by.

For all: I need to hit the sack, as I have to get up early for a museum trip with my family tomorrow morning.
It's certainly not the military that's opposing a single payer system of health care in the US. They've already got one, and so do the seniors on Medicare. The same greedheads that want global warming to continue -- the same greedheads that think that the rich paying no taxes means they pay too much, --and the same greedheads who cry about national debt (that they collect the interest on), are the same people who oppose common sense health care for all Americans.
I wonder if it isn't just a matter of keeping one's own forces in the best possible health while keeping a potential enemy as poorly cared for as you can.

It is no secret that the elite call upon the military to defend them and their wealth whenever they feel threatened by the citizens who create that wealth without ever getting a fair and decent share of it.

Eventually this, as it always has in the past, will lead to a revolution of those so badly treated. Better for the elite if they are in ill health while the troops defending that elite are in the best of health.

The elite didn't get to being the elite by being stupid - just by being greedy......
The real war is actually not the military war. We are not threatened by Afghanistan nor by Iraq. They may indeed have bad guys in them, but so do many places. Winning there will not make us safe.

At present, the real war is one of economics—trying not to bankrupt ourselves, trying to restart commercial infrastructure that has been sold out to make a quick buck. If the US is economically healthy, we will survive and if it's not, we will lose. We need a ready force of workers capable of responding to economic challenges. They need to be healthy, and they need to know their families are. They need not to be taking time off to take care of family because it's too expensive to get someone else to. They need to be able to move from company to company as needed for business without having loss of health care be the reason.

All the reasons you cite are good ones... And they apply equally well to the civilian situations.
ONL: You’re absolutely right! What’s more intriguing is that the military establishment mostly adheres to the Republican ideology. Yet, I’m sure they like their ‘free’ healthcare (at least before they are deployed).

skypixieo: Very interesting take on this issue. Like you said, perhaps the government would like to quickly put down any ‘insurrection’. What better way than preventing these enemies within from getting access to appropriate health care. I’m sure that most militia members have no or inadequate health insurance.

Kent: I agree completely! If we don’t have a healthy work force, how can we have a strong economy? As discussed above, I talked with several colleagues of mine when I traveled to Europe earlier this summer. Some of them worked in the medical field. They all agreed that as a minimum the government should provide health care to all. This way people can participate positively towards the society (and the economy). Furthermore, my colleagues could not understand why Americans almost always voted against their own interest.
The military has single payer, full coverage insurance as a matter of ensuring peak performance. That's the same reasoning, basically, as our Founders used when implementing our first Federal single payer plan in 1798 -- as a matter of peak economic performance.

As Dean Baker and other economists have pointed out, America's budget problem is a health care problem - the source of those godawful deficit projections. The reason that cannot be addressed in the same manner as did our Founders -- improving economic conditions by implementing single payer -- is because of bribed legislators and empty-minded ideologues. Curiously, those purchased reps and ideological Rwing clowns cite their reverence for the Founder's wisdom while ensuring our economic demise.

I include too many Dems and El Presidente in that group of bribed reps...
Paul: Yep, here in the US, bad ideology trumps good business, as discussed here:

GMs Healthcare Double Standard: Bad ideology trumps good business

And this article was written more than 5 years ago!

Folks, I'm leaving for the rest of the day. Thus, I won't be able to respond until later tonight. You all have a good one.
Rw005g: Thank you very much! I also hope that the analogy will have a greater impact than previous posts on this subject (by others and myself). Some of my posts on health care are a little bit on the theoretical side, which may scare away some readers. Thanks for the info about the Soviets. For many tea baggers (and others too), raising the Soviets as a model to follow is a kiss of death! Over my dead body...
Good point Rw005g! We'll remove the word Soviets when we present further evidence.
Yes, as Paul points out, the military has single-payer full coverage for all. Ironic, no? And the VA extends that to what amounts to a lifelong benefit for many. I used to work with that system on behalf of a provider of mental health benefits. It was seamless and generous in its coverage--even though today mental health coverage is the spurned stepchild of our healthcare system.

When things are sold to the American people, they are usually sold on the basis of national defense--and of course that is the only way anyone in the U.S. would ever get single-payer coverage.
To reinstate the draft would be abominable under any circumstances. Could Congress possibly stink any worse at governing our country?
Steve: Indeed, this is very ironic. Good only for a given segment of the society.

Poor woman: Good to see you back. I would be surprised that the draft would be re-instated. However, everything is possible.
Its funny (no it isnt really) that if you can couch something in terms of war preparedness it becomes acceptable. Another little piece of having a population healthy enough to fight is the school lunch program. It was created around WWII when it was discovered that many of the young men that were drafted were actually too poorly nourished to be fit to fight! So everyone accepted the school lunch program, up until Reagan called ketsup a vegetable and got people to think that only welfare queens driving cadillacs dropping their kids off at school before they went to get their nails done were taking advantage of it.
Tim4change: Thanks for the info about the school lunch program. For many a tomato is vegetable... BTW, if you type "tomato" in, the first sponsored link on top of the answer labels tomatoes as vegetables!
You're welcome Cindy! I hope your son is doing better.
Excellent point.

However, since most industry is now outsourced and American workers are mostly working at McDonalds or unemployed, the armed forces are the only 'productive' sector and thus the only one that counts.

(mutters to self "crazy fucking Americans" .... had a chance, and for a while, were that Shining City shit, now cutting off their feet to spite their legs...)
And gonna take the rest of us 'first world'ers with them...
Completely true, Myriad! The US Government believes that only the military is worthy to have access to the Universal health care system. The rest can go to hell (almost)…
This comment is for people who read the version I posted on OEN. The comment section closed down before I could post this comment.

Uninsured people have the best medical services they can buy… In other words, very little.

As discussed in this link (reproduced below), uninsured people in the US have excellent medical services and are treated fairly or equally when they show up at the hospital or the ER. Consequently, being uninsured should not affect the risk of mortality. Hey, it’s so good that everyone should forgo their medical insurance and pay on their own, like everybody else does in most third world countries. Why use a third party payment structure?

Obviously, this is far from being true, but this is what some people would argue to no end, even faced with facts that show the complete opposite. Furthermore, recall that cancer survivability (when used with caution, since it is not a good measure to assess whether cancer treatments work well – see comment above) for the uninsured is about half those who can afford cancer treatments (very few can pay out of their own pocket) or have medical insurance (good insurance that is).

Here are some studies on how lack of insurance affects mortality for the uninsured.

Uninsured Trauma Victims More Likely to Die

Even after adjusting for injury severity and comorbidities, trauma patients who did not have insurance had higher mortality rates than those who did, researchers said.
Lack of insurance increased the risk of death following traumatic injury by up to 89%, relative to individuals with commercial insurance, for various subgroups chosen to control for comorbidities, reported Heather Rosen, MD, MPH, of Children's Hospital Boston, and colleagues.

These differences were seen in patients 18 to 30 years old, who would be expected to have few comorbidities; those whose records indicated that they had at least one comorbidity; and victims of head injuries, the researchers said in the November issue of Archives of Surgery. The findings were not a function of income, according to their report: trauma victims with Medicaid coverage fared no worse, and in some cases better, than those with commercial insurance.

Rosen and colleagues said such factors as treatment delays, fewer diagnostic tests, and decreased health literacy -- all of which may disproportionately affect the uninsured -- could have explained the findings. But they also acknowledged limitations in their data that made the findings somewhat uncertain.

The researchers analyzed records of some 690,000 adult patients entered into the National Trauma Data Bank from 2002 to 2006, after excluding children, patients with burns, and those with incomplete data.

"Payer status can affect many processes of care," they pointed out, although federal law stipulates that hospitals cannot refuse treatment or transfer emergency cases because of lack of insurance.

Rosen and colleagues cited earlier research indicating that lack of insurance is associated with delayed care, fewer radiologic assessments, and lower rates of hospital admission.
"Physicians may not be cognizant that they are providing different care to the uninsured," the researchers said.


Lack of insurance negatively affects trauma mortality in US children

These results demonstrate that uninsured and publicly insured American children and adolescents have higher mortality after sustaining trauma while accounting for a priori confounders. Possible mechanisms for this disparity include treatment delay, receipt of fewer diagnostic tests, and decreased health literacy, among others.


Analysis of 23 million US hospitalizations: uninsured children have higher all-cause in-hospital mortality

Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance.

And there's this article on how lack of insurance can, consciously or not, affect how doctors treat patients.

Equal Treatment for the Uninsured? Don't Count on It.

Although the uninsured look like any other patients, it's easy to spot them: Their charts have places for their address, emergency contact and insurance information; an empty insurance box is a telltale sign. Some doctors examine this sheet before examining the patient -- a practice we refer to as a wallet biopsy.

The 1986 Emergency Medical Treatment and Active Labor Act declares that hospitals cannot refuse care to critically ill patients and that the physician on call must treat them. Internists with privileges at a hospital (like my friend) are usually part of the on-call rotation for the emergency room.

"I used to get angry every time the emergency room admitted an uninsured patient," he said. "I would try to spend less time with them -- 20 minutes instead of 30 -- and try to get them out of the hospital quickly and hope they would not come to my clinic."

It's not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent.

Some of these adjustments make little difference: Uninsured patients received more generic drugs and multiple drugs. A doctor might prescribe two generic pills for high blood pressure -- an ACE inhibitor and a diuretic, which together would cost $20 for a given period -- instead of a combined brand-name pill, which would cost $241.

The impact of other decisions is more worrying. A heart surgeon told me he operates on uninsured patients but schedules them for the end of the day; if other cases take longer than expected, the uninsured get bumped. Some gastroenterologists are quick to perform endoscopies or colonoscopies on insured patients; not so for the uninsured...

There may be a few among the uninsured who prefer to buy $149.99 sneakers than health insurance. Far more common are stories of preexisting conditions that make insurance unaffordable or jobs that offer none. My primary care friend told me about a patient who had left a boil untreated until it needed surgical drainage and intravenous antibiotics. When asked why didn't have insurance, the man said he had lost his job and was recently divorced. Stories like that helped my friend realize what injustices the uninsured face.

What’s more intriguing is that despite the fact that under a single-payer system, even when there are more medical visits per patient (a topic I already discussed before), we don’t see this kind of discrimination with two distinct classes of citizens. We don’t observe these distinct classes within the Armed forces as well. Go figure.

For people who are arguing about how good the US health care system is, why not forgo the medical insurance you and your family have and pay all the medical out-of-pocket costs on your own (without the help of your community) similar to the 50 million people who already do? Then, we’ll see whether these people still agree that the system (as whole) is the best in the world.
Damned those html codes. The last two paragraphs are mine and should not have been in italic.