On Visiting The Doctor

I’ve gained a personal perspective on the vast difference between Government-Run health care and Free-Market Driven heath care over these past several months.

As a military retiree my family is eligible for the Military TriCare HMO program.  As part of the program, we’re eligible to use nearby military hospitals if space is available at the time of Tri-Care enrollment.  There is a military hospital nearby but due to lack of physicians (they’re all in Iraq now) the hospital stopped accepting new Tri-Care patients a couple of years ago.  I was already enrolled in the hospital, but Winnie couldn’t get in so needs to use local civilian care facilities approved by TriCare.

As Winnie still has difficulty with English I always sit with her in her doctor visits helping to translate.  And I am shocked by what I am experiencing.

Her primary care is through a small clinic of four doctors.  We never wait less than 30 minutes past her appointment time to get her vital signs checked.  Seeing the doctor is normally another 30 or more minutes.

Her assigned doctor looks half-dead, walks with a cane and wheezes. He enters the treatment room without greeting us, barely listens to what the issue is, scribbles a prescription or a referral to a specialist without explaining what the treatment plan is, and then walks out without a civil goodbye.

A specialist we visited this past week really impressed me (not) – the entire time we were talking with him he continually yawned. I wanted to ask him if we were keeping him awake.  He had lost her charts from a previous visit and asked me what he had done on the prior visit.  All I could remember was waiting two ours past our appointment time sitting in his office listening to the phone ring off the hook.  For all that waiting we received about ten minutes of his time.

To be fair, he does seem to know his business once he gets Winnie on the examining table.   He’s courteous and professional, and actually does explain the treatment plan.  But his rush to get us out and on to his next patient concerns me.

We’ve also had to go to a different clinic for her Immigration physical – the INS approves the doctors for these.  We had to deal with this clinic three times as they expected us to know (mind-meld?) what she needed for her physical. This clinic – selected by the INS to do INS prescribed immunizations as part of the physical – does not provide immunization shots.  They sent us to the local public health clinic for her shots and then we brought the paperwork back to the INS doctor.  It was a $120 cash-only fee to get her immunizations, and another $120 cash-only fee to get her forms from the INS-approved clinic signed by a doctor.  And we never even saw that particular doctor.

In no case has Winnie ever spent more than ten minutes actually in the presence of her doctor.  The full cost of each office visit for ten minutes of doctor time is $120, with a ten percent TriCare co-pay.  We have never gotten an appointment within less than two weeks from time we called.  The clinic expects us to use the nearby civilian hospital (or the more distant military hospital) for anything needing “immediate care.”  Their apparent translation of “Immediate” seems to be “anything that can’t wait two weeks.”

My military-provided TriCare experiences are completely different.  For starters, on a routine issue I always get an appointment within one week.  Usually it’s within two days.  For something serious I can normally get an appointment for the next day.

I’ve never waited more than a few minutes past my appointment time to get my vital signs checked.  After my vital signs are taken, never wait more than ten more minutes to be seen by my primary care doctor.

On my most recent visit, the doctor greeted me courteously and professionally as he entered the treatment room.  He took his time listening and taking notes, asking questions to be sure he understood my issues.  He explained what he thought was causing my symptoms, different options for treatment, and what he’d like to do as follow-up.  He also recommended some preventive health care measures appropriate for “a person my age.”  If I was not initially comfortable with a recommendation we discussed it.

You know, almost like the doctor’s that were once portrayed on TV shows.

The military hospital actually started a preventive health care program last year for cholesterol problems, consisting of personalized diet planning and education.  (It was canceled due to Katrina.) There is nothing here in the civilian medical world I’m aware of for any preventive health care.

I pay nothing for my visits; TriCare covers the full cost of military-provided treatment.  If the medication is available at the military pharmacy, then there’s no charge.  If it’s not available or the pharmacy is closed and I need to go to a civilian pharmacy, then a ten percent co-pay.  TriCare monthly premiums are cheaper than my co-workers pay for their company-sponsored medical coverage by a lot.

I’m not going to claim that all the military doctors I’ve dealt with over the years have been perfect.  There have been times I’ve felt rushed, that the doctor was too anxious to prescribe medications I didn’t want or they didn’t listen to me.  But never have I witnessed any doctor yawning while I attempted to talk.  And the military hospital has never lost my medical history.

Winnie also has a unique perspective of our health care in comparing it to what she received back in China. Needless to say, she is less impressed with her doctors than I am.

I recognize that we are fortunate to even get health care at a price we can afford.  But I am deeply shocked at what I’m seeing in this Free-Market medical world. Just how in the HELL did it ever get this bad?

Perhaps people reading this are not surprised.  But for me, what Winnie is experiencing for health care is a shock.

So, my question million-dollar question; why wouldn’t everyone in the US want a medical care system that is similar to the Military TriCare?