Friday, August 28, 2009

Single Payer Health Care System

Up until a few days ago, I was a strong advocate of single payer U.S. health care. However, an experience with the Veterans Administration health care system last Tuesday caused me to lose some if not all of my confidence in a single payer system.

Since 2001 I’ve been using the VA health care system. I didn’t have a choice when I lost my job at the hotel where I worked in Lionville, PA. Luckily for me I had signed up for the VA health care system in 1998 just in case I would ever need it. Lucky because in 2001 the Bush administration discontinued the eligibility of non service connected (meaning we didn’t have a service connected disability) veterans like me from using the VA health care system which I was promised when I joined the Army in 1960. This act alone (making veterans like me ineligible to use the VA system) was the main factor in causing me to change my political registration from Republican Party did not care for me or my well being unless I was connected to the power structure. Since I neither was employed, rich or have political connections, I was on my own according to the Republican Party. My first doubts about the Republican Party began during the 1992 Republican Party convention in Houston Texas after the hateful homophobic speeches of Pat Buchanan and Pat Robertson. That was my first clue that I, as a gay man, was not welcomed in the Republican Party unless I turned straight. But that is another story for a future blog posting.

The VA health care system was a lifesaver for me. During the time I was unemployed I had one medical emergency and two operations. The VA took excellent care of me. In fact, they took better care of me than my private health care ever did. The one major operation I had with my private health care system almost killed me. I contracted a staph infection and it took me six months and three operations to finally get rid of it. I barely survived. The whole ordeal was a nightmare which I will never forget. I never received an apology from any of my private medical care providers for what happened to me, including the doctor I went to who insisted it was "all in my head" when I complained of horrendous headaches. It was only when my surgery scar burst from the build up of pus that I was delivered to the contagion ward of the hospital in an ambulance. Then the medical establishment realized that something was dreadfully wrong.

I liked the VA health care system because they seem to really care about me. I wasn’t just a number to increase the doctor’s volume of patients. The VA had a different attitude. Since they’re not operating for profit, they took more time with me. My doctor (or nurse practitioner) actually sat down with me and made eye contact with me and discussed my health. I had annual labs to monitor my health. Except for the fact that since I moved the main VA facility was now 90 miles away (as opposed to ten minutes away when I lived in Pennsylvania), I was very happy with the VA system. No, I couldn’t choose my doctor but I always had the best doctors available for me when I went to the VA for care.

Alas, it seems that has changed now. Last year the VA opened an outpatient facility in Georgetown. No longer would vets like me have to travel 90 miles one way to Wilmington, DE just to take labs or to visit our doctor. Now we could travel to the outpatient clinic in nearby Georgetown. It all looked good on paper. However, what looks good on paper and what is reality are two different things.

I have visited the VA Outpatient Clinic in Georgetown about a half a dozen times. Every time I have visited them I have a different doctor. This wasn’t good. There was no continuity. The last time I visited I had a doctor and I expressed my concern about the turnover. He assured me he would stay there because he said he liked treating “old vets” like me. I think that was a compliment. So imagine my disappointment this past Tuesday when I visited the VA Outpatient Clinic for my labs. A lot of red flags went up.

First, there was no sign in sheet. There were no instructions as to what to do. I see the obese woman behind the glass partition (what’s with the glass partition? Afraid someone is going to rob them?) I asked her “where is the sign-in sheet?” She looked up at me with a dull look and said “Hepa.” I said “Hepa?” She repeated “Hepa.” I said “Oh, it’s a privacy thing?” She said “Yeah.” Okay. Then I tell her I have an appointment for my labs. She now asks my name (why didn’t she do that sooner?)

I take my seat. A short time later a woman in a white medical jacket comes out and proceeds to rip a new one for one of the veterans. I don’t know what he did but she said to him “Sir! You will have to wait your turn! There are 30 other patients before you and you will have to wait your turn! Do you understand?” Oh that was nice. Not what you would call professional or respectful. Even if the vet was inquiring about when his turn was I don’t think that was an appropriate way to answer his question. The woman turns on her heel and stomps in the back to continue doing whatever it was she was doing before this hapless vet dared to ask his question. An uncomfortable tension settled over the rest of us vets in the waiting room. What next?

Then I was called into the back to get my blood drawn for my labs. It was all very organized, including the needle at the ready. My brother had told me a few weeks earlier that whenever a medical person inserts a needle into your arm you should see them break open a new needle and throw that needle away. I didn’t see that and I’m ashamed to admit that I didn’t question it either. I should have. I was intimidated by the white jacket woman who was administering a needle to the veteran sitting next to me. Yes, they were taking our blood simultaneously. Yes, we were on a production line.

After three vials of blood were taken from me I returned out front and inquired as to when my next appointment would be. The usual procedure was to schedule an appointment the next week to go over the results of the labs or blood test. I was told that they would contact me “if there was a problem.” Otherwise, if I wanted a copy of my labs I could call them next week. So there you go. No longer did I have a doctor, or even a nurse practitioner to discuss my medical condition with me. I wasn’t asked if this is what I wanted. The decision was made for me.

Another incident which also caused me great concern was that they had no record of my partner Bill. He had not heard from them in over a year about getting his labs. He went with me and inquired at the front desk. He was told “You’re not in the system.” Not in the system? He’s been in the system since the early 90’s. They made an appointment for him and also a follow up appointment to review his labs. Why didn’t they make a follow up appointment for me?

As I was leaving I overheard another vet questioning the person at the front desk as to why he had not received his heart medicine. The woman at the front desk didn’t seem to care. The old veteran was pleading with her that he needed his medicine. She finally advised him to see the woman around the other side of the front desk. Hopefully that woman took care of his problem.

All these events on this past Tuesday morning in the span of about a half an hour left my confidence in the VA health care system very shaken. It has even affected my sleep. That’s when I know something is serious because I rarely have problems sleeping. I can sit in front of a TV or read a page or two of a book and I’m off in Wonderland in only a few minutes. Not now, I’m waking up during the night worried about my health care.

This morning I decided to do something about it. I called the VA in Wilmington and explained my concern to the operator. She immediately connected me to a woman who is the patient’s advocate for veterans. She wasn’t in so I left a message. Much to my surprise, she called me back in about 20 minutes. I told her of my experience at the Georgetown outpatient clinic and explained my concerns. She told me that the Georgetown clinic was having a great deal of difficulty keeping a doctor. She said part of the problem was probably the computer system which was frustrating to use for the doctors and nurse practitioners. She seemed genuinely concerned about my loss of confidence. She offered to reconnect with a primary health care provider at the Wilmington location. She acknowledged that it would be a long trip for me but I told her that didn’t concern me as much as I needed a primary health care provider. The trip by the local American Legion Post 28 van takes up half of my day. That is a small price to pay for the peace of mind to have a permanent, consistent health care provider with whom I can discuss my medical condition.

The lesson I am taking from my experience this past week was even though I ran into difficulty with the single provider system that I’m using through the VA, I was able to resolve the problem immediately through the VA’s patient advocate and thus stay with the system that has provided me the best health care I have ever received in my life. I have regained my confidence and peace of mind and now I can sleep again at night.


Anonymous said...

Hi Ron,

Sorry to hear about your problems at the VA office. My step dad was a veteran of WWII. He chose to never go to the VA office for care because he didn't like how they treated his brother when he was sick. Thru the years he paid for insurance & had a relatively concerned dr. that treated him well.

After his death I took my Mom to the VA office in Salisbury, MD to file for a VA widows pension. When the the clerk gave us the amount she would be receiving monthly we were blown away. I immediatly asked why she was receiving almost 7 times more than my step dad did & he was the veteran who fought in the war. After asking us several questions about his prior health we were told that some of his medical problems were considered to be war related. Such as the numbness he felt in his feet was a direct cause of the frostbite many of the veterans experienced during the war. If he had gone to a VA dr. who knows how many more of his medical problems were related to what he went thru in the war.

My point is, I think all Vets should be monitored by a VA dr. that has the medical knowledge & up-to-date info that may directly affect their pensions. My parents struggled financially during their married years. He paid high ins. premiums that were unnecessary and in the end it caused income hardships that were unnecessary. Such a shame! Sometimes it doesn't pay to be so stubborn. I'm glad you spoke to VA directly concerning your problems. Maybe it will cause them to monitor what's going on in the Georgetown office before someone else gets fed up & leaves the VA system.


G said...

It's been awhile since I read a good book. Good story, food for thought.

Ron said...


Thank you for sharing your story with me. I was reluctant to use the VA health system when I was out of work but had no choice. Wouldn't you know it but I developed two medical conditions that I needed an operation. They took wonderful care of me and it didn't cost me a cent (I wasn't earning any money so they didn't charge me - I was below the income threshold.) If I wasn't out of a job I would never have used the VA health system. Now that I have private insurance I was reluctant to leave the VA health system because they have all my medical history and they have taken good care of me. They are pro-active rather than waiting for you to get sick to go to the doctor. They're not operating for profit basis and it tells.

Your story about your mom receiving widow's benefits I've heard before. A good friend of mine mother is now in an assisted care facility. Her father was also a World War II vet. She didn't know that his widow was eligible for a monthly pension. Someone at the VA told them. She now receives over a World War II widow's pension of $1,000 a month which greatly helps to pay the monthly bill at her assisted living facility.

The Bush administration did everything it could to discourage veterans from using their promised and earned benefits. Thank goodness there are good people in the VA health care system that is willing to help. Of course no system is perfect. I have encountered the frustrating bureaucracy. But you work around that. I'm glad I took action this morning by calling the VA patient advocate with my concerns about the Georgetown VA outpatient clinic. I realize there can be problems anywhere but one must at least take steps to try and solve it.

I'm sorry that your father and your family had to endure unnecessary expenses because of a lack of knowledge and his stubbornness in utilizing the VA healthcare system. Both of my brothers and a good friend have also refused to use the VA health care system even though they were entitled to use it. They are all paying high monthly premiums now for their private insurance.

I didn't know the VA had a patient advocate. I'm glad I called this morning with my concerns. As I said in my blog, now I can sleep. It was really bothering me.

Thank you again for sharing your family’s story.

Ron said...


I knew it would be a long story. I try to keep my blog postings short. This one I had to get off of my chest. I guess you've figured out by now that my blog postings are a form of therapy for me. I have to talk it out. The VA health care system has saved my life and Bill's. A couple of years ago he had a burst gall bladder. He spent a week in intensive care at their Philadelphia facility. I was very upset by the thought that I would have to leave the VAMC. I'm glad I called this morning and talked to the patient's advocate. I didn't know such a position existed. Now I can sleep again that the problem will be addressed. No more "books" for awhile on my blog. I can't make any promises though. :)


G said...

Ron, I enjoy, and appreciate you sharing your experiences. My Dad, and step father both passed away while they were in the VA hospital. The VA took great care of them.

Ron said...

My Uncle Bruce and Dude Tipton also both passed away at the VA hospital, the same one I go to in Elsemere, Delaware.