Walter Reed and the Larger Implications

Today is Walter Reed day in the Congress, with two field hearings taking place. And the weekend was pretty much all about this disaster as well. This morning Anne Hull and Dana Priest have a story suggesting that more VA hospitals than Walter Reed have been suffering from disrepair, which only makes sense, as Walter Reed is supposed to be the crown jewel of the system. Priest and Hull document the scores of letters and emails they received from around the country detailing the substandard care at various medical facilities for veterans. It's the lack of concern for these returning vets but also the lack of preparedness which induces the most anger. Our prowess in field hospitals in Baghdad is saving more lives than ever before, and yet the medical centers stateside are not being properly funded to handle these returning wounded. As Rep. Tierney mentioned this morning at the hearing, "Cockroaches and mold don't happen overnight." This has been an unfolding disaster in slow motion that could have been stopped at any time over the past four years. For some reason it wasn't.

And one major explanation for that is that the feds don't even control these hospitals anymore, preferring to contract out and privatize the service like they do everything else.

The House Committee on Oversight and Government Reform, chaired by the unstoppable Henry Waxman, uncovered the background to the scandalous living conditions of some vets housed at Walter Reed. It turns out that last September Garrison Commander Peter Garibaldi wrote a memorandum (PDF) to the then head of Walter Reed, Maj. Gen. George Weightman, and sent on to the Army Medical Command (italicized words added for clarification), describing how the imposition of a privatization plan upon Walter Reed was rapidly undermining the Center's ability to serve its patients. The Army Times has the story:

The memorandum “describes how the Army’s decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of ‘highly skilled and experienced personnel,’” the committee’s letter [to Weightman] states. “According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed.”...

During the year between awarding the contract to IAP and when the company started, “skilled government workers apparently began leaving Walter Reed in droves,” the letter states. “The memorandum also indicates that officials at the highest levels of Walter Reed and the U.S. Army Medical Command were informed about the dangers of privatization, but appeared to do little to prevent them.”

The memo signed by Garibaldi requests more federal employees because the hospital mission had grown “significantly” during the wars in Iraq and Afghanistan. It states that medical command did not concur with their request for more people.

“Without favorable consideration of these requests,” Garibaldi wrote, “[Walter Reed Army Medical Center] Base Operations and patient care services are at risk of mission failure.”

There was a $120 million dollar contract with a private contractor run by a former Halliburton official. All of the employees managing the facility at Walter Reed are now private workers answering to their corporate bosses instead of the government. So cost-cutting became the priority instead of caring for veterans. The support personnel dropped dramatically, budgets were slashed, and money was put toward studying how to privatize VA jobs rather than patient care. The whole sordid story is here.

And the lesson is that private, for-profit involvement in the health care of any citizen, veteran or civilian, man, woman or child, will inevitably produce a value placed higher on money than the well-being of the individual. This is maybe the most shocking example of that you'll ever hear.

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.

Children are really cheap and easy to cover with full medical care, including dental, but in our society they are neglected because for-profit insurance companies feel no compunction to cover the poor, who can't really afford insurance and who have a greater percentage of maladies. The pay-to-play system is practically immoral, and for those who say that the emergency room is a de-facto universal care system, they're wrong:

According to a new report, among hospitalized children, the uninsured are twice as likely to die from their injuries as children with insurance. And this isn't some unrelated effect: The data in the report was adjusted to account for age, health, severity of injury, etc. The difference is that the uninsured get worse care, for less time, and wait longer to be treated.

None of this, of course, is a surprise. But sometimes it's worth remembering that the uninsured aren't simply a fascinating policy problem. They are people, many of them are children, and because they are unlucky enough to lack parents with health coverage, they die from conditions that insured kids survive.

We hear a lot from those who have a vested interest in sustaining the for-profit insurance system that single-payer universal coverage means long lines and substandard care. That's exactly what we have today in America. And the situation in all other Western industrialized nations gets slandered a lot, but in fact it's quite civilized compared to vermin crawling up the walls at Walter Reed. We know that we pay more than any country on Earth for health care and receive care that is less effective than that in other nations. It is rank demonization to describe this situation in the inverted way conservatives normally do, and the American people aren't buying it anymore. They live with this system every day of their lives, they want it to change and they're willing to pay for it.

Buried in the big New York Times poll released late yesterday is a number showing that a solid majority would be willing to pay higher taxes in exchange for government-guaranteed health care for all.

Respondents were asked the following question: "Would you be willing or not willing to pay higher taxes so that all Americans have health insurance that they can't lose no matter what?" Sixty percent said they were willing, while only 34% said the were not.

People are demanding a totally different health care system, one that is not employer-based, one that does not preserve the for-profit insurance industry, one that recognizes that health care is a right and not a privilege. That's why the California debate is so important. The choice is between fig leaf changes on the margins and a real revolution in how health care is distributed:

Senate Bill 840 by Sen. Sheila Kuehl, D-Santa Monica, would scrap the status quo and replace it with a government-run, single-payer system providing comprehensive health care benefits for all, financed by taxes and free to patients at the point of service.

"California needs a system of truly universal health care now more than ever," Kuehl said this week as she reintroduced her bill, which Schwarzenegger vetoed last year. "This is not the time to wait patiently for universal health care. It's time to move forward." [...]

What would all this cost? One detailed economic study, by the Lewin Group, concluded that the plan could be financed simply by redirecting all of the money Californians and the federal government already spend on health care in the state. Care for those not covered now would be paid for with savings in administrative costs and the elimination of insurance company advertising and profits.

We have everything we need to institute real change on health care except political will. As revelations like those at Walter Reed continue to emerge, perhaps that will get stronger.