Long before the debate over the Affordable Care Act, the military’s own government-run health care system has been, for me, a mixed bag. On the one hand, my health care has always been “free” (if you can call paying with duty, deployments and, sometimes, life “free”).
On the other hand, the military health care system has been confusing, inefficient and short on options. It is a complicated balance of entitlement, subsidies and bureaucracy — sentiments that have often been reflected in peoples’ reactions to my columns over the years.
First, 14 years ago, during the only six weeks when I did not have a military identification card (between my college graduation and wedding), I broke my leg. I was technically uninsured, but the Navy hospital casted my leg anyway. Later, I wrote about how the military had “taken care of its own.” People were enraged. “That cast wasn’t ‘free,’” they said “The taxpayers paid for it.”
It’s true. Since the day I was born, taxpayer money has covered my health insurance and medication. This has led some people to believe they have input about my lifestyle. When people pay into something, they naturally want control over how their money is spent.
Sarah broke her leg because she chose to wear high heels? We the taxpayers will have to cover that mistake.
Sarah’s overweight? We have to buy her blood pressure medicine.
Sarah wants a third child? Yep, taxpayers will cover that, too.
I’ve always contended that my husband’s service is our “payment.” For Dustin’s sacrifice to the country, taxpayer money covers our health care.
Sounds perfect, right? Except, when the government spends other people’s money, they have to be careful. They have to make wise choices. And the beneficiaries don’t wield much power.
The doctors I’m allowed to see are limited, and getting a referral to a specialist is complicated. Usually, when the location permits, I’m restricted to the military hospital, where all the comparably ranked doctors make the same pay and move every two to three years.
Yes, there are many wonderful and talented doctors in military medicine, but without an element of financial competition, motivation to be the best doctor has to come from something else.
Wait-times in lobbies and at the pharmacist are legendary. I once took an hour nap across three hard, plastic chairs waiting for my antibiotics.
When Lindell was an infant, the Navy hospital accidentally gave him the same series of shots twice on consecutive days. I was furious, but there was nothing I could do. I couldn’t leave that practice and go to another one. I didn’t have a choice. And complaining is pointless; no one loses their job or their customers.
Then there was the time when Owen needed a tonsil- and adenoidectomy. Technically it was elective surgery because it wasn’t an emergency. But Owen was losing weight — at 3 years old, he still wore a size 18-months pants — and I was frantic.
My options were to pay out-of-pocket on the “outside” (at a civilian hospital) or wait months to have the procedure done at the military hospital. Why months? Because of the hospital’s backlog, and because the military has to review and approve these things. They have to be careful with taxpayer money.
But military medicine is “free” and equally available to all who qualify. Or is it? The funny thing about making everyone equal is that people still find a way to give one group preferential treatment over another group.
Many years ago, writing about military medicine, I said a system that requires users to be savvy in order to get the best treatment is a system that is broken. I was speaking to the fact that in the world of waiting for a referral, an appointment or a procedure, sometimes the patient who “works the system” is seen faster.
However, often the patient need not (and, of course, should not) manipulate anything. My dad retired as an admiral. Although we were raised to never “use” his position in any way (nope, not even when Dustin almost couldn’t get leave for our wedding), after I married an ensign, I definitely noticed a change in treatment.
When your ID card states you are the daughter of an admiral, people notice. When your ID card states you are the wife of a new ensign, you take a nap while you wait for antibiotics.
My concern, however, has always been for the spouses who are neither married to an ensign nor an admiral. My concern is for the enlisted families. What chance do they have in a “free” system that has been reduced to using rank as currency?
People didn’t like this either: There is manipulation of our taxpayer dollars? I thought all of it was free and equal.
So, without getting overly political on either side, I am sincere when I tell you that I have been intrigued by the country’s eagerness to be part of this government-run health care system that I have come to both love and hate. Because the pros and cons of the Affordable Care Act seem strikingly familiar to the pros and cons of the military health care system. And if 38 years of being at the taxpayers’ and government’s mercy has taught me anything it is this: nothing — nothing — is ever free.
Sarah Smiley is a columnist and author of “Dinner With the Smileys,” a memoir of a year of dinners and motherhood.