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Socialized Medicine for Me, but Not for Thee

This isn't a regular stop on the tour, but beneath the Congress lies an impressive Navy medical clinic called the Office of the Attending Physician that ostensibly exists to deal with emergencies and public health threats and terrorist attacks. In reality, it also provides primary care to an awful lot of congressmen. In 2008, 240 congressman paid $503 each to receive services, "though some sources say congressmen who didn't pay the fee were rarely prevented from using OAP services."

And what are those services? The OAP's offerings "include physicals and routine examinations, on-site X-rays and lab work, physical therapy and referrals to medical specialists from military hospitals and private medical practices. According to congressional budget records, the office is staffed by at least four Navy doctors as well as at least a dozen medical and X-ray technicians, nurses and a pharmacist." Matthew Yglesias comments:

What’s noteworthy here isn’t just the existence of the perk, it’s the specific form. Congress could have voted itself higher salaries. Or better travel benefits. Or larger appropriations so the congressional cafeterias can serve better food. Or just more generous health insurance. But what they wanted here was socialized medicine — health care that’s not only financed by the state but also directly provided by government employees. This kind of state-provided health care is basically universal in the UK, it accounts for an important chunk of the health care in Sweden, and it’s what we give to our veterans in the United States. But most members of Congress regard it as a horrifying prospect. And yet in practice, they appear to like it just fine.

A nationwide network of well-staffed primary-care clinics available to all Americans for a nominal fee sounds pretty good. You could even build off of the highly successful community health center model.

By Ezra Klein  |  September 30, 2009; 6:00 PM ET
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great title . also a sad title.
you so defined ,,i would say hypocracy and greed, and egocentrists..
oh well. to believe these ppl represent the "common" man .
is the saddest .

where is an answer?
(FYI, i have the most wonderful healthcare in this country.......
but i don't care about me, i am healthy.
i care about people who need and have nothing.)
why not write an article:
"What is wrong with public Option?"

Posted by: jelizbooki | September 30, 2009 6:23 PM | Report abuse

"A nationwide network of well-staffed primary-care clinics available to all Americans for a nominal fee sounds pretty good. You could even build off of the highly successful community health center model."

Do you accept a "nominal fee" for writing this column?

Posted by: kingstu01 | September 30, 2009 6:44 PM | Report abuse

A commenter on my blog offered a form of this suggestion, with more detail, and we worked out some further ideas on my blog, a couple of months ago.

The basic idea is very good: something that sets up a lot of low-cost clinics.

I suggested we institute several tax breaks and be sure no laws prevent extensive use of nurse-practitioners (with supervising doctors), making such clinics viable.

Posted by: HalHorvath | September 30, 2009 6:46 PM | Report abuse

Funny, this same story just made ABC evening news. heh heh...

Posted by: HalHorvath | September 30, 2009 6:52 PM | Report abuse

Here's our discussion of how to set up such clinics:

Look in the comments starting at "1:54"

Posted by: HalHorvath | September 30, 2009 6:58 PM | Report abuse

1) Does the FEHBP pay the Navy for these docs' time, or are they moonlighting?

2) With the Grassley amendment forcing Congress to buy insurance on the state exchanges, does that mean some people will find themselves out of network?

Posted by: bmull | September 30, 2009 7:19 PM | Report abuse

From the ABC News story in the links:

"Instead, members pay a flat, annual fee of $503 for all the care they receive. The rest of the cost of their care, sources said, is subsidized by taxpayers."

I like that, "sources said", as though no one could figure that out. Okay, maybe Yglesias and Klein needed it, so they could skip mentioning it.

Granted, sitting at the top of the socialist food chain is pretty nice, the best Navy doctors on call, and all, but it's still ripping one's luxury and ease off the backs of the earnest citizenry.

The rot is shot through America.

Posted by: msoja | September 30, 2009 8:48 PM | Report abuse

I know some people hear the words San Francisco and cringe.

But since Ezra brings up public clinics, I urge him to talk about the use of city clinics, hospitals and partnering entities to provide free or heavily subsidized access to care to all families up to 4 times the federal poverty level.

Here is an op-ed in the Times from August.

Posted by: ArininSF | September 30, 2009 9:30 PM | Report abuse

Further, from the link:

"Last year, Congress appropriated more than $3 million to reimburse the Navy for staff salaries at the office. Sources said additional money to operate the office is included in the Navy’s annual budget."

I don't suppose anyone is interested in knowing what that "additional money" equals.

But what a good idea: Force doctors into a military-like regime, and pay them accordingly. They'll like it.

The story (and Yglesias and Klein) also leaves out that the Office of the Attending Physician probably doesn't provide all the health care needs that our elite political masters have need of. It's just something special they've accorded themselves amidst the general despotism of the times.

Posted by: msoja | September 30, 2009 9:33 PM | Report abuse

Yawn. Fallacy of composition. Just because it works for a small group does not mean it will work the same way for everyone.

Especially when the small group is subsidized by everyone else. No such subsidy exists to pay for the big group.

Posted by: whoisjohngaltcom | September 30, 2009 9:46 PM | Report abuse

I'm more interested in a far more significant aspect of this general idea. Don't get hung up on one possible implementation. Just because a certain, high-cost clinic is an outrage for several reasons does not imply that inexpensive clinics cannot be an excellent solution to many health care problems. Can the free market create low-cost clinics. Of course. It already does. But...what if such clinics got tax breaks?

Posted by: HalHorvath | September 30, 2009 11:53 PM | Report abuse

Mr. Galt,
Except it works for millions of Britons and US veterans just fine. How will you next edit reality to fit the demands of your ideology?

Posted by: michaelterra | October 1, 2009 2:39 AM | Report abuse

I am part of a group that is trying to bring a Federally Qualified Health Center (FQHC) to an under-served area in SW Virginia. FQHC's charge sliding scale fees. If you have good insurance and can pay co-pays etc, you will pay just the same as you would with a private doctor. If you are uninsured or low-income, fees are adjusted accordingly.

We were recently informed that there will be no money to start new FQHC in 2010. It is uncertain when the money will be available.

Even if Congress passes a wonderful health care reform bill - and it won't - and BHO signs it, it will be years before any major good would be seen from the bill. If we had gotten the money in 2010, we would have likely been up the same year.

Remind me again: Why was it so important to vote Democratic? The Democrats have both houses of Congress by solid majorities and the WH. They are worthless.

Posted by: dflinchum | October 1, 2009 7:18 AM | Report abuse

Yeah, it's the Fallacy of composition, sure, but there's more to it than that. The phrase "socialized medicine", used in the context it is, is something I'd call a false equivocation by inference. Members of Congress haven't "socialized" their medical assets, they've simply stolen from their constituents and given themselves a nice perk. That they've drawn some of the more competent practitioners from the bureaucratic behemoth to service their needs is immaterial. To refer to what the political elite has done with the Office of the Attending Physician as socialist, one would have to find that the Senators and Representatives had limited themselves to a pooling of their own assets to create and maintain that office. Clearly, they haven't done so. Clearly, Yglesias and Klein, are lacking in the least analytic abilities.

Posted by: msoja | October 1, 2009 9:57 AM | Report abuse

Make that "equivalence".

Posted by: msoja | October 1, 2009 10:34 AM | Report abuse

"Except it works for millions of Britons and US veterans just fine."


1. The care 535 people in Congress consumes is only cheap because its cost is spread over 300,000,000 other people. It's not like the rest of us can bill our care to China -- it's impossible to provide for everyone at the same level that Congress receives.

2. Brits have resorted to pulling their own teeth.

3. The VA has its own tiers of care, and only the best facilities rival private care. Many if not most VA patients would rather be in the private sector system.

This ABC thing is the ultimate bait and switch. What people need to take away from it is that a) you WON'T get the same care Congress is getting here, and b) Congress would never accept for themselves the same care they're selling to you.

The story is targeted at idiots. Are you actually falling for it, or are you just hoping that everyone else will?

Posted by: whoisjohngaltcom | October 1, 2009 12:26 PM | Report abuse

Chuck Grassley would say "for you to get the same thing, just go work for Congress".

Posted by: RogerThal | October 1, 2009 5:52 PM | Report abuse

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