Toward the end of the health care reform debate, there was a big outcry (championed most publicly by Howard Dean) that the end result should be "Medicare for all". That's not a half bad idea, as far as it goes. And it would have been an improvement on what the final HCR bill looked like. I'm wondering, though, if we missed an opportunity. The end result of a comprehensive overhaul of the provision of health care in the United States might actually be closer to the Veterans Administration health care system.

Allow me to explain my own first encounter with the VA model. Now, granted, my experience yesterday was only my first visit, but the coordination of the care I received from the moment I checked in was extremely - and I mean, extremely - efficient.

Here are the bullet points of my day:

12:55 - Arrived at VA medical center, checked in

1:05 - Called by a team nurse, vitals checked, basic information collected, received flu shot

1:15 - Taken to waiting room to see my primary

1:20 - Primary comes to waiting room, introduces herself, we go to her office

2:00 - Leave primary's office, go to nurse station. Receive Tdap booster.

2:05 - Sign up at lab station

2:10 - Called for lab work

2:15 - Lab samples drawn; head for specialty clinic to make appointment

2:20 - Go to pharmacy to pick up prescriptions; prescriptions are ready

2:25 - Go to radiology clinic

2:45 - Chest Xray and EKG complete

2:55 - Make appointment at another specialty lab

3:00 - Take care of some administrative details at Eligibility station

3:15 - Leave VA medical center

The Details

My primary was very thorough, and took a good amount of time with me to get all of my background, discuss my overall health issues, and conduct a brief physical exam. She was able to write up all of my current meds right from her computer. I can't emphasize enough how absolutely thorough she was in her data collection and evaluation, and all of this was entered into my profile right on her computer as we talked. More on this in a minute.

During the course of my day, I received a lab workup, a flu shot, Tdap booster, EKG, chest xray, and two specialty referrals (including audiology). By the time I finished the lab, and went to the pharmacy, my prescriptions were ready and waiting - no more than 20 minutes after I had left the primary's office. I did not wait more than 5 minutes at any one station, from the time I checked in, until the time I checked out. In my 56 years on the planet, that alone made this a unique experience.

I went to Eligibility after everything was complete, and got a form for a hardship request (because I'm out of work) to lower my copays, and to have my picture taken for an ID. And finally, per my primary's request, I walked the EKG results down to her, knocked on her door, she looked at them and said, "looks great! See you in a month." I asked her if she wanted the graph. "Not necessary," she said. "It's already in the computer and I'll get a reading sent down by the cardiologist."

Damn.

The entire process took 2 hours and 15 minutes, from the time I walked in until the time I walked out. I was truly amazed that any health care system that was this efficient, and thorough, was available to me. As I was leaving, I complimented the process to the last woman I spoke with in Eligibility. And I told her: "Every person in America should experience that efficiency and level of caring one time. One time."

In a two and one quarter hour period, I accomplished more for my medical care than I would have in days with my prior physician, and the outside labs and radiology clinics and specialists. The longest wait time that I had all afternoon was waiting for the elevator after I left the radiology lab.

Here's the real kicker. Remember that computer stuff the primary was doing? Actually, from the time I first contacted VA about health care, a computer record of me was established. What we did yesterday was to fill in the holes in that record. And now, I can walk into any VA medical clinic or hospital anywhere in the United States, and the medical personnel in that facility will have access to my complete medical history. Talk about records portability.

The cost for all of this? $18 co-pay for each of my 3 prescriptions, and $15 co-pay to see my primary. The efficiency, cost effectiveness, and care that I felt along the way? Priceless.

I have absolutely no doubt that if everyone had the opportunity to experience what I experienced yesterday just once, that there would be a nationalized, single payer health care system in the U.S. in a relatively short period of time.

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This diary would be incomplete without acknowledging the assistance of several Kossaks who are also VA customers and military vets. The advice and direction that they generously provided in my previous diary (and off-list email) on the VA medical system helped me to understand the process and navigate the bureaucracy a bit more cleanly before I walked in the door for the first time.