Update: My apologies. I initially misquoted the number of Tricare beneficiaries, astutely noted by Cinnamon Rollover. My intent of this diary was certainly not to overstate Tricare numbers. I made the changes to the diary to reflect a more accurate number of beneficiaries (teh damn google). Thanks for the catch Cinnamon. So much for the perfect first post.

According to the GAO website:

TRICARE is the Department of Defense’s (DOD) health care system for active duty

and retired uniformed service members and their families. TRICARE consists of four

separate programs. Three of these programs—TRICARE Prime, a managed care

option; TRICARE Extra, a preferred provider option; and TRICARE Standard, a fee

for service option—cover active duty personnel, their dependents, and retirees under

age 65.

According to the 2008 Tricare Stakeholder's Report:

More than 9 million Americans rely on us for their health care needs

9.2 Million active duty and retired uniformed service member and their families receive their healthcare from the federal government. My family and I receive free healthcare from the federal government. I repeat, over 9 million citizen already receive their healthcare from the federal government. I provide healthcare for the federal government. I'm an active duty obstetrician/gynecologist in a major medical facility on the East Coast. I'd like to share a couple of observations regarding the current single payer healthcare system that I work in and for which my family receives its care.

"Rationing" of healthcare in this single payer system is simply not reality. As a physician in one of the busiest departments (over 4000 deliveries/year) in the military, I practice with the same diagnostic technology, with the same subspecialty support as my civilian colleagues. If I have a patient who is in preterm labor, I simply walk down the hallway, talk to the maternal fetal medicine specialist (high risk obstetrician), admit her to the hospital. I have the utmost confidence that she will be taken care of in the best way possible and that if she does deliver early, the Neonatal Intensive Care Unit (NICU) will use every available technology to rescucitate and care for the premature baby. If my patient has pre eclampsia or postpartum cardiomyopathy or any other serious conditions, she is cared for in the exact same way as any civilian hospital in the country. Only one caveat- when they get discharged, their bill is always the same: $0.

Single payer healthcare does not eliminate scientific inquiry, research, or the pursuit of evidence based medicine. In fact, quite the opposite. In my department alone, over 90 peer reviewed journal articles have been published since 2002. Research is vital to the medicine and anyone who goes through four years of undergraduate education, followed by four years of medical school, followed by three to six years of specialty residency obviously has an intellectual curiosity which will occur no matter who is "paying" for it. Additionally, some of the best research and scientific breakthroughs, comes from physicians in those "socialized" European countries. To say that progress and research in the field of medicine can only occur in our current system is disingenuous at best and insulting at worst.

Pre existing conditions don't prevent patients from receiving care in our system, rather it is identified and considered in their current medical situation. I'm glad to know if my patient has diabetes or hypertension prior to her pregnancy and it simply allows me to give the best evidence based treatment during the time of her pregnancy.

When a patient sees me, she is my patient. If she wishes to see someone else, she can see one of my colleagues. I believe that is called choice. Physicians, in general, like to see their patients and follow their progress and offer interventions when indicated.

I can prescribe any medications I wish if I believe it is the best for my patient. Sure, there is a DoD formulary that guides many of my decisions, but this formulary if not static. In fact, there are committees who meet regularly to add or subtract drugs based on (I'm hoping I establishing a pattern here) the best available evidence. If a medication is not on the core formulary, I simply put a notation in the prescription that states "nonformulary" and provide a reason that this medication is indicated. While I do not prescribe nonformulary medications often (there is often no need), I have never had a medication prescription not filled in the six years I've practiced medicine.

This system is far from perfect. The administrative bureacracy can be frustrating and often painful and confusing to patients and providers alike. The electronic record that we use as providers called AHLTA is the most nonintuitive, mind numbingly inefficient program I have ever encountered. There are many issues that could make this system better.

The point of this diary is not to suggest that the system I work in that all taxpayers are currently funding is the solution to our nation's healthcare ailments. I am struck however that nobody has brought up the simple fact that the government already provides free healthcare in a single payer model to over 9 million of its population. While this system is not perfect, I believe I provide that same quality of care, offering empathetic, evidence based (one more time for good measure) care as any other physician who practices at any hospital in the country.

If you spent the time to read this, thanks for your time. This community is vital to the progress of this issue and I value many of the opinions here. After completing this, I also respect all who write diaries way better than my effort. Let's get universal healthcare for all! Peace.

Update:I'd like to thank everyone who commented on this thread. I learned much from many of the comments and it is more than apparent that there are passionate and intelligent people in this community who all have similar goals regarding this topic. This is not an issue that is going to be resolved overnight or without some hiccups. The hard part, I think, is to move in the right direction with substantive legislation while knowing it is only the first step. Frankly, I like our guy in the Office of the Presidency. If anything, he appears to have the ability to distinguish the forest from the trees- a skill vital in this healthcare battle. Again, thanks for the nice words. Peace.