As Washington politicos drive pell-mell towards some kind of health care reform plan, it is wise to slow down enough to take note of prior experience in health care systems. Much has been made of the virtues as well as the flaws of the Canadian and British single-payer models, and the relatively high public satisfaction that such systems build should be considered in addition to persistent problems of rationing, extended waiting periods even for critical care like chemotherapy and radiation treatments for cancer, and the serious problems with disincentives to high-technology development and equipment investment that plague those systems.

But lessons from other countries will always be an imperfect source of information. The U.S. system has some unique features, including its hosting of the world’s most productive research and development industries, that make any direct application of lessons from other countries fraught with potential for errors and unforeseen consequences. For example, no one knows how research and development in pharmaceuticals will be affected when price controls that have a relatively low impact when used in Canada (with a population of 21 million) are applied to the massive 300-million-person market that has until now been acting as a kind of subsidy for Canada and other price-controlled systems. And no one knows how government rationing and access controls to care will work in a hybrid public/private insurance system like that envisioned by the Democratic partisans that currently hold a hammerlock on the political system.

There is, however, one overlooked source of information on government-run health care from the United States itself. It is one of the great ironies of the Cold War that the primary agency empowered to fight Communism — the U.S. military — is in many ways organized internally as a socialist economy, particularly in the area of health care. Until the 1990s and the introduction of TriCare, health care for military members and their dependents was directly owned and operated by the U.S. government. It was then partially privatized to contractors operating triage operations and clinics that supplemented the government-owned hospitals on military bases. Some lessons about the functionality of both single-payer and public/private hybrid systems could thus be gained by looking to the experiences of the military health care system.

My own information is anecdotal, but I believe it points to both some virtues and some areas of concern. Among the virtues is universal access — the military health care system is pretty good at serving most of its target population, including dependents. Access for its secondary target population — retirees — can be a bit of a problem. In some locations, retirees find it difficult to find available appointment slots on a space-available basis and, in other areas, the flood of retirees who have the available time to deluge the telephone lines make it difficult for active-duty members to get through. I remember one military hospital where the only way that an active-duty person could receive care was through the emergency room because all available scheduled appointments were immediately snapped up by a huge contingent of local retirees within minutes of their being made available. This points to the problem of waiting lists and rationing that are also experienced in other systems. An excellent triage operation can help mitigate, but not remove, these issues.

Quality of care is often highlighted as a major defect of the military health care system. One luxury of a private health care system is the ability to invest in staff and equipment based on expected future demand rather than just present demand. A publicly-funded health care system is constrained by the budget provided by the government which is, at best, based on current demand alone. That means that public health care always operates at a disadvantage in addressing changes in levels of demand. The consequence, borne out by the experience in the military health care system, is lessened access to expensive equipment (which is purchased less frequently by hospitals in a public system where they cannot act based on future expectations but must instead be limited by current budgets).

The restrictions of a publicly-funded budget also means that political processes can interfere with needed funding levels. During the depths of despair in the Iraq War, many liberals screamed bloody murder about the dilapidated state of military health care facilities. Blogs and the mainstream media highlighted mold outbreaks at Walter Reed and other instances of grossly inadequate military health care facilities as evidence of a Bush administration that neglected soldiers. But few seem capable of looking at real causes — budgets. Its not like the commanders of those facilities were throwing lavish parties with the generous funds they were given for building maintenance. The buildings at Walter Reed and elsewhere were falling apart because there was no money in the budget to maintain and upgrade them. Does anyone seriously believe that public health care programs would be immune to arbitrary budget limits that would degrade both the quantity and quality of health care provided? Anyone who notes the state of parts of the Veteran’s Administration health care system should take a cautionary note of the dangers of that assumption.

None of this is to say that health care reform should simply be rejected out of hand. But since we’re going to do this, let’s do it right and not drive to hasty designs that ignore the lessons available to us. While certain trade-offs between cost and access levels are inevitable, it is possible to design a system that at least improves on the models built in other countries and for our own military. Putting away the ideological blinders built by purists is a necessary step to any good reform program.