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VA health care
VA health care
The Washington Times
By Robert Goldberg
December 18, 2007
Less than a year ago, Paul Krugman wrote a column in the New York Times that held up the Department of Veterans Affairs health system as a model for single-payer health care. His main point was that far from caring about profits, the VA was a better system because it cared only about patients, the veterans of America:
"The key to the VA's success is its long-term relationship with its clients: veterans, once in the VA system, normally stay in it for life. This means that the VA can...make much better use of information technology than other health care providers...which reduces both costs and medical errors. The long-term relationship...also lets the VA save money by investing heavily in preventive medicine, an area in which the private sector - which makes money by treating the sick, not by keeping people healthy - has shown little interest. The result is a system that achieves higher customer satisfaction than the private sector, higher quality of care by a number of measures and lower mortality rates - at much lower cost per patient."
Let's ignore the fact that Mr. Krugman is both wrong about the lower mortality rates and fudges 10-year-old data to make his case. Ideologues that want to use the VA as example of what socialized medicine can deliver should judge the VA in terms of what the system was created for in the first place: caring for wounded warriors returning from the battlefield.
Mr. Krugman would have plenty of more recent evidence for doing so. Here's Donna Shalala, co-chairman of the federal task force reviewing care for Iraq vets who suffer from brain injuries, amputations and post traumatic stress disorder: "Without designated care coordinators to plan the best treatment path for new patients, an untold number ended up lost."
In addition, injured combatants must go through two antiquated disability assessments (one by the military and one by the VA) to determine what treatment options are available. This means that many are forced to jump through bureaucratic hoops that might not even get them to the right place, Miss Shalala said. "For veterans' families to give up everything just to coordinate this care themselves is fundamentally unfair," she said. "The process is too old-fashioned. It has nothing to do with modern medicine, and we ought to be embarrassed."
Mr. Krugman should ask Sarah Wade about the long-term relationship the VA provides returning vets. According to USA Today, Mrs. Wade, who lives in Chapel Hill, N.C., with her husband, said their problems with the VA started after Ted Wade left the VA center in Richmond, which offers specialized care for severe and multiple injuries. She has been acting as her husband's case manager since the VA manager didn't know enough about his injuries.
"One of the things with the VA is that they can always tell you what they can't do, but they can never tell you what they can do," she said, citing the time his private rehabilitation benefits ran out. "When his contract was up, they (VA) tried to put him in an adult day care program and transfer his medical care back in-house. They had no one who has the expertise to treat him there, otherwise he wouldn't have been sent to this doctor in the first place."
Mr. Krugman's response will likely be to blame President Bush for not spending more. That won't wash. Spending on the VA has doubled under the Bush administration. And spending more, as the United Kingdom and Canada health systems have shown, doesn't reduce waiting or ensure that doctors can actually practice effective medicine instead of guideline-driven drivel like limiting therapy for combat veterans suffering from post-traumatic stress disorder to three months.
Vets should have a choice about where to get the care the VA has denied them by indifference, by delay and by delivery of one-size-fits-all medicine. Medicaid already has a successful program called Cash and Counseling where families and individuals with disabilities are given the option to manage a flexible budget and decide for themselves what mix of goods and services will best meet their personal care needs. Veterans and their families deserve no less.
Pundits like Mr. Krugman are holding the veterans hostage to a failed vision of single-payer health care because they believe the VA is politically unassailable. Similarly, supporters of a massive expansion of State Children's Health Insurance Program counted on using kids as a human shield to advance their cause. But Mr. Bush vetoed SCHIP to stop the spread of government-run healthcare. Now he and others should take on the VA monopoly. Instead of promoting its expansion, he should give vets the same freedom and dignity they were fighting for in Iraq.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest. |
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