More than four months ago (5 August 2012) I quoted Princeton economist Uwe Reinhardt on the Veterans Administration (VA) health system:
So far I have not received a satisfactory answer from detractors of “socialized medicine” to my question of why we have the V.A. health system when socialized medicine putatively is so evil.
Do you have an answer?
Since then, I came across a post by libertarian economist John C. Goodman that takes up the challenge of Professor Reinhardt.
Don’t you think our military veterans deserve decent health care? I certainly do. That’s why I like Mitt Romney’s idea of setting the veterans free. Give them the opportunity to choose private health care alternatives to the Veterans Health Administration (V.H.A.), a system that too often fails them.
Why can’t we do for veterans what we do for seniors? About one in every four Medicare beneficiaries is not actually in Medicare. They have enrolled instead in private health insurance plans operated by such entities as Aetna, United Health Care, Cigna, etc. Why can’t we give people who risked their lives for the rest of us similar options?
John C. Goodman, “Free Our Veterans Now“, Town Hall, 3 December 2011.
Those private health care plans for Medicare beneficiaries cost taxpayers more than than traditional Medicare does, a minor problem that Mr Goodman overlooks.
Mr Goodman faces another problem. The VA system is widely believed to perform better than private insurers in provision of health care. There is even a book in print, authored by journalist/demographer Phillip Longman, with the title Best Care Anywhere: Why VA Health Care Would Work Better For Everyone (Berrett-Koehler, 3rd edition, 2012). There is no equivalent book with the title “Worst Care Anywhere” or “Free our Veterans”! Wikipedia, in reference to evaluation of the Veterans Health Administration (VHA), has nothing but praise for the agency. Here is the relevant section, in full:
“Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index.” In 2008, the VHA got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. In the same report the VHA outpatient care scored 3 points higher than for private hospitals.
“As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators.”
A study that compared VHA with commercial managed care systems in their treatment of diabetes patients found that in all seven measures of quality, the VHA provided better care.
A RAND Corporation study in 2004 concluded that the VHA outperforms all other sectors of American health care in 294 measures of quality; Patients from the VHA scored significantly higher for adjusted overall quality, chronic disease care, and preventive care, but not for acute care.
A 2009 Congressional Budget Office report on the VHA found that “the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelines — particularly those that VHA has emphasized in its internal performance measurement system. Such research is complicated by the fact that most users of VHA’s services receive at least part of their care from outside providers.”
“VA Today: Overall Evaluation“, Veterans Health Administration. Wikipedia, accessed 25 November 2012.
John C. Goodman, in his post, attempts to show the VHA in a poor light, but much of the ‘evidence’ that he cites shows, at best, that VA health care is equal to private care. The only source that he shares with Wikipedia is the 2004 RAND Corporation study:
To the V.H.A.’s credit, a RAND study concluded that overall the V.H.A. is providing higher quality care than other patients receive, although it also noted that the system does best on the quality metrics it measures than on the ones that go unmeasured. …. On the most important quality measure of all — did the patient survive? — V.H.A. patients appear to do no better than other patients.
The RAND Corporation study was published in the Annals of Internal Medicine, 21 December 2004.
The Veterans Health Administration (VHA) is a giant bureaucracy. As of 2011 it had nearly 280,000 employees and an annual budget of $47 billion. More than six million veterans are VHA patients, but the VHA is set up to attend primarily to service-connected disabilities, so there is a large overlap of veterans enrolled also in Medicare and Medicaid.
In the mid-1980s and early 1990s, the VHA was widely criticised for poor quality care and high mortality rates. President Bill Clinton in 1994 appointed Dr Kenneth W. Kizer, a physician trained in emergency medicine and Public Health, to reform the VA health care system. The changes were profound, and the quality of care increased markedly, along with patient satisfaction.
Two entries in the Wikipedia article caught my attention. The first refers to pioneering use of electronic records, an important component of Dr Kizer’s reforms:
VHA is especially praised for its efforts in developing a low cost open source electronic medical records system VistA …. With this system, patients and nurses are given bar-coded wristbands, and all medications are bar-coded as well. Nurses are given wands, which they use to scan themselves, the patient, and the medication bottle before dispensing drugs. This helps prevent four of the most common dispensing errors: wrong med, wrong dose, wrong time, and wrong patient. The system, which has been adopted by all veterans hospitals and clinics and continuously improved by users, has cut the number of dispensing errors in half at some facilities and saved thousands of lives.
The second refers to the cost of physician services:
Doctors who work in the VHA system are typically paid less in core compensation than their counterparts in private practice. However, VHA compensation includes benefits not generally available to doctors in private practice, such as lesser threat of malpractice lawsuits, freedom from billing and insurance company payment administration, and the availability of the government’s proprietary VistA electronic records system.
Phillip Longman discusses his book, Best Care Anywhere, in this YouTube interview. There is also a link to the article on which the book was based.