Health care reform

The VA Health System Is a Tragic Warning Against Government-Run Health Care

Liberals love the now-scandalized veterans health program, but even at its best, it's not worth copying.

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A damning report released by the Department of Veterans Affairs (VA) Inspector General will likely leave Democrats and their liberal allies clamoring for reforms to the government run health system for those who have served in the military. The report found that workers in the Phoenix VA network systematically manipulated wait time data, leaving thousands of military veterans waiting for medical appointments, and some 1,700 stuck in limbo after being left off the waiting list entirely. According to the report, the average initial wait time for a primary care appointment in the Phoenix VA system was 115 days—a far cry from both the system's 14-day goal and the 24 days Phoenix officials had reported. 

Until recently, Democrats have not been particularly shy about expressing their feelings about the VA health care system. For years they have been telling us that it's great—a model system from which the rest of the nation's health care systems could learn a thing or two. 

In 2011, New York Times columnist Paul Krugman called the program a "huge policy success story, which offers important lessons for future health reform." A few years earlier, he lauded it as a "real live case of impressive cost control." Writing in Slate in 2005, journalist Timothy Noah dubbed the program a "triumph of socialized medicine."

It's not just liberal advocates. Democratic politicians have made their fondness for the program known as well. In the lead-up to the passage of Obamacare, Sen. Dick Durbin (D-Ill.) praised the Veterans Administration, and all government health care, as a "godsend"—and then mocked a Republican Senator for imagining a future "government [health] plan where care is denied, delayed, and rationed." That future, Durbin said, was "fictitious."

Around the same time, Democratic Sens. Sheldon Whitehouse (R.I.) and Sherrod Brown (Ohio), gave a statement describing the "government health care" provided by the VA as "among the very best health care in the world." In another speech, Sen. Durbin piled on, insisting that veterans reliance on the "quality care" offered by the VA proved critics of government health care wrong. The White House got into the game too, posting a "health insurance reform reality check" declaring veterans' health care to be "safe and sound."*

The ongoing VA scandal over falsified records, and the deadly long wait times for care that appear to have been the result, seems to suggest otherwise: Veterans are not safe and sound within the fully government-run system, its quality control leaves much to be desired, and its lengthy wait times are not a fictitious prediction but an all-too-grim reality.

In other words, it's hardly a triumphant, model system. But even if there were no scandal at all, the VA wouldn't be a system worth emulating.

West Point—The U.S. Military Academy (CC BY-NC-ND 2.0)

When Obamacare passed, we dodged getting a provision that was supposed to emulate the VA. The outbreak of Democratic praise over the program noted above revolved mostly around the possibility of a "public option" in the president's health care overhaul—a government-run health insurance plan intended to compete with private sector alternatives. The idea was scrapped, and Obamacare became law without it.

So what happens when the federal government actually makes an attempt to take an idea long used by the VA and apply it to the rest of the system? For that, we can look at recent efforts to spur adoption of electronic health records.

In health policy wonk circles, the VA has an electronic records system that is legendarily good. Yes, it's comparatively expensive, judged against other types of health records systems, but studies have found that the expense pays off with even greater savings. And it helped coordinate better health care too. "The VA's investment in the Veterans Health Information Systems and Technology Architecture is associated with significant value through reductions in unnecessary and redundant care, process efficiencies, and improvements in care quality," wrote a team of health IT researchers in a 2010 study for Health Affairs.

When the federal government earmarked about $20 billion (to start with) to help encourage health providers to install health IT systems in 2009, as part of the stimulus, it was hoping for a similar payoff. Just a few years earlier, researchers at RAND had published a report estimating that widespread adoption of electronic health records could eventually save $80 billion annually. The stimulus boost was a down payment on the potential for massive future savings.

The stimulus money was sent out to hospitals all over the country, and, with federal funding and a slew of incentives to act, new electronic records systems were rapidly installed. But the hoped-for savings never arrived. In fact, the health IT push may have helped drive federal health spending upwards, by making it easier and more efficient for hospitals to send bigger bills to Medicare.

The system-wide efficiency improvements never appeared either, because too many of the new health records systems couldn't communicate with each other. The federal government's health IT investment was supposed to make health care better and cheaper. Instead, it made it more expensive and worse.

The operating theory of most health policy wonks often seems to be that if something works somewhere, it will work everywhere. But the history of health care administration is littered with failed attempts to replicate small successes on a larger scale. All we really know is that if something works somewhere, it will work somewhere.

Defenders of government health care might argue that electronic health records adoption hasn't worked in the U.S. because of its fragmented, partially private health system. But Britain's fully socialized National Health System spent more than a decade trying to make a $20 billion health IT overhaul work before scrapping it entirely. It was the most expensive health policy failure in history.

The point is that even when and where the VA works well it's not necessarily a system to emulate. That goes for the VA's vaunted cost control methods too. Paul Krugman is right when he says that the system offers a real-life example of cost control; it really is cheaper than many competitors. But that's only part of the story. It's also necessary to account for how the system achieves its savings.

And one of the chief methods the VA uses to control spending is to organize its beneficiaries into eight "priority groups" that determine who gets the most care. The sickest and the poorest are at the top of the list, but everyone else gets shuffled into lower priority groups. And not all types of care are covered, which means veterans in most of the priority groups get the majority of their care outside the system. In 2007, the Congressional Budget Office reported that none of the eight priority groups received more than 50 percent of its care from the program. In 2010, the VA reported that just two of the priority groups—the two groups that have the highest cost per enrollee—had barely crept above 50 percent usage.

It's not a full-featured system designed to handle the complete health care needs of the population it covers. But it is an example of how government controls costs in health care: through strictly defined prioritization systems and limitations on treatments.

And that's how the system is supposed to work. Add the systematic lies and manipulations that the recent scandal has brought to light, and you have an accurate enough picture of how government health care works in practice. 

That's the government system that Democrats and liberal advocates say they like, and that we should learn from. The scandal shows how bad a government-run system can get, but even the best-case scenario mostly provides lessons in what not to do.

*Hat tip to Phil Kerpen for unearthing a bunch of these examples

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28 responses to “The VA Health System Is a Tragic Warning Against Government-Run Health Care

  1. Peter Suderman on Why the VA Is Not a Model Health System

    Because it’s run by the government and they have no accountability.

    That was easy.

    1. That was a really good TL:DR

  2. I just slogged through Kruggie’s blog. He has not posted anything on the scandal.

    1. Of course not. He’s been busy fellating Piketty.

  3. Single-payer medicine. The answer to all our health care woes. Why can’t we finally join all other civilized nations and provide this level of quality coverage to all of our citizens?

    1. As a Canuck who relies on your healthcare system being around in case I actually need healthcare: no, please don’t go there.

      Single payer medicine is just fancy speak for “just don’t get sick and you’ll be fine”.

    2. The VA isn’t single payer, it’s nationalized health care. The government doesn’t just send you a claim check, it owns it all.

  4. Obama was aware the VA was shit, and campaigned on the issue of ‘fixing‘ its problems in 2007

    “Obama said that he will improve medical care for veterans and help eliminate bureaucratic backlogs that delay disability claims by making sure that every service-member has individual electronic medical and service records…. “

    “In 2008, the Obama admin received further info on the problems in the VA, particularly concerns that stated wait-times were already being falsified

    “””The problems and causes associated with scheduling, waiting times and waiting lists are systemic,” the officials wrote. The memo urged the to “properly document desired appointment dates and ensure patient waiting times are accurate”

    The Department of Veterans Affairs as well as Congress were aware of continued problems with falsification of wait times @ VA facilities in 2010

    A 2012 GAO report ‘raised red flags’ about VA wait-times and delays in care that had stretched back over a decade

    Last night on “The Independents”, the hosts had to ask a guest whether ‘all of this information was new and surprising to them’

    Maybe they should try Google first next time.

    1. Obama forgot it, before he got mad about it.

  5. Try this explanation. Bush invades Afghanistan and Iraq creating thousands and thousands of veterans who are physically and mentally maimed. Obama leaves our Armed Forces in Afghanistan creating many more veterans who are physically and mentally maimed. Bingo! The VA system is overloaded. This happened after Vietnam, so what’s new?

    This has everything to do with liberal and conservative assholes in government who apparently are too busy making sure their contractor friends make as much money as possible from these wars. In Congress, very few people have ever served in the Armed Forces of the United States of America. What the hell would they know about combat, much less the end results of it.

    Get ready for the next war and the war after that no matter who is in The White House. Get ready for more physically and mentally maimed veterans in our already exhausted Armed Forces who are ordered to fight no win wars in various armpit stink hole countries around the world.

    1. The problems of the VA predate any supposed vast influx of post 9/11 vets. The main population is the remaining WWII guys/Korea and the very large Vietnam group.

      The VA has been a shambolic clusterfuck since inception. Why should it have been different than any other unaccountable, wasteful government operation?

    2. On The Road to Mandalay:

      Bingo! The VA system is overloaded. This happened after Vietnam, so what’s new?

      Great explanation! And, it highlights government incompetency. If they can’t react to an increase in veterans with medical issues a full 11 years after the main hostilities end, and 7 years after the “surge”, what can they do?

      I thought government was supposed to take care of health care because it was just too damn important to leave to a market. Apparently, it’s so damn important that you leave people out to dry for a decade until a scandal erupts, including fraud in the system.

      If an insurance company or a doctor tries to screw you and me, we can sue. Who do the veterans sue over the VA? Is that even legal?

      Based on this scandal, I assume that socialists will stop advocating for a “public option” and just skip to single-payer-only care. The last thing you want with a system as screwed up as this one is another, more market-based system to compare it to.

    3. “Try this explanation. Bush invades Afghanistan and Iraq creating thousands and thousands of veterans who are physically and mentally maimed. Obama leaves our Armed Forces in Afghanistan creating many more veterans who are physically and mentally maimed.”

      You could try that explanation, but it’s wrong. The VA divides their patient population up into 6 era groups: Gulf War (including OIF and OEF as well as ODS), Peacetime only, Vietnam, Korean Conflict and WWII. Vietnam War represents the largest part of the patient population. Gulf War is second with Peacetime nipping at its heels.
      http://www.va.gov/vetdata/docs….._31_14.pdf

      I guess pointing that out makes me an ass chunk, right?

    4. The VA was fucked up long before 9/11, or Vietnam.

  6. Socialism only seems to work if you lie about it. Telling the truth about socialism always requires a description of tragedy.

  7. I had two hernia operations courtosy of the V.A. This was the mid to late ’70s. It wasn’t the really good then, but I did survive. They held up pretty well.

    I haven’t been back and hope I never need to.

    1. Man I wish we had an edit button or I’d read before submitting. I was going to say wasn’t the best… but changed to wasn’t really very good. I got neither.

  8. “In health policy wonk circles, the VA has an electronic records system that is legendarily good. Yes, it’s comparatively expensive, judged against other types of health records systems, but studies have found that the expense pays off with even greater savings.”

    Ummmmmmm, did these studies use VA data as their reference? Just curious because the VA’s data also said that there where not any issues with scheduling appointments.

    1. Hey, HEY, You get out of here with that Logic.

      Bastard.. /s

  9. Health care by government is a failed notion that the government won’t admit to !.. just like trying to increase the size of you favorite recipe doesn’t really work all that well BIGGER is NOT Better

  10. It is amazing to the lengths the D’s are going to defend their sacred cow. Remember the VA is touted by every single-payer NHS and Obamacare advocate as a shining example. Bernie Sanders is even going so far as to actually reading the bill before he wants it brought to a vote. Watch how they will bluster and screech and then come up with the usual solution to every government program. “WE DIDN’T GIVE IT ENOUGH MONEY!”

  11. If the US had single payer health care it would be necessary to create the biggest government bureaucracy in history with a budget of about $2.5 trillion. That would be bigger than the entire GDP of Great Britain. What non-drooling human being thinks that would even be within the realm of the possible? (Don’t say Paul Krugman because he is an obvious drooler).

    1. It may even require its citizens to pay into a healthcare system, regardless of how much they make. This will upset delicate American sensibilities. They just about faint if the price of gas near 4.50 a gallon.

      In America, your “right” to healthcare will even more spelled out than Canada or elsewhere. The panicked politicians will do whatever is necessary to make sure that hospitals can’t ration care, create waiting list, or not accept insurance, etc.

      Calamity all around.

  12. All the democrat idiots will do is scream for more money, grow the bureaucracy, and wonder why it gets worse.

  13. Just compare the VA with health coverage for most government workers. They are covered by a choice of many private insurers, each year they have an open season to switch if they are unhappy. Not a single instance of any of the VA problems existing with health coverage for them. The power of choice in the free market works.

  14. Fake scandal!

    BOOOOOOSSSSSHHHHH!!!!

    Christfag peanuts hate the President because Rush told them to and BOOOOOOOSSSSSSHHHH!!!!

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