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Don’t Blame The VA

Jul
19
2007

I like to combat the odd Republican in my columns in Spot-on, but it’s fairly unusual that the object of my humorous chiding is a fellow Spot-on-er. But this week Scott Olin Schmidt reworks the tired argument over Walter Reed Army Medical Center saying that since the hospital was revealed as a disaster some months back the government has no hope of competently running health care facilities, and by extension no hope of successfully running any type of health care organization including health insurance.
The evidence that Scott introduces – based on a somewhat misleading Associated Press story – is that Jim Nicholson Secretary of the Department of Veterans Affairs (VA) has resigned, apparently because of the Walter Reed scandal. Scott then makes the huge leap to say that if you don’t want to see the kind of problems Walter Reed represents, then you should be opposed to the very notion of universal health-care. And for good measure, he suggests that it is all Hillary Clinton’s fault as she “would apply the VA model for healthcare to everyone with one single-payer.”
The problems at Walter Reed were indeed severe, but they were mostly concerned with the incredibly disorganized treatment of outpatients, and their being housed in shameful conditions, while the system essentially ignored them. No one is denying that these were terrible problems, or that whoever was in charge should have fixed them. But blaming this on the VA as a knee-jerk reaction reveals a teeny tiny error.
Walter Reed is not a VA-run hospital. It is an army hospital, run by the U.S. Army and the Department of Defense. They are different organizations.
First an observation: The U.S. does an incredibly bad job looking after its veterans. In amongst all the propaganda about supporting the troops, we’ve spent 35 years leaving some of our veterans on the street and without all the care they need. But this has no connection to the VA system, or at least not much to its performance in the last decade. It has even less connection to the capability of the government to run healthcare facilities. And it has absolutely no connection to the concept of universal health-care.


So, there are two places Scott’s argument against increasing government involvement in health care can take us. After the Walter Reed scandal earlier this year, the VA did a major inspection of all its hospitals, and discovered apart from a few minor issues and wear and tear, they were in relatively good physical shape. More importantly, – and this may require those of you on the unthinking right to take a seat – over the last 10 years the VA has completely reinvented itself. It’s developed a computer system (VISTA) giving every veteran a full electronic medical record, it has become one of the leaders in providing chronic care management using advanced technology for veterans in their homes, and the quality of the clinical care it delivers to chronically ill veterans has been shown in peer-reviewed studies to exceed that of some of the better private sector HMOs. That’s why Philip Longman wrote a great article a couple of years ago calling the VA “The Best Care Anywhere.”
So if we don’t approve of the VA running hospitals for our veterans because “the government can’t do it”, then why should we approve of the Army doing it? Especially when the Army has shown that it actually can’t do the job very well! The logical conclusion? We should privatize the Department of Defense in its entirety. You may be a fierce patriot who believes that the Marine Corps is the best fighting force to be found on the planet, but there’s really no reason to suspect that the private sector could not do it better. And in fact by use of Halliburton for support and Blackwater for mercenary operations, it appears that we’re doing this by default.
But do you really want to privatize the Marines, just because the army can’t run social services for wounded soldiers?
Scott’s preferred post-war era health care solution – the creation of private sector subsidies as for education – is also a bit off the mark. The U.S. did have huge private sector subsidies in the post-war era. Chief among them was the sanctification of health care insurance as a tax-free benefit, which led to the huge growth in the private health insurance industry in the 1950s and beyond. But equally important was the Hill-Burton Act which provided massive public subsidies for the building of community hospitals all over America. So the concept of a private health care system emerging purely “by its bootstraps” after World War II is a rewriting of history.
Now I would agree with Scott in saying that it might have been better if, after WWII, a separate but equal system for veterans was not created. It would have been better if veterans had been transferred into an existing universal care system. That’s essentially what happened in every other country. That that didn’t happen – mainly because there was no such universal care system in the U.S. But, as the VA has shown, government-run facilities can do a very decent job with the limited resources that they receive.
It also apparent that all classes of American hospitals have both very good and very bad examples amongst them. For example, there are some excellent city and county-run hospitals in virtually every state, which do an incredible job on very limited resources. Scot might want to visit Santa Clara Valley Medical Center on his next trip to northern California. He probably would not want to visit King Harbor in south central Los Angeles (better known by its former name King-Drew) which is about to close after many years of complaints about terrible care. And of course there are many fabulously run community- or religious-order based non-profit hospitals in the U.S., but then again some notable ones within some of our more prestigious provider organizations have had significant problems. For example, in tony Marin County the biggest community hospital, Marin General which is part of the massive Sutter system, narrowly avoided being thrown out of Medicare for numerous patient care problems. And while there may be some excellent for-profit hospitals in the nation it doesn’t take long to find evidence in some of them of reckless disregard for patients at the expense of profits, such as happened at Tenet’s Redding, California hospital a few years back. So to say that private is good and public is bad is just a vast over-simplification.
Finally there’s the Hillary Clinton question. Admittedly if you got all your information about health care policy from watching Sicko, you might think that in the 1990s Hillary supported a single-player Canadian style system, or even a government provided UK-style system (which would look like the VA for everyone). But neither in 1993 nor in 2007 has Hillary Clinton nor any Democrat presidential candidate, with the exception of Dennis Kucinich, proposed either such system. In fact, had Scott paid attention to his liberal friends, he might have heard the health wonks among them criticizing Clinton for maintaining a role – and a leading one at that – for private insurance companies, employer-based health benefits, and for-profit hospitals in her proposal. There’s even greater criticism of Barack Obama for not even guaranteeing universal coverage at all.
There is room for a great mix of delivery solutions in the future of a fair and high-quality health care system. Right now we have neither. Making leaps from anecdote to policy statement because of one poor example is sadly all too common.

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