A few months ago I introduced some of the audience to the idea of "VA (Veteran's Administration System)logic". VA logic is the bizarre culture that has crept into the bureaucracy of the VA system that lead doctors who have trained or work in the VAMC system to shake their head when the system is held up as some paragon of universal health care.
While the VA system has America's only comprehensive electronic medical record system (which is a great thing), it has the world's most effective system of "nurses with clipboards" (NWC), non-clinical personal who walk around nagging everyone and serving little utility. Ironically, it's many VA employee's goal to be promoted to NWC/supervisor status because they get pay raises for doing less work then actually taking care of patients.
The VA system is much better benefits then no insurance at all or medicaid, but offers much less choice of providers or locations then a federal program like medicare. Veterans' reactions to the VA are very polarized in my experience. Some are very emotionally attached to the system, while others are resentful of the inconvenience of having to travel great distances and then having to suffer thru puzzling bureaucracy for appointments, consults, and surgery. My grandfather-in-law, a multiple purple heart & bronze star veteran from Iwo Jima & Guadalcanal in WW II, refuses to set foot in the VA even for free prescription benefits he'd be eligible for.
It is puzzling to imagine how building some parallel healthcare universe like the VA system is either cost-effective or sustainable. There already exists enough capacity in the "civilian" system to accommodate veterans without having to federally subsidize each and every VA hospital, clinic, & pharmacy. The federal benefits we're also covering for VA employees are also often much more generous then regular health systems.
I got thinking about this after reading the world's worst syndicated columnist, New York Times liberal Paul Krugman's column on "Voodoo Health Economics". Reading Paul Krugman columns regularly is like subjecting yourself to the cesspool of the Daily Kos (which I used to like BTW). Both have become so hyper-polarized with ideology they've ceased to be relevant.
As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.
Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”
That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.
I'd first like to offer a squid like Mr. Krugman the middle finger for disrespecting a man like John McCain.
On substance I could not agree more with Sen. McCain. We should be offering vets more flexibility rather then herding them into the VA system. How do you do that? You simply make them preferred Medicare enrollees which instantly give them access to any hospital (and potentially 90-95% of providers) they want. How do you guarantee the vets access? You sweeten the payment for this class of beneficiaries 3-5% above medicare rates or offer tax rebates for their care. Even that slim margin would start tremendous competition to serve that group. If vets are as happy with the VA as Krugman suggests, he should have to little to fear from offering them choice in the private sector, he's supposed to be an economist for chrizsake!
If Mr. Krugman was as savvy as he thought, he'd be encouraging something like this because Medicare is the front & back door towards the Universal Health Care system he's always ranting about. The more people enrolled, the greater the momentum it gets.