Commentary on the VA health care system

Thanks to a loyal reader for this link. Disclaimer – I am a part time VA employee and attend on the wards there 4-5 months each year.

Revamped Veterans’ Health Care Now a Model

For years, the Department of Veterans Affairs’ sprawling health care system was criticized by veterans groups and government investigators as a dangerous backwater of medicine. Report after report portrayed it as suffocating from top-heavy bureaucracy, dirty and unsafe hospitals, and little or no accountability. Thousands of eligible patients opted to get their care elsewhere.

But in the past decade, largely unnoticed by the public, the system has undergone a dramatic transformation and now is considered by some to be a model.

Researchers laud the VA for its use of electronic medical records, its focus on preventive care and its outstanding results. The system outperforms Medicare and most private health plans on many quality measures, including diabetes care, managing high blood pressure and caring for heart attack patients. Demand at veterans clinics and hospitals is soaring — so much so that Congress last month appropriated $1.5 billion in emergency funds to cover a budget shortfall that the department did not anticipate.

Some experts point to the VA makeover as a lesson in how the nation’s troubled health care system might be able to heal itself.

The VA of 2005 barely resembles the VA of 1975 when I was an intern. The system has an exemplary EMR which does work for medical care. Outpatient care has greatly improved.

One can criticize the VA still. It does have waiting list problems. This occurs with diagnostic testing, routine appointments, surgical consultations and surgery itself. The system does result in de facto rationing. It is a flawed system, yet I could easily argue that all health care systems have flaws.

It does have the advantage of a controlled formulary. The VA negotiates excellent prices on pharamaceuticals.

The VA system makes a very interesting example to study. Many veterans use the system to their own advantage. They receive much of their care at the VA, but also use the greater US health care system when they find such usage to their own convenience.

So the VA does work much better than it once did. It provides excellent but not perfect care. We must understand when evaluating the VA that it would not work as well without our commercial health care system.

Perhaps our best long term option is to expand the VA (or a VA like system) to provide basic care to non-veterans and allow patients the option of purchasing speedier less rationed care. This issue is complex, but a very interesting starting point. Remember the HL Mencken quote on the left. For every complex problem, there is a solution that is simple, neat, and wrong. The VA system makes a nice starting point, but using that system as an anchor does have both advantages and disadvantages.