Since early May of this year, the Veteran’s Administration hospital system has been in the news when it was revealed that at least 40 veterans had died while awaiting care at the Phoenix VA hospital. An investigation of the delays revealed that delays were not only widespread throughout the VA system, but that personnel at many facilities had collected bonuses in part because of outright deception related to the reporting of backlogs. At the end of May, VA Director Eric Shinseki took the blame and resigned.
History of the VA system
The first federal government agency to treat armed forces veterans was established in 1812. It wasn’t until after the Civil War ended in 1865 that Congress established homes for disabled veterans. President Hoover, an engineer who took pride in efficiently solving problems, created the Veterans Administration to consolidate all services for veterans in 1930. The modern VA hospital system was created in 1945 with the building of new hospitals to specifically serve veterans. During that time, many of those hospitals became affiliated with medical schools and still continue to serve as training grounds for newly minted doctors. There are now nearly 1700 separate VA facilities including hospitals, outpatient clinics, and nursing homes. The VA system employs about 280,000 full time workers, has a budget of about $55 billion per year, and treats as many as 9 million veterans annually
The VA system is completely separate and distinct from the Military Health System, which is geared to serve active duty personnel. Like the VA, however, the military’s health facilities cannot accommodate the demand for care by all active duty service people, their dependents, and retirees (many of whom are not eligible for VA services). So it has its own government-provided insurance plan, called TRICARE, for those who cannot obtain care at a military health hospitals or clinics. TRICARE, much like Medicare, is insurance that is paid by the government, but uses private doctors and hospitals. In fact, TRICARE rates are tied to Medicare rates.
The scope of the problem
The entire VA system is the purest realization of single payor government health care. Although progressives believe such a system is preferable to the Affordable Care Act, which combines government benefits mandates administered through private insurance companies, it should be no surprise to anyone that the system is broken. An audit by the VA Inspector General found nearly 60,000 veterans are waiting to get appointments at the VA, and 70% of facilities have used an alternative to official appointment schedules to make wait times appear shorter. The audit of 731 VA facilities and nearly 4,000 employees found widespread problems that included pressuring of employees to change data. More than 10% of scheduling staff were given instructions on how to alter patient-appointment scheduling, according to the audit.
Since 2005, the agency’s inspector general has issued 18 separate reports identifying national and local problems with scheduling. Why is it any surprise to hear how awful they can be? Has anyone been to the DMV or Post Office lately? The typical congressional solution is to simply throw more money at the problem rather than fix the inherent problems at the VA. Which is exactly what they did last week.
What is the cost of the VA relative to private hospitals?
Operating rooms at VA hospitals are typically used for 2-3 operations/day instead of the 4-6 in private hospitals. Nevertheless, the VA may in some aspects be cost effective. The advantages of a single payor system has made the logistics of care more efficient at VA compared to private hospitals. The VA has electronically integrated records for labs, pharmacies and imaging. Its physicians do not utilize heavily promoted but only marginally more effective but wildly more expensive drugs. Certainly the care at some hospitals has been substandard, but stories abound of veterans who claim wonderful outcomes. The social aspects of veterans’ care alongside that of other vets is repeatedly cited as a huge benefit.
How do we fix the problems?
Perhaps the fastest way to improve the VA system would be to make Congress and staff use the facilities and just watch how fast they improve. This is of course unrealistic as Congress and their staff don’t even subject themselves to the provisions of the Affordable Care Act.
Few Americans would deny that our veterans are entitled to quality care. But the reality is that the 20 million or so of our veterans primarily use the VA system for old age related problems. That care is readily replicated elsewhere. Government does nothing as well as the private sector because they are legally unable to respond to problems and change. There is no one to complain to, and administrators are essentially unable to fire under performing personnel. Scapegoating Eric Shinseki won’t change very much. He probably didn’t even know about the problems. Several layers of bureaucracy were either lied to or so unreliable that they didn’t look.
The best solution to the never ending pattern of scandals and funding increases is to get the government out of the business of providing general health care. The VA system should be privatized and our veterans should be brought into the Medicare system. Let’s let individuals sort out where to receive their care and vote with their feet if that care is not provided in a timely and professional manner.