The VA 'model'
By Robert Goldberg
THE WASHINGTON TIMES
Published March 12, 2007
Recently, John Stossel of ABC had lunch with Sen. Hillary Clinton. Mr. Stossel writes that when he launched into one of his usual libertarian rants about free markets, Mrs. Clinton cited the VA as an example of government success. Indeed, under her husband's administration, the Veterans Health Administration came to provide the "best care anywhere," according to the Washington Monthly. It was clear in the Monthly piece and in Mrs. Clinton's other remarks about the glories of the VA health-care system that it was a model for expanding coverage to all Americans. Similarly, Democrats and the media could not contain their enthusiasm for the way the VA doled out drugs at bargain-basement prices as an alternative to the current Medicare drug benefit.
Democrats beat a strategic retreat from imposing restrictions on access to medicines that veterans deal with when it became clear that seniors valued freedom of choice. Mrs. Clinton might want to reconsider her recent depiction of the VA as a medical paradise she created in light of growing dissatisfaction and poor treatment of the mental-health needs of the members of the armed forces returning from Iraq. We know accepting responsibility is too much to ask.
The VA is having a hard time handling all the most common battle-related injuries: traumatic brain injury and post-traumatic-stress disorder. It is not a matter of lack of funding or staffing or compassion. It is a matter of trying to do what a single-payer government system does anywhere in the world: force as much of the treatment of specialized care of complex and chronic illnesses down to the primary care doctor in order to hold down costs.
The VA system has made much of the fact that some of its outpatient centers outperformed commercial managed-care organizations on certain process measures (screening for diabetes and diabetes-related illnesses, checking cholesterol levels) more than seven years ago. And no one should dispute that the VA has made strides to improve the ability to follow patients through the system, something that makes it easier to reduce errors and improve care.
But there are simple measures for judging the quality of care. If you need care, you get it when you need it. If you're sick, when you get treatment you get better. Finally, what is done is based on total well-being and for the long haul, not to meet a short-term budget goal. And the way to guarantee quality is simpler still. If you don't get care that meets those standards, you should be free to seek it out and get it somewhere else.
And when it comes to treating traumatic brain injury and post-traumatic-stress disorder, we have very good evidence about that earlier admission that newer medications and more aggressive treatments are essential to better outcomes. Both illnesses are also associated with other psychiatric disorders and substance-abuse problems. Meanwhile, on average, it takes six months for the VA to process a new claim for coverage. And once enrolled, it takes nearly a month to even get a primary care doctor, let alone to see a specialist for complex conditions. The VA is often in the forefront of research in such areas, but efforts to translate findings into clinical practice are stymied by the one-size-fits-all approach to doling out care.
And no amount of funding will change this approach fast enough to provide veterans the kind of care they deserve. More choice and the freedom to go outside the VA system rather than die waiting could make the difference. But don't hold your breath. Under the visionary leadership of Rep. Pete Stark, California Democrat, Congress is already seeking to reduce the amount of money spent on Medicare managed health plans to pay for other social programs. Since the so-called savings go to plans with the sickest seniors, siphoning that cash will not only hurt the elderly but would also deny veterans another choice of health care.
Congress is eager to give airplane passengers the right to a refund if they wait longer than three hours on the tarmac before takeoff. Why can't it give returning veterans the same right if they have to wait longer than what is medically prudent for care?
The failure of the VA system to meet the mental-health needs of returning soldiers is a direct result of the fact that they are not consumers but captives. If we are asking them to fight for our freedoms, the least we can do is give them the freedom to seek care when they return wounded from the battlefield. They truly deserve to receive the best care, anywhere they can get it.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest.