Trying To Maintain Rationality

Tuesday, July 11, 2006

"The Best Medical Care In The U.S."

(Crossposted in a diary entry at DailyKos)


The July 17th edition of Business Week [that publication known for its wacky, liberal agenda **cough**] magazine just came out with a big article on how Veterans Affairs gives the best medical care in the United States.

How about that? The VA. Single-payer, government-provided healthcare... is the best. This "socialized medicine," as it turns out, is a misnomer -- it's actually "efficient medicine." I suppose could go into the economic theory, definitions and esoterica explaining why publicly-provided healthcare makes sense, but... not now.


Let me simply give you some blurbs from the article:


The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.

According to a Rand Corp. study, the VA system provides two-thirds of the care recommended by such standards bodies as the Agency for Healthcare Research & Quality. Far from perfect, granted -- but the nation's private-sector hospitals provide only 50%. And while studies show that 3% to 8% of the nation's prescriptions are filled erroneously, the VA's prescription accuracy rate is greater than 99.997%, a level most hospitals only dream about. That's largely because the VA has by far the most advanced computerized medical-records system in the U.S. And for the past six years the VA has outranked private-sector hospitals on patient satisfaction in an annual consumer survey conducted by the National Quality Research Center at the University of Michigan. This keeps happening despite the fact that the VA spends an average of $5,000 per patient, vs. the national average of $6,300.

Ok then. Works better for less money.


A nationwide health-care network that gets its funding from a single payer can institute mighty changes. Proponents of national health-care reform extrapolate even further. "The VA proves that you can get better results with an integrated, organized, national health-care system," says Dr. Lucian Leape, a professor at the Harvard School of Public Health and a leading expert on hospital safety. "We will not achieve even close to the level of quality and safety we need [in the U.S.] as long as we have individual practitioners and hospitals doing individual things."

The VA is, in many ways, the exact opposite of America's fragmented private-sector system, where doctors work for hospitals as independent contractors, and third-party insurers pay the bills as they see fit.

Jeepers. What else?

Because it treats patients throughout their lives, it can invest in prevention and primary care, knowing it will reap the benefits of lower long-term costs. Because the government pays the bills, the VA doesn't have to waste time or money on claims-related paperwork. Unlike Medicare, the VA is allowed to negotiate prices with drug companies and other suppliers, and it uses that power aggressively. The consumer group Families USA estimates that Medicare Part D enrollees, on average, pay 46% more than the VA for the same drugs.

The VA also gets to keep any money it saves through cost efficiencies. In the private sector the savings flow back to whoever is paying the bills.

Zoinks. I'll bet the caregivers suck, huh?

That doesn't mean it's settling for second-rate physicians. Among the VA staff is a Nobel prize winner, and clinical research is conducted throughout the system. The Buffalo VA recently hired one of the city's top surgeons, Dr. Miguel A. Rainstein, as chief of surgery. He had spent 26 years in private practice, where, he concedes, he made a lot more money, but he was ready for a lifestyle change. "I feel the VA has always gotten a bad rap. They have an excellent medical staff here, in surgery and in specialties."

The staff is happier, too, since much of the bureaucracy that once hobbled the organization has been streamlined.

Oh - guess not.

... here's the part that I normally work with - the VistA system:

The centerpiece of that culture is VistA, the VA's much praised electronic medical-records system. Every office visit, prescription, and medical procedure is recorded in its database, allowing doctors and nurses to update themselves on a patient's status with just a few keystrokes. In 1995, patient records at VA hospitals were available at the time of a clinical encounter only 60% of the time. Today they are 100% available. Some 96% of all prescriptions and medical orders, such as lab tests, are now entered electronically. The national comparison is more like 8%. "One out of five tests in a civilian hospital have to be repeated because the paper results are lost," says Veterans Affairs Secretary R. James Nicholson. "That's not happening in our hospitals." VistA is a big reason why the VA has held its costs per patient steady over the past 10 years despite double-digit inflation in health-care prices.

VistA has also turned out be a powerful force for quality control. The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies. Such tracking pays off. When Rand did an extensive study comparing quality of care at the VA with private-sector hospitals, it found that performance measurement played an important role in helping the VA score higher in every category except acute care, where it came in about even.

Pretty spiffy, huh?


There's much more to the article; read up!

The whole thing is right here.

Single-payer. Publicly-provided. That's the future of healthcare that WORKS.


  • Excellent post! And congrats on being a part of the best medical care in the nation.

    By Blogger Desi, at Tuesday, July 11, 2006 8:14:00 PM  

  • **salutes**

    By Blogger EconAtheist, at Wednesday, July 12, 2006 10:20:00 AM  

  • The state of our VA hospitals (and the lack of funding) is a slap in the face to those who served their country honorably. And you know that if the fat cats who regularly underfund the VA had to use that same system for their own health care, things would change in a snap!

    On another note, my family has s similar medical history to yours (myself included), and I congradulate you for how much you've accomplished.

    Personally, I heard it all throught my youth, "you're so smart.... if you'd only APPLY yourself"...

    Sometimes I think that the only thing between me and total insanity is letting out my thoughts (on my blog, and also by 'commenting' on other sites) about what's going on with our so-called 'leaders' in DC, and the failure of the 'Free Press' to do their job, which is to question the status quo.

    Anyway, good job and keep up the good work.

    By Blogger TR, at Tuesday, August 01, 2006 9:03:00 PM  

  • I should also add that my mother worked as a nurse at the VA hospital in Florence, Mass. after teaching nursing for years. She cared very deeply for her patients, and did the best she could within the system, but there were always problems with funding.

    I applaud all those who work at these VA hospitals, I just wish that you didn't have to work so hard to stretch the dollars.
    Granted, lessons are being learned in how to do the most with your budget allotment, but you shouldn't be put in that position. The VA should be well-funded amd should reflect the sacrifice that our courageous men and women make to serve this country.

    Imagine what you could accomplish if the VA was fully funded!

    Unfortunately, too many Washington lawmakers think it's more important to have their 'pet projects' make it into the budget than things like taking care of our troops after they've served our country.

    BTW, my mother is now in an altzheimers facility (also in Florence,Mass.) and she still trys to help the other patients any way she can. She's amazing...

    Anyway, I just wanted to clarify my comment.

    By Blogger TR, at Tuesday, August 01, 2006 9:47:00 PM  

  • Thank you, Tom. Sorry to hear about your mom's condition...

    Yeah -- I'm always left wondering how much better the VA system could be if it were properly funded.

    We have to squeeze the crap out of every penny over there... the department that I'm in had been understaffed (due to external hiring freezes; had less than 1/2 staff) for close to two years, and it, predictably, fell far behind in so many aspects... fortunately it's getting better, but that's only because we have a full staff again. Oh - and it's patently ridiculous when we - not kidding here - have administrative freezes on purchasing hi-liters...

    Man. We're gonna have a bunch of Vets needing medical care for many decades, that's for certain.

    By Blogger EconAtheist, at Wednesday, August 02, 2006 5:02:00 PM  

  • It seems to be obvious to me that none of you are veterans (I am), nor have you ever worked for the Veterans Administration (I have). While you prop your blogs up with figures derived from VA sponsored surveys you are totally ignorant of the truth.

    I have seen (and experienced) the VA's treatment of patients and if you had you would be shocked. When I worked for them in the 80's (for free) they would not treat me, but i did see what they had done to other persons. One example was the drugging, with major tranquillizers, of an alcoholic, while drunk' and then sent back on to the streets to be homeless. I won't recount to you the horrors I saw in the wards because it is too painful.

    In the middle-late 90's they practically begged me to come in for treatment and strangely enough they out-did themselves in taking fairly good care of me. However, instead of using non-addictive pain-killers, since they were not on their pharmacy list as accepted, I was forced to use narcotic analgesics resulting in addiction. (I am since free of this addiction on my own, having withdrawn myself from them while living on the streets, since the VA decided to mail my disability checks to just any old address they chose and when they tired of that they started sending my checks to the address of a Sober-living/Half-way house I had managed over five years before, resulting in my having to live on the streets even longer.)

    Now since my last period of exile on the street as a non-person they refuse to let me see my physician of record for almost 10 years without my jumping through the hoops and going through re-testing and re-examining me for the same problems that I have had all along. They have and will continue to offer me surgery, performed by students, on my back, that is an antiquated proceedure that has an over 50% chance of crippling me, causing me to be incontinent and even have more pain that I already have. There are proceedures offered in private hospitals that can repair my back without the problems, but because of the imaginary privatization of the government system(s), they will not pay for it because it is not life threatening.

    Recently I went to the VA ER because I was urinating blood. I believe it was happening because I was exposed to Agent Orange. The hospital and their web-site is littered with material about getting tested for Agent Orange, but when I approach them about it all I get is blank stares or 'I don't know(s)'. They sent me home that night, still bleeding and set me an appointment for 2 and one-half months later. By then I had stopped bleeding, but I still have times when it occurs. The point is, I could have bleed to death during that waiting period. Fortunatley, I haven't, yet...

    I have another diagnosis and the is I am bi-polar. They will and do see me at the drop of a hat and happily drug me. I guess they figure, that if they drug me, like they do to so many other veterans, they can keep us 'under-control', that is placated into a state of bliss, that we won't be a bother to them, and we won't demand anymore of the services we were offered in our military contracts when we signed up. And they won't be bothered by us so they won't have to do the job they are paid to do.

    So, in the face of the above, I have chosen to live with my crippling pain, take their psychiatric drugs and have ordered my survivors to sue them for everything they can get should I die due to the VA's neglect and the government's failure to honor the contract they signed with me when I enlisted in the military.

    So, no, Sirs, I cannot agree with you that the VA system is a good model to present to the public as one of excellence. Since I am politically Socialist, I can't say that the public sector is a good model either. What I will say is that all medical services in this country ought to be socialized and aimed at helping those who need it for whatever reason, and not be allowed to continue to polish it's own apple as the VA is currently doing.

    By Blogger j_e_alexander, at Saturday, August 19, 2006 12:51:00 PM  

  • j_e -

    Your situation sounds terrible.

    I guess I can only offer you the most sincere best wishes and hope that you get the medical care that you deserve, being a military veteran.

    You're correct - I'm not a veteran. I must point out that I do, in fact, work for the VA.

    As far as the system goes. Hm. The experiences you've described - while awful and unacceptable - are certainly not representative of the VA as a whole, at least not as it stands now.

    Again, I hope you get your due care. You fulfilled your end of the bargain.

    Here's to better days,


    By Blogger EconAtheist, at Saturday, August 19, 2006 9:58:00 PM  

  • Well contrary to j_e_alexander's expierences, I too am a vet..100% disabled Gulf War vet, and I have expierenced rather good care at the hands of those who work there. that is NOT to say I have never run into rude people or sometimes had to wait until they could take care of a more serious case(this is medical care, and sometimes emergencies do not wait), but on the whole the care at the VA is even better than the care I recieved while I was still in the Army after returning from the deseret.

    And your right econatheist, the transition from large paper files to the computerised system has improved the care we can get. No longer do I have to carry referals from doctor to doctor, when my primary provider send me for an X-ray or other specialised care. And even though you do not work at the hospital I go to Louisville Ky. VA, I as a vet would like to thank you for the service YOU provide to my fellow vets.

    By Blogger clif, at Saturday, September 23, 2006 2:39:00 AM  

  • Naw - thank you.

    It's my pleasure, clif.

    My pleasure.

    By Blogger EconAtheist, at Friday, September 29, 2006 9:17:00 PM  

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