American Elephants

Can the Problems at the VA Be Fixed? An Open Question. by The Elephant's Child

The backlogs at the Veterans Administration Hospitals appear to have resulted from demand from higher-ups to serve more people in less time in order to save money; and I  immediately remembered the scandal in Britain’s National Health Service (NHS), where they were keeping patients in ambulances parked outside the hospital so they wouldn’t have to log them in. Government guidelines  stated  how long patients would have to wait to be seen. If they were parked outside and not logged in, who would know? British reporters are not as politically correct as ours usually are.They reported the facts, and soon the whole world knew about their wait-list scandal.

The British newspapers have been, over time, a great source for following the failings of socialized (single-payer) medicine. The stories, and the failings, get reported.  However, there was a case where the work of our reporters did prompt real change — from former Secretary of Defense Robert M. Gates new book Duty: Memoirs of a Secretary at War:

On February 18 and 19, 2007, The Washington Post ran a two-part series by reporters Dana Priest and Anne Hull on the administrative nightmare and squalid living conditions endured by wounded warriors at Walter Reed Army Medical Center in Washington D.C. …The reporters described, in detail, Building 18, where a number of recuperating soldiers were housed, as rife with mold, filth, leaks, soiled carpets, rodents, cockroaches, and overall shabbiness. There were clearly not enough caseworkers to help outpatients and not enough help for outpatients and families to navigate through the huge hospital complex or the massive and confusing paperwork. I was shocked by the conditions described in the articles. At my morning staff meeting on February 20, I said we had a big problem on our hands, a failure to take proper care of our wounded warriors and their families. That had to be addressed immediately.

The secretary held a press conference 3 days later to announce an outside group to investigate the situation in depth, recommend remedial actions, and he gave them 45 days to report back with their findings. He held a press conference at Walter Reed, said the situation was unacceptable and would not continue. He expressed his gratitude to the reporters for bringing the problem to the attention of the Department of Defense. and said how disappointed he was that they did not discover it themselves. People were fired, military officers retired, but the situation was fixed, and promptly.

Apparently the Congress, successive administrations and the veterans groups relied on wait times as a primary performance measure. This emphasis, according to Yuval Levin who served as a health policy staffer in the Bush White House, was not tied to structural reforms that might make the VA system work more efficiently.

Centrally run, highly bureaucratic, public health-care systems that do not permit meaningful pricing and do not allow for competition among providers of care can really only respond to supply and demand pressures through waiting lines. It happens everywhere, but when it has happened at the VA the response has been to criticize waiting times rather than to reconsider how the system is organized.

The core of the scandal is what seems to be a highly organized effort to cook the books in order to be ale to report shorter wait times for care than were actually achieved. In order to work this system had to involve large numbers of people at each facility, and since it is in many facilities in the system, there had to be some collusion between them. The Obama administration set a goal in 2011 of 14 days between the time a patient asked for an appointment and the time that patient sees a doctor or a nurse. These targets, Levin says, did not account well for the huge differences between different kinds of patients seen by the VA, and they were directly tied to bonuses and salary increases for hospital administrators, creating a huge incentive to game the system and, as happened here, just lie about wait times.

The Phoenix hospital reported that it had managed by last year to get average wait times down to 24 days. The inspector general report found the actual average wait time was 115 days. That’s a lot of cooking the books.

Yuval Levin says the Department of Veterans Affairs is the most poorly managed cabinet department and probably among the most poorly managed agencies in the whole government. The veterans’ disability system has enormous problems as well. It is hard to overstate the political power of the veterans interest groups over the VA. The department is not subject to congressional or administrative oversight in the usual sense. It answers to veterans groups, who are likely to be resistant to fundamental change. Mr. Levin’s article is more informative about what the real problems are than most I have seen. Do read the whole thing.

The current problems at the Phoenix hospital and others are far different than the administrative dysfunction that has been a hallmark of the VA for so long. This is a massive conspiracy to benefit VA employees at the expense of their patients.


1 Comment so far
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Winding up seeing a new doctor far too often because of staff turnover leaves no fluency in treatment.


Comment by Carl D'Agostino

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