Author Topic: The VA Health System Is a Tragic Warning Against Government-Run Health Care  (Read 2921 times)

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Christians4LessGvt

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The VA Health System Is a Tragic Warning
Against Government-Run Health Care


Liberals love the now-scandalized veterans health program,
but even at its best, it's not worth copying.


By Peter Suderman
May 29, 2014

Until recently, Democrats have not been particularly shy about expressing their feelings about the VA health care system. For years they have been telling us that it's great, a model system from which the rest of the nation's health care systems could learn a thing or two.

In 2011, New York Times columnist Paul Krugman called the program a "huge policy success story, which offers important lessons for future health reform." A few years earlier, he lauded it as a "real live case of impressive cost control." Writing in Slate in 2005, journalist Timothy Noah dubbed the program a "triumph of socialized medicine."

It?s not just liberal advocates. Democratic politicians have made their fondness for the program known as well. In the lead-up to the passage of Obamacare, Sen. Dick Durbin (D-Ill.) praised the Veterans Administration, and all government health care, as a "godsend" and then mocked a Republican Senator for imagining a future "government [health] plan where care is denied, delayed, and rationed." That future, Durbin said, was "fictitious."

Around the same time, Democratic Sens. Sheldon Whitehouse (R.I.) and Sherrod Brown (Ohio), gave a statement describing the "government health care" provided by the VA as "among the very best health care in the world." In another speech, Sen. Durbin piled on, insisting that veterans reliance on the "quality care" offered by the VA proved critics of government health care wrong. The White House got into the game too, posting a "health insurance reform reality check" declaring veterans? health care to be "safe and sound."*

The ongoing VA scandal over falsified records, and the deadly long wait times for care that appear to have been the result, seems to suggest otherwise: Veterans are not safe and sound within the fully government-run system, its quality control leaves much to be desired, and its lengthy wait times are not a fictitious prediction but an all-too-grim reality.

In other words, it's hardly a triumphant, model system. But even if there were no scandal at all, the VA wouldn't be a system worth emulating.

When Obamacare passed, we dodged getting a provision that was supposed to emulate the VA. The outbreak of Democratic praise over the program noted above revolved mostly around the possibility of a "public option" in the president's health care overhaul?a government-run health insurance plan intended to compete with private sector alternatives. The idea was scrapped, and Obamacare became law without it.

So what happens when the federal government actually makes an attempt to take an idea long used by the VA and apply it to the rest of the system? For that, we can look at recent efforts to spur adoption of electronic health records.

In health policy wonk circles, the VA has an electronic records system that is legendarily good. Yes, it's comparatively expensive, judged against other types of health records systems, but studies have found that the expense pays off with even greater savings. And it helped coordinate better health care too. "The VA's investment in the Veterans Health Information Systems and Technology Architecture is associated with significant value through reductions in unnecessary and redundant care, process efficiencies, and improvements in care quality," wrote a team of health IT researchers in a 2010 study for Health Affairs.

When the federal government earmarked about $20 billion (to start with) to help encourage health providers to install health IT systems in 2009, as part of the stimulus, it was hoping for a similar payoff. Just a few years earlier, researchers at RAND had published a report estimating that widespread adoption of electronic health records could eventually save $80 billion annually. The stimulus boost was a down payment on the potential for massive future savings.

The stimulus money was sent out to hospitals all over the country, and, with federal funding and a slew of incentives to act, new electronic records systems were rapidly installed. But the hoped-for savings never arrived. In fact, the health IT push may have helped drive federal health spending upwards, by making it easier and more efficient for hospitals to send bigger bills to Medicare.

The system-wide efficiency improvements never appeared either, because too many of the new health records systems couldn't communicate with each other. The federal government?s health IT investment was supposed to make health care better and cheaper. Instead, it made it more expensive and worse.

The operating theory of most health policy wonks often seems to be that if something works somewhere, it will work everywhere. But the history of health care administration is littered with failed attempts to replicate small successes on a larger scale. All we really know is that if something works somewhere, it will work somewhere.

Defenders of government health care might argue that electronic health records adoption hasn't worked in the U.S. because of its fragmented, partially private health system. But Britain?s fully socialized National Health System spent more than a decade trying to make a $20 billion health IT overhaul work before scrapping it entirely. It was the most expensive health policy failure in history.

The point is that even when and where the VA works well it?s not necessarily a system to emulate. That goes for the VA?s vaunted cost control methods too. Paul Krugman is right when he says that the system offers a real-life example of cost control; it really is cheaper than many competitors. But that?s only part of the story. It?s also necessary to account for how the system achieves its savings.

And one of the chief methods the VA uses to control spending is to organize its beneficiaries into eight "priority groups" that determine who gets the most care. The sickest and the poorest are at the top of the list, but everyone else gets shuffled into lower priority groups. And not all types of care are covered, which means veterans in most of the priority groups get the majority of their care outside the system. In 2007, the Congressional Budget Office reported that none of the eight priority groups received more than 50 percent of its care from the program. In 2010, the VA reported that just two of the priority groups?the two groups that have the highest cost per enrollee?had barely crept above 50 percent usage.

It's not a full-featured system designed to handle the complete health care needs of the population it covers. But it is an example of how government controls costs in health care: through strictly defined prioritization systems and limitations on treatments.

And that's how the system is supposed to work. Add the systematic lies and manipulations that the recent scandal has brought to light, and you have an accurate enough picture of how government health care works in practice.

That's the government system that Democrats and liberal advocates say they like, and that we should learn from. The scandal shows how bad a government-run system can get, but even the best-case scenario mostly provides lessons in what not to do.

http://reason.com/archives/2014/05/29/the-va-health-system-anti-role-model
"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

Xavier_Onassis

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Yeah, sure, let's privatize the VA.

Most of the veterans are quite fond of the VA. But it has a LOT of clients and the ones that get mistreated can always get a writeup in the press, because they were preventing the Vietnamese, the Panamanians, the Grenadians or the Iraqis from taking away our freedom.
"Time flies like an arrow; fruit flies like a banana."

Christians4LessGvt

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"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

Xavier_Onassis

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The cartoon is totally bogus.

The VA is entirely unrelated to Obamacare.

When Juniorbush mongered his unnecessary war, money was not allocated to care for the inevitable casualties, nor for the thousands of aging Vietnam Vets.
"Time flies like an arrow; fruit flies like a banana."

Plane

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  How will Obamacare escape the problems that the VA is having?

   Will there be no government involvement?

Xavier_Onassis

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The VA is run by the government, so of course there will be government involvement.

The same is true of Obamacare, There is, should be and always will be government involvement in health care, because market forces do not apply,and because citizens' lives are at stake.
"Time flies like an arrow; fruit flies like a banana."

Plane

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Would there be no benefit from having more free market forces apply?

The government is prone to having little empires in it , where the whole effort is in presenting an illusion of quality and effectiveness.

All governments are prone to this.


Julius Ceaser tried to conquer Britain, the British beat him by outthinking him and with guile.

Julius wrote an action report that got him promoted.


This is normal for government agencies.

sirs

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...not to mention what's a significant impairment to anything the Government touches, ESPECIALLY one's health and healthcare.  Who is going to be a better steward of their own money?.....the person who earned it, or the Government who takes it? 

For all the rhetoric the Government uses in pushing "compassion" and "its for the children", will never EVER be as vigilant at taking care of the $$$$, as a person who earned it in the 1st place.  Free market, with all the negatives that can be associated with it, at its core has the people themselves deciding what's best for them and their finite amount of resources.  A 3rd party government bureaucrat/politician has no incentive to be so diligant.  It's not their money. 

So the Government can say all the right things about lock boxes, and pledges, and support, and "citizens lives are at stake", but in the end, there's going to be far greater fraud and abuse in Government run systems, than in those steered by free market forces.  And that abuse will get worse, the bigger Government gets.  It's like a self feeding monster.  Yes, there will be the occasional Enrons, but compared to the abuse the Government gets away with, is not even a drop in the $$$$$$ bucket
"The worst form of inequality is to try to make unequal things equal." -- Aristotle

BT

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I have zero complaints about the care i have received at the VA. And the budget for the VA has gone up every year since 2001 in anticipation of returning vets and the aging of Vietnam era vets.

Christians4LessGvt

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the budget for the VA has gone up every year since 2001 in anticipation of returning vets and the aging of Vietnam era vets.

Last 8 Years:
8% increase in Veterans
34% increase in VA Budget

per CNN "State of the Union" TV Show today.
"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

sirs

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I have zero complaints about the care i have received at the VA. And the budget for the VA has gone up every year since 2001 in anticipation of returning vets and the aging of Vietnam era vets.

Excellent    8)    You need to post more often Bt.  Your postings are missed
"The worst form of inequality is to try to make unequal things equal." -- Aristotle

sirs

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*cue the crickets with the Bergdahl debacle*
"The worst form of inequality is to try to make unequal things equal." -- Aristotle

Xavier_Onassis

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Last 8 Years:
8% increase in Veterans
34% increase in VA Budget
===============================
Not at all surprising. In the last 8 years, the number of servicemen wounded by explosive devices has increased, and the number of VA vets reaching 65 has also increased.
Cancer treatments, open heart surgery and prosthetics are very expensive.
"Time flies like an arrow; fruit flies like a banana."