The VA and the Health Care Debate

Anyone who is serious about genuine health care reform should immediately go to Amazon — or preferally their local, independent book store – and buy/order Philip Longman’s excellent book “Best Care Anywhere: Why VA Health Care Is Better then Your’s”  The book is much more than an exploration of the kind of care delivered at the nation’s largest public health system.  It explains precisely why “socialized” systems like the VA,  and other countries’ national health systems are the only ones that have an incentive to deliver better care and do it at lower costs than private systems.  Although right wing politicians excoriate “socialized” medicine, it turns out that almost half of our health care system is “socialized.”  (Note can we get rid of the bogeyman once and for all and realize that what “socialized” really stands for is “socially responsible.”)

In Longman’s book we learn that the VA has pioneered some of the most extraordinary health care information technology that is now used internationally as well as in the private sector.  This technology keeps patients much safer and it’s a direct result of the efforts of innovators who were working for the government.  Yes, that’s right, the government does actually do some things right.

We also learn that the VA delivers much more preventive and health maintenance services than private insurers.  Why?  Because the VA takes care of its patients from the moment they enter the system to the moment they die.  This long-term perspective gives the VA an incentive to deliver better care and to actually prevent or manage chronic illnesses that is utterly lacking in the private insurance market.  Why is it lacking?  Because the enrollees in private insurance plans turn over almost entirely every seven to ten years.  That means an investment in the long term care of patient A enrolled in insurance company B makes no economic sense because that investment will probably benefit insurance company H — the company the patient will land in twenty years down the road.  The same is true of private employers.  They have little incentive to initiate wellness programs for their employees.  “It makes no financial sense,” Longman writes,” for their employers to spend money to help them put off or avoid, for example, the various chronic diseases of old age, because most of these workers will be retired or moved on to a new job before anyone realizes the benefit of such an investment.”

The VA has an incentive to make a long-term investment in quality care– including prevention and health mainteance — because its patients stay in the system over the long-term.  That’s why, Longman, tells us, the VA will often purchase more expensive rather than cheaper medications because they are better and more effective and their perspective extends over years and is not fixed on the quarterly profit statement.  The VA also does more work with diabetics on nutrition and exercise and can actually tout it’s care of the sick because taking good care of people makes not only human but economic sense.

If hospitals and insurers advertise the fact that they have better services for sick people, like say diabetics, what happens?  They are punished for their good deeds.  They are inundated with sicker patients but not reimbursed commensurately.  Longman relays amazing data on why private insurers and hospitals don’t advertise their initiatives for chronically ill patients..”Suppose an HOM takes a more idealistic attitude and decides to invest in improving the quality of its diabetic care anyway.  Then not only will it risk seeing the return on that inevestment go to a competitior, but it will face another danger.  What happens if word gets out that this HMO is the best place to go if you have diabetes?  Then more and more costly diabetic patients will enroll there, requiring more premium increases, while its competitors enjoy a comparatively large supply of low-cost healthy patients.”  Ditto hospitals.  Why is it that insurers and hospitals only advertise pictures of healthy people.  Because they don’t want too many sick people to crowd the corridors.  Moreover, if hospitals initiate programs that make people healthier, then they are paid back by losing revenue.

Not so the VA.

This book, as I said before should be required reading for all policy makers and anyone interested in health care reform.  It should also encourage us all — not just vets and the families of vets – to support or local and national VA health care institutions.  Turns out, we are all benefiting from the innovations of this wonderful service and its dedicated workers.  Maybe instead of Medicare for all, the motto should be VA care for all.