The VA 'Model'; to Improve Care, Let Veterans Choose

Article excerpt


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. …