Privatizion, Medical Care, and Walter Reed

This a three part posting about privatization, medical care, and Walter Reed. The first part consists of an extract from an excellent article form the Boston Globe describing how the Veterans Administration managed to create one of the best health delivery systems in the country — suggesting the potential of national health care.

The second piece discusses Linda Bilmes’s important work estimating the enormous cost of the care of Iraq war veterans, which could come to $2.5 trillion. Her estimate might be high, not because she overestimates the cost, but because of the efficiency of the government in denying health care — HMO behavior writ large. The article also describes how the government has taken measures to obfuscate the looming costs by fudging figures.

The third piece consists of notes from Henry Waxman to Major General George W. Weightman, former commander of Walter Reed Army Medical Center. This letter details how privatization has violently cut the number of personnel at Walter Reed and led to the voluntary departure of many skilled workers. As a result of this screw up, the reputation of government health care will be tarnished.

Here is the first article:Bennett, Drake. 2007. “Unlike the Army’s Walter Reed Hospital, The VA Hospital System Is Ranked, by Many Measures, as the Best in the Country.” Boston Globe (11 March).

“By many measures, VA hospitals and clinics are in fact the best in the country, and they achieve these results while spending 25 percent less per patient than Medicare. Recent studies from the Rand Corporation, the New England Journal of Medicine, and the National Committee for Quality Assurance, a healthcare watchdog organization, ranked the VA system, by a variety of criteria, as better not only than the sort of care offered by Medicare but even the best civilian healthcare plans.”

“Phillip Longman, a fellow at the New America Foundation and author of the forthcoming book “Best Care Anywhere: Why VA Health Care Is Better Than Yours,” says that among the veterans who rely on the system, “The overall picture is one of overwhelming satisfaction with the care”.”

“Indeed, the great complaint among veterans today is not about the care they receive in VA hospitals, but about the difficulty of getting into the system in the first place.”

“To cut down on the sort of doctor errors that kill tens, if not hundreds, of thousands of patients in the US every year, the VA system spelled out clear, evidence-based treatment guidelines for its physicians. Doctors and hospital directors were evaluated and publicly rated, for example, on how often their diabetic patients had their vision and kidney function checked, or how often heart attack victims were given cholesterol-lowering drugs and beta-blockers.”

“To aid its medical staff, and to help keep an eye on them, the VA developed an electronic medical-records system called VistA. In contrast to the civilian system, in which at most a quarter of hospitals have computerized records (few of which can effectively share information with other hospitals), all VA patient records are now computerized, and a doctor at any VA hospital or clinic can immediately pull up the complete records of any patient nationwide. Safeguards built into the software have all but eliminated drug prescription errors: In civilian hospitals and pharmacies, the error rate is as high as 8 percent, in the VA system it’s 0.003 percent.”

“Phillip Longman argues that it’s not in spite of the fact that the VA is a large, monolithic federal agency that it’s had such success, but because of it. Sweeping changes mandated at the top of the organization can be instituted throughout the system, and the fact that the VA gets its funding in a lump sum rather than in small payments from insurers (the way civilian hospitals do) makes it far easier to invest in large infrastructure improvements. Unlike Medicare, the VA can use its size to bargain over prices with pharmaceutical companies, and has done so aggressively.”

“Since 2003, however, only those who make less than $27,790 a year (the cut-off is higher if they have dependents) or who have “service-related” conditions or recent combat experience can get in.”

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