Should the Veterans Health Administration (VHA) serve as the model for the entire U.S. health care system? Many commentators, both left and right, sing its praises. The American Prospect's Ezra Klein calls it the "best medical system in America." The Competitive Enterprise Institute's Eli Lehrer states that it "has emerged as one of the best-run federal agencies." And many highly respected research institutions and journals have given it high marks, including the RAND Corporation, the National Committee on Quality Assurance, and the New England Journal of Medicine.
But one has to wonder if all of the praise captures the complete picture of the VHA. A Government Accountability Office (GAO) report (PDF) noted that "Most of the nation's 24 million veterans are eligible for some aspect of VA's health care services if they choose to enroll. In fiscal year 2005, about 7 million veterans were enrolled to receive VA health care services." If the VHA is so wonderful, why are more than 2 out of 3 veterans eschewing it? Furthermore, anecdotal evidence suggest some serious problems with the VHA, as with this commenter at Michael Medved's blog:
I'm a disabled veteran and I qualify for "free" healthcare through the Veteran's Administration....It takes six months to get an appointment, the last doctor I saw was foreign and had to have his nurse translate for him, they gave me medication that caused an allergic reaction and when I called to get the proper medication I was told that I had to wait another six months for an appointment to correct the problem. When I call to make an appointment I have no input into when it will be. I have to take what's available, even if it means missing half a day of work to get there. Many tests, procedures, and medications that are common downtown aren't available through the VA. There's a complaint system, but the attitude of the employees seems to be "If you don't like our service, go somewhere else".
Of course, relying on a blog comment as evidence is always risky, but it seems representative of many government reports on the VHA. In 2003 minority staff on the House Government Reform Committee examined VHA wait times in Georgia, Kansas and Oklahoma. The report on Georgia found that an estimated 36,000 veterans in Georgia would wait more than 30 days for an appointment in 2003, while the report on Kansas found that the average wait time was 58 days to see a primary-care physician, 76 days for an orthopedic appointment, and 49 days for an audiology appointment. In Oklahoma, the report (PDF) found 41% of eye appointments, 27% of cardiology appointments, and 20% of urology appointments were not made within 30 days.
In fairness, those reports relied on data from the VHA that is not always precise. For example, the Inspector General of the Veterans Administration investigated (PDF) wait times in the VHA in 2003 and found that the number of veterans who were waiting for an appointment was overstated. Yet even with the overstatement accounted for, there were still 218,000 veterans nationwide on a waiting list. However, the mis-measurement also seems to occur the opposite way. According to McClatchy Newspapers, a draft report by the Inspector General found that about 75% of scheduled appointments in the VHA occurred within 30 days. Earlier in the year, VA officials told Congress it was 95%.
Back in February, McClatchy Newspapers reported on considerable problems with the VHA's mental health system. Although the VHA began reforming its mental health treatment facilities over a decade ago, nearly 100 local VHA clinics provided virtually no mental health care in 2005. While spending on mental health increased slightly over that period, the VHA began treating many more veterans for mental health, driving down the amount spent per veteran from $3,560 in 1995 to $2,581 in 2004. Spending for outpatient treatment varied wildly, with some areas spending $2,000 per veteran and other spending as little as $500. Finally, in the last ten years average annual psychiatry visits for those on the VHA mental health system dropped from 11.7 to 8.1.
What about the various studies that gave the VHA such high marks? Interestingly, none of them track waiting times, and very few measures of mental health are included. The RAND study examined the greatest number of indicators, and on most of the indicators the recommended care was received no more than 80% of the time. Do we really want to model our health care system where the proper treatment is not given 1 out of 5 times?
Indeed, we don't want the U.S. health care system modeled on the VHA, and not just because the notion that the VHA is the best system in the U.S. is laughable. Putting everyone under a VHA type system would amount to "one-size-fits-all" for health care. A population of 300 million has very diverse health care needs, and any "system" needs to give the market sufficient liberty to meet those needs. Among other things, we should desire a health care system that doesn't ration by using waiting lists. The VHA doesn't measure up.
David Hogberg is a Washington writer and host of the website Health Hog.
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