A few years ago, Paul Krugman wrote this:
I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system – it runs the hospitals and clinics.
No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.
In the 1980’s and early 1990’s, says an article in The American Journal of Managed Care, the V.H.A. ‘‘had a tarnished reputation of bureaucracy, inefficiency and mediocre care.’’ But reforms beginning in the mid-1990’s transformed the system, and '‘the V.A.‘s success in improving quality, safety and value,’’ the article says, ‘‘have allowed it to emerge as an increasingly recognized leader in health care.’’
And also this:
Yes, this is “socialized medicine” … and suggests what it will take to solve the troubles of U.S. health care more broadly.
So there’s no doubt about it. The VHA is a fine, pristine example of what we ought to expect from socialized medicine. And how’s that working out? Well, some folks in the recent pit thread say they haven’t heard anything about the topic. So here are the some high points:
At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list. The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.
Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it. Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments: There’s an “official” list that’s shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there’s the real list that’s hidden from outsiders, where wait times can last more than a year.
“The scheme was deliberately put in place to avoid the VA’s own internal rules,” said Foote in Phoenix. “They developed the secret waiting list,” said Foote, a respected local physician. According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor’s appointments for veterans within the computer system. Instead, Foote says, when a veteran comes in seeking an appointment, “they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there’s no record that you were ever here,” he said.
Okay, so we’ve got the federal government killing veterans by denying them care, lying, violating its own rules, and an devising an elaborate scheme to cover it all up. That’s at the Phoenix location. Is this an isolated incident?
Nope. Similar things have happened in Colorado. And Texas. And North Carolina. And Wyoming. And St. Louis. And Chicago.
And the government assures us that the revelations thus far are “the tip of the iceberg”. So apparently the VHA has been doing a lot of stuff that’s as bad or worse than this.
Needless to say, a lot of media coverage immediately delves into political implications and how much blame the Pres. deserves. And indeed, even though there’s been reporting on these issues for years, Obama has been forced to say yet again that he didn’t know what his own administration was doing until the media reported it to him, while even supporters are admitting that it’s hard to defend him on this one. But broadly this is more about government in general than about the actions of the President. As we’ve already seen, the VHA is touted by its fans as an example of the wonderful things that socialized medicine can achieve. And indeed, socialized health care systems in other countries have given people long waits for cancer treatment, huge waiting lists, restrictions on treatments, and falsifying records. And in Canada, with its true single-payer system, “The estimated cost of waiting for care in Canada for patients who were in the queue in 2011 was $1.08 billion—an average of about $1,144 for each of the estimated 941,321 Canadians waiting for treatment in 2011. This is a conservative estimate.”
In health care debates, we hear a lot of horror stories about what can happen to people when they can’t get insurance or get bad insurance in a private insurance market, and indeed bad things can happen. But we need to be honest about the bad things that can happen in a socialized system too.