Of course, that was before the Arizona Republic reported last month that at least 40 veterans had died while waiting for appointments at the Phoenix VA hospital and before CNN reported last month that the hospital’s managers had created a secret wait list and shredded documents in an attempt to hide the fact that 1,400 to 1,600 sick veterans were forced to wait months to see a primary care physician. [“Deaths at Phoenix VA Hospital May Be Tied to Delayed Care,” by Dennis Wagner, Arizona Republic, April 10; and “A fatal wait: Veterans languish and die on a VA hospital's secret list,” by Scott Bronstein and Drew Griffin, CNN, April 30]
Since then other problems have come to light at veterans hospitals around the country, including those in Fort Collins, Colo.; Austin and San Antonio; Cheyenne, Wyo.; Durham, N.C.; St. Louis; and Chicago. [See Avik Roy’s rundown of the problems in his article “No, the VA Isn’t a Preview of Obamacare—It’s Much Worse,” Forbes, May 23, 2014]
Back in 2011, Paul Krugman wanted us to think the Veterans Health Administration offered lessons for health care policy:
Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records.
What’s behind this success? Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. And because V.H.A. patients are in it for the long term, the agency has a stronger incentive to invest in prevention than private insurers, many of whose customers move on after a few years.
And yes, this is “socialized medicine”—although some private systems, like Kaiser Permanente, share many of the V.H.A.’s virtues. But it works—and suggests what it will take to solve the troubles of U.S. health care more broadly. [New York Times, November 13, 2011]
And in 2009 Ezra Klein wanted to let everyone go to Veterans Hospitals:
If you crudely ordered America’s different health-care systems from least government control to most, it would look something like this: individual insurance market, employer-based insurance market, Medicare, Veterans Health Administration (Medicare is single-payer, but VA is actually socialized medicine, where the government owns the hospitals and employs the doctors).
If you ordered America’s different health systems worst-functioning to best, it would look like this: individual insurance market, employer-based insurance market, Medicare, Veterans Health Administration.
That symmetry should get more attention in the health-care discussion than it does. [Washington Post, June 3, 2009]