Tuesday, June 3, 2014

qotd: Phillip Longman: VA health care is still the best

June 2, 2014
Poll: Confidence in veterans' care plummets to new low
By Susan Page

Americans' confidence in the medical care provided for soldiers
returning from Iraq and Afghanistan has plummeted to new lows in the
wake of the VA scandal, a USA TODAY Poll finds. Most people see the
problem as widespread and systemic.

Just one in five rate the job the government does in providing veterans
with medical care as excellent or good, about half the percentage who
said that in a Pew Research Center survey in 2011. Then, half rated the
care as "only fair" or poor; now seven in 10 do.

42% have little or no confidence that the problems can be fixed.

Eight in 10 worry that the issue is turning into a political battle in
which Democrats and Republicans are more interested in scoring points
than solving the issue. On that question, there is almost no difference
by party affiliation.



Washington Monthly
June 3, 2014
VA Care: Still the Best Care Anywhere?
By Phillip Longman

Last week, when I accepted an invitation to go on Hugh Hewitt's
nationally syndicated talk show, his first question to me was, "So how
does it feel to be the author of a book about the VA that has been
thoroughly discredited?"

Well, yes, as the author of the title Best Care Anywhere, Why VA Health
Care would be Better for Everyone, it's been dispiriting to have it
confirmed by a preliminary inspector general's report that some
frontline VA employees in Phoenix and elsewhere have been gaming a key
performance metric regarding wait times. But what's really has me
enervated is how the dominate media narrative of the VA "scandal" has
become so essentially misleading and damaging to the cause of health
care delivery system reform.

I don't mean just the fulminations of the right wing press. It's nothing
new when Fox rolls out Ollie North to proclaim that any real or reported
failure of the VA is proof of the case against socialized medicine.

I'm also talking about the work of hard-working and earnest reporters,
who due to a combination insufficient background knowledge and the
conventions of Washington scandal coverage, wind up giving the public a
fundamentally false idea of how well the VA is performing as an
institution. Over the next several days, I plan to make a series of
posts here at Political Animal that I hope will be helpful to those
covering the story, or for those who are just trying to get the full
context for forming an opinion.

Today, let's just start by scrutinizing the now almost universal
assumption that there is a "systemic" problem at VA hospitals with
excessive wait times. Even progressives, including the likes of Jon
Stewart and Bill Maher, seem predisposed to believe this for their
different reasons. Some voices, like my former colleague Brian Beutler
of The New Republic, even speculate that the scandal may ultimately
bounce in a way that harms the Republicans more than it does the Democrats.

But before we go there, can we get clear on just what the underlying
reality is? There is, to be sure, a systemic backlog of vets of all ages
trying to establish eligibility for VA health care. This is due to
absurd laws passed by Congress, which reflect on all us, that make
veterans essentially prove that they are "worthy" of VA treatment (about
which more later). But this backlog often gets confused with the
entirely separate issue of whether those who get into system face wait
times that are longer than what Americans enrolled in non-VA health care
plans generally must endure.

Just what do we know about how crowded VA hospitals are generally?
Here's a key relevant fact that is just the opposite of what most people
think. For all the wars we've been fighting, the veterans population has
been falling sharply (pdf). Nationwide, their number fell by 17 percent
between 2000 and 2014, primarily due to the passing of the huge cohorts
of World War II- and Korea War-era vets. The decline has been
particularly steep in California and throughout much of New England, the
Mid-Atlantic and industrial Midwest, where the fall off has ranged
between 21 percent and 36.7 percent.

Reflecting this decline, as well a general trend toward more outpatient
services, many VA hospitals in these areas, including flagship
facilities, want for nothing except sufficient numbers of patients to
maintain their long-term viability. I have visited VA hospitals around
the county and often been unnerved by how empty they are. When I visited
two of the VA's four state-of-the-art, breathtakingly advanced
polytrauma units, in Palo Alto and Minneapolis, there was hardly a
patient to be found.

But at the same time there is a comparatively small countertrend that
results from large migrations of aging veterans from the Rust Belt and
California to lower-cost retirement centers in the Sun Belt. And this
flow, combined with more liberal eligibility standards that allow more
Vietnam vets to receive VA treatment for such chronic conditions as
ischemic heart disease and Parkinson's, means that in some of these
areas, such as, Phoenix, VA capacity is indeed under significant strain.

This regional imbalance in capacity relatively to demand makes it very
difficult to manage the VA with system-wide performance metrics. Setting
a benchmark of 14 days to see a new primary care doc at a VA hospital or
clinic in Boston or Northern California may be completely reasonable.
But trying to do the same in Phoenix and in a handful of other sunbelt
retirement meccas is not workable without Congress ponying up for
building more capacity there.

Once you have this background, it becomes easy to understand certain
anomalies in this scandal. If care is really so bad, for example, why
did all the major veterans services remain unanimous in recent testimony
before Congress in their long-stranding praise for the quality of VA
health care? And why have they remained stalwart in defending the VA
against its many ideological enemies who want to see it privatized? It's
because, by and large, VA care is as good, if not better than what vets
can find outside the system, including by such metrics as wait times.

Similarly, if VA care were not generally very good, the VA would not
continue to rank extraordinarily high in independent surveys of patient
satisfaction. Recently discharged VA hospital patients for example, rate
their experience 4 points higher than the average (pdf) for the health
care industry as a whole. Fully 96 percent say they would turn to VA
inpatient care again.

Now if you go out looking for vets who say they have been victimized by
the VA, you will have no trouble finding them, and many will be
justified in their complaints. But as I'll argue further in future
posts, the key question to ask when confronting the real deficiencies of
the VA is "compared to what?" Once that context is established, it
becomes clear that VA as a whole continues to outperform the rest of the
American health system, making its true lessons extremely important to

(Phillip Longman is senior editor of the Washington Monthly.)



Comment by Don McCanne

Phillip Longman, as the author of "Best Care Anywhere, Why VA Health
Care would be Better for Everyone," is a person to whom we can turn to
get the full story on the VA health care "scandal" and how
representative it is of the system at large. According to him it is not
only the right wing attacks claiming that this is proof of the case
against socialized medicine, but it is also "hard-working and earnest
reporters" who "wind up giving the public a fundamentally false idea of
how well the VA is performing as an institution."

The new USA Today poll confirms that the reporting has caused Americans'
confidence in the VA health system to plummet, with the perception that
the problem is widespread and systemic. Americans do recognize that the
politicians are more interested in scoring points than they are in
solving the issues (Sen. Bernie Sanders being a notable exception).
Nevertheless, the poll indicates that they now believe that the
government is doing a poor job and 42% have little or no confidence that
they can fix the problems.

Longman states, "it becomes clear that VA as a whole continues to
outperform the rest of the American health system, making its true
lessons extremely important to learn." When individuals make the claim
that the VA "scandal" proves that single payer would not work in the
United States, refer them to this series being written by Phillip
Longman where they can learn the truth.

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