Category: Health Care Quality

The VA waiting list scandal is a strong piece of evidence that governments running monopoly health systems have few incentives to provide quality health care. The easiest way to cut costs is to deny access to prompt care, advanced treatments, and new drugs. As far back as 2007, the VA Inspector General reported that some of its facilities keep poor records and had long waits for care. It has never accurately estimated the size of its waiting lists, or been able to say exactly how it spends its budget.

VA care looks better than it is because a lot of veterans have Medicare or other private insurance. They can switch to private care when the VA fails. And VA care does fail. Even if they make it to the top of the waiting list, people stuck in the VA are 35 percent less likely to receive kidney transplants or effective modern drugs than people with private insurance.

Like most government entities, the VA often seems more concerned about the people who work for it than the patients it is supposed to serve. In 1995, he GAO reported that the VA shields “its physicians from the professional accountability that is required of private sector practitioners,” and it is not clear whether all of its hospitals have formal processes to report incidences of serious injury, death, or potential legal liability. In 2003, its electronic records were found to contain numerous errors, and did not include some important adverse events. As of 2007, its electronic patient records could be edited by unauthorized people.

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Ben Shapiro (Truth Revolt) has posted a list of recent quotations from leading public intellectuals cheerleading the VHA as a model of a well-functioning health system. Here’s former Enron adviser Paul Krugman in 2011:

Multiple surveys have found the VHA providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers…the VHA 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.

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(Fowles, et al. Journal of Patient Education and Counseling, 2009)

If you “strongly agree” with most of the questions above, you are a “highly activated,” patient. According to an article in the Wall Street Journal, health researchers have determined that the Patient Activation Measure (PAM) can identify “highly activated” patients, and that “highly activated patients” have better outcomes. (A New Vital Sign to Gauge: The Patient’s “Activation” Level, p. D1).

Judith Hibbard, identified as lead developer of the PAM assessment and a senior researcher at the University of Oregon’s Health Policy Research Group, assured the article’s author that the PAM is more than just a non-stick cooking spray: “Everyone assumes this is sort of a soft science, but we can measure patient activation just as rigorously and scientifically as other things in health care,” she reportedly said.

If that’s the case, health care is in bad shape.

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