The VA Scandal and Cheap Government Medicine

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.

It took years of scandal to finally motivate the VA to close the brachytherapy program at the Philadelphia VA. Brachytherapy inserts radioactive seeds into tumors to kill the cells. According to The New York Times, a Philadelphia VA physician botched 92 of 116 cancer treatments over a span of at least six years. In some cases, seeds were inserted into in patients’ healthy bladders or anuses rather than into their cancerous prostate.

The Philadelphia program had no organized peer review. The problems were discovered by the Nuclear Regulatory Commission when a radiation safety official at the Philadelphia VA mistakenly ordered seeds with a dosage 20 percent lower than had been prescribed for the patient they were intended for.

In 2009, Joseph A. Williams, Jr., the Assistant Deputy under Secretary for Health for Operations and Management at the Veterans Health Administration, had the nerve to testify that “some of the brachytherapy treatments did not deliver the intended dose.” He then went through the usual anodyne claims that government officials resort to when crises disrupt their normal existence. Although 92 medical events were found, he reminded the committee that a medical event “does not necessarily mean Veterans were harmed,” never mind that he also promised that the Veterans Administration was paying for the additional treatments required to make things right. All would be well due to the new regulations requiring more paperwork and more procedure even though part of the problem that created the scandal was that existing procedures were ignored.

Committee members were also supposed to be comforted by the claim that “Secretary Shinseki and VA’s senior leadership are conducting a top-to-bottom review of the Department and are implementing aggressive actions to ensure the right policies and procedures are in place to protect our Veterans while providing them the highest quality health care possible.”

As long as it is run by government and patients have no real choice, VA scandals will come and go and the VA will not change. In Britain, waiting list falsification has been a problem for decades. In Canada, no effort was made to even monitor waits for care until the nonprofit Fraser Institute began to keep track. Waiting lists kill, but nothing is done about them — delaying surgery for a hip fracture by just 2 days increases mortality up to a year later, and people who wait for bypass surgery have a higher probability of dying.

The lessons for health care reform are clear. Power over patients corrupts. Absolute power, whether held by government or the private sector, corrupts absolutely.

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