The current debate in Washington has more than a few complaining about the expanding role of government in health care. The question should be, can government do a better job than private industry?
Heck yes.
I’ve never been one to buy into the ‘government can’t do anything right’ meme. Sure, government (which, incidentally, is run by people elected by us) can make mistakes – some pretty big ones at times. But it can also perform very well – NOAA, the CDC, the Coast Guard, Head Start, the NIH, the GI Bill, National Weather Service are a few examples.
But perhaps the best is the Veterans’ Administration and the health system run by the VA.
Here are a few factoids…
– compared to commercial managed care plans, the VA provided diabetics with better quality care on seven out of eight metrics by NCQA.
– In 2005, VA hospitals were the highest-rated health system, outperforming other systems including the Mayo Clinic and Johns Hopkins.
– the VA achieves higher scores than private hospitals for patient satisfaction, staffing levels, surgical volume and other significant quality measures
– for six years running, VA hospitals scored higher than private facilities on the University of Michigan’s American Customer Satisfaction Index.
And costs haven’t increased nearly as fast as they have in the private sector. In the ten years ending in 2005, the number of veterans receiving treatment from the VA more than doubled, from 2.5 million to 5.3 million, but the agency needed 10,000 fewer employees to deliver that care – as a result the cost per patient stayed flat. (costs for care in the private sector jumped 60% over the same period).
The VA did this by closing down unneeded facilities, developing an industry-leading electronic health record system, opening clinics, and dramatically increasing the quality of care, especially for patients with chronic conditions.
Oh, and patients can access their own health records – securely – anytime on the web.
It wasn’t always like this; two decades ago the VA’s quality was suspect, to say the least. Yet this Federal government organization has been able to turn itself around from a mediocre outfit to one of, if not the, best health systems in the nation.
In his recent piece in the New Yorker, Atul Gawande offhandedly suggests the Feds open up the VA to anyone who wants to buy in.
Sign me up. I’d be only too happy to ditch the Golden Rule (in the running for most misnamed company…) insurance/HSA policy and head down 95 to the VA facility in West Haven, Conn.
Feb
9
Joe,
First, I love your blog!! I do not always agree with your views, but it is one of the best out there.
I do agree with you that the government can run some things better, but healthcare, I am not sure. Let’s look at Medicare, for example, are you telling me that they are running that federal program the best that it could be run? If that was the case, private insurance companies wouldn’t be involved. I believe that they like to have their hand in it to say that they have the power and provide the heavy-hand of oversight, but when the rubber meets the road, the program would be in alot worse shape that it is today, and that is saying something!!!
http://www.washingtonmonthly.com/features/2005/0501.longman.html
Joe–
Yes, I have toured a couple of VA facilities and they were very impressive, BUT the Federal government is a mixed bag. The same people also gave us FEMA. The VA is very targeted and managed by people with a mission. Compared to the US population as a whole, the VA system is quite compact. I would be very concerned about what could happen when the Feds try to scale up by a factor of, what? a hundred perhaps? We have well run and poorly run medical facilities in every large community, but we do have a choice (sometimes) to avoid the ones we know do not work well. Should the Feds become the only game in town and the model turns out to be FEMA and not the VA, where do we go then? There is a huge gamble inherent in the concept. Are we ready to take that gamble? If we try it and it doesn’t work, there is no turning back.
My grandfather would have called that betting the mortgage.
Gary
Joe, I think you make some good points, particularly about costs in the private sector, but I am not sure that socializing medicine is the answer. A lot of the issues you point out could be just as easily addressed by reforming insurance company behavior. The barriers that they put up to quality care are a big part of the problem. Check out this website (www.fairmanagedcare.org) and see for yourself. FAIR wants the same thing you- health care reform- the approach is just not as dramatic. FAIR is interested in implementing change and working toward a FAIR reform to America’s broken health care system. Go to http://www.fairmanagedcare.org, become a member, and fight back