Politicians are climbing over each other to see who can express the most outrage over the failings of the VA. Sen. John McCain as usual led the charge, the first to demand the resignation of the Phoenix VA hospital director. Other eagerly joined in.
The Obama administration swung into their now familiar “we’ll get those perps” mode. At least Obama isn’t claiming for now that the VA’s problems are a contrived crisis like the Benghazi and IRS scandals he was originally outraged about too.
The problem isn’t that the VA has been hijacked by devious slackers. Sure, it’s a typical self-protecting bureaucracy, not a well-oiled machine. But most veterans in the system are appreciative of the care they receive. I personally had some contact with the VA in my fathers declining years. Many workers obviously saw their job as a calling, to provide care for those who have defended America. I was impressed
Nor is the problem a lack of effort to provide adequate resources. VA funding has actually increased 76 percent (24 billion) from 2007 to 2012, while enrollment climbed only 13 percent during that period.
Nobel prize winning economist Paul Krugman unwittingly got to the heart of the problem when writing a while back in his New York Times column that “exhibit A for the advantages of government provision [of health care] is the veterans administration, which runs its own hospitals and clinics, and provides some of the best healthcare in America…”
Alas, the VA is indeed another example of how a government-run medical system works. Here’s why. In functioning economic markets, the price of a good or service serves as a signal to all the players. If the price goes up, supplies enter the market until the price stabilizes while if prices fall, demand increases. If the price is zero, the demand is theoretically infinite and some other way must be found to limit the supply.
In medical care, this is rationing. Rationing can be accomplished by limiting services or providing them only to certain patients. Alternatively, rationing can be accomplished by long wait times. It is not necessarily venal, it is inevitable.
The veterans administration had a couple of special factors contributing to its “perfect storm.” The first was the large number of veterans returning from wars with physical and psychological damage. We not only have a contract but a solemn obligation to provide for those who risked everything for our country. Their needs are simply not met by an appointment in a few months.
The other problem is that the VA mission is indefinite. Many veterans without service-connected conditions are eligible for lifetime services “as available” or “if eligible.” Yet their rights to services are often confused in media accounts with those of higher priority.
Still, the VA produces overall results similar to other government bureaucracies that run healthcare systems. In Canada, whose system is often touted as a model we should emulate, the average wait between referral from a general practitioner to receipt of elective treatment is now 18.2 weeks, 39.6 weeks (almost 10 months) if you unfortunate enough to require orthopedic surgery. A recent report identified over 44,000 female deaths from wait times since 1993, 2.5 percent of total women dying.
In the UK’s government run system too, patience is necessary. Surgical patients are four times more likely to die than in the US, partly because “long waiting lists mean diseases are more advanced before they are treated,” according to researchers from University College London.
Here, politicians will huff and puff and some more heads will probably roll. But the reality is we could fire every VA administrator today and rationing medical care would still be necessary tomorrow. It’s the nature of the beast.
Ideally, we could provide our veterans with entry into a patient centered system where they would receive personalized services based on a doctor’s judgment without bureaucratic delay. Unfortunately, this option is vanishing as U.S. medical care becomes more like the VA.
Obamacare is based on the notion that we can promise virtually everything to everybody and “someone else” will pay for it. We are about to find out there’s nothing more expensive than free medical care.
• East Valley resident Tom Patterson is a retired physician and former state senator. He can be reached at firstname.lastname@example.org.