D. Dowd Muska


Ask a Veteran About Single-Payer Healthcare

June 26, 2014

Anomalies. Rarities. Anecdotes.

When government bureaucracies are exposed for laziness, waste, ineptitude, or fraud, administrators hasten to tell taxpayers that abuses aren’t common. Most “public servants,” spinners aver, are capable, honest, hardworking, and on the prowl for ways to improve efficiency.

That argument’s always been shaky, and making it just got tougher. “Friendly Fire: Death, Delay, and Dismay at the VA,” a report by the office of Sen. Tom Coburn (R-OK), is a compendium of horrors culled from federal documents and press coverage. Don’t read it at night.

The Veterans Health Administration (VHA), a division of the cabinet-level Department of Veterans Affairs (DVA), “operates the largest integrated health care system in the country. With over 288,000 employees, [it] provided medical care to over 6.4 million patients in 2013.”

As the Cato Institute’s Michael D. Tanner explained in May, “Like all single-payer health systems … the [VHA] controls costs by imposing a ‘global budget’ -- a limit to how much it can spend on care. Thus year-to-year funding varies according to the whims of Congress, not according to what consumers want or are willing to spend. … When resources can’t meet demand in a given year, the [VHA] does what other single-payer systems do: It rations.”

Limiting supply, “Friendly Fire” charges, contributes to services that are “inappropriate and insufficient, or provided too late or not at all.” Result: lots of dead vets.

Sure, the system stinks. Former Pentagon chief Robert Gates believes that “Congress has micromanaged veterans affairs in such a way that changing anything that has to do with dealing with veterans requires literally an act of Congress.” But VHA employees consistently demonstrate a preference for reliable paychecks over quality care: “Thaddeus Raysor, an Army veteran, reported to a VA hospital yearly for chest x-rays. For three years, VA staff failed to diagnose a growing lesion in his lung -- which ultimately killed him. … In Ohio, Air Force veteran Charles Pennington bled to death following a liver biopsy, because hospital staff did not check in on him after his procedure.”

According to a whistleblower’s report filed with the U.S. Office of Special Counsel, “a resident admitted for a service connected major depressive disorder went more than five years without appropriate psychiatric consultation, treatment, or medication.” In addition, “an individual diagnosed with … schizoaffective disorder and drug-induced Parkinsonism went more than 11 years without appropriate psychiatric treatment and specific lab monitoring.” When a VHA psychiatrist in West Virginia complained that some patients with mental problems were experiencing ten-month waits for counseling, “her bosses stopped talking to her.” (Unsurprisingly, the Government Accountability Office found that the VHA “does not have a reliable and accurate method” to determine if it is “providing patients timely access to mental health care services.”)

Cover-ups are a department specialty. Top management “has known for at least six years that ‘scheduling tricks’ were being used to hide the delays for veterans’ health services, according to an internal memo.” Meanwhile, compensation remains sweet. Of the ten highest-paid federal bureaucrats, “all work at the [DVA].” In Phoenix, where “at least 18 veterans died due to delays and scheduling misrepresentations,” nearly “$10 million in bonuses” were paid in the last three years. In 2011, Legionnaires’ disease killed six and sickened 22 at a Pittsburgh VHA nursing home. Yet the regional director in charge received a “Presidential Distinguished Rank Award at a gala in Washington” and “a $63,000 bonus, in part to recognize [his] infection prevention policies.”

Coburn understands that additional revenue is no solution -- it’s likely to be squandered on construction-cost overruns, AWOL employees, “official time,” travel and conferences, excessive salaries, improper bonuses, decorations and renovations, red tape, unauthorized purchases, IT snafus, overpayments, and malpractice settlements.

“Friendly Fire” wants Congress “to hold the VA accountable,” and recommends enhanced oversight and transparency. Fine. But the best way to help veterans is to not create more of them -- i.e., shift foreign policy toward America First, not policing the planet in a bloody and futile attempt to protect “U.S. interests” and “international norms.” Next up, the sale of all VHA land, facilities, and equipment, then the crafting of a mechanism to issue veterans vouchers to purchase the services they need in the healthcare marketplace.

Oops. There isn’t a healthcare marketplace.

Well, then, that’s the step to start with. Recognize the folly of healthcare either run or micromanaged by government. Deregulate and desubsidize. Empower consumers, entrepreneurs, investors, and charities to improve services for both military and civilian patients.

In the Age of Obamacare, that’ll be a long, hard slog.

D. Dowd Muska (www.dowdmuska.com) writes about government, economics, and technology. Follow him on Twitter @dowdmuska.

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