How could anyone have known that the Veterans Administration’s health care delivery system is a catastrophe? Easy. By reading Nobel Prize-winning Keynesian economist Paul Krugman in 2011, and then taking the opposite position.
What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform.
Many people still have an image of veterans’ health care based on the terrible state of the system two decades ago. Under the Clinton administration, however, the V.H.A. was overhauled, and achieved a remarkable combination of rising quality and successful cost control. Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records.
Anyone can become a competent economist by following this career path. Krugman announces a successful government policy or program. You take the opposite position. Then wait. It won’t take long. The headlines will validate your position soon enough. He does the heavy lifting. You just follow along behind, identifying the next big failure.
FRONT PAGE FOLLIES
The rule governing the news business is this: “If it bleeds, it leads.”
The rule governing bureaucracies is this: “Suppress it or spin it.”
The two rules are in conflict today in the Veterans Administration scandal. The media’s rule is winning this time. It rarely does.
My guess is that the Republicans are going to be successful in Congress when they push to find out what has happened in the VA.
When it comes to shortchanging veterans, no politician is willing to say that expenditures have got to be cut, and veterans have got to stand out in the cold, waiting to get inside. Veterans are politically untouchable. They are well organized. Obviously, there are degrees of importance in budgets. But, at the top of the list of importance, is care for veterans who have been wounded in military service, and who are shortchanged by the veterans’ hospitals. Anything that comes close to this story is the equivalent of cancer for the whole agency.
Something has happened that I cannot ever recall in my lifetime. The House overwhelmingly voted for a bill to make 400 VA bureaucrats legal targets for dismissal. This will overcome civil service rules making them nearly immune.
The Senate will probably pass it. Democrats are hopping mad. This is not seen as a partisan measure. If Obama fails to sign it, this will blow up under his Teleprompter.
The story of the Phoenix branch is getting a lot of publicity. It turns out that there had been repeated warnings about the complete breakdown of services in Phoenix. One physician warned in 2012 about the problem, and she was silenced. She was deliberately transferred to another department. This is standard operating procedure in every federal bureaucracy, but when it goes public, and it has to do with dead veterans, there is no way to hide.
When USA Today gets on your case, you are in big trouble. It has a lot of readers. They read this.
• Early 2012: Dr. Katherine Mitchell, a Veterans Affairs emergency-room physician, warns Sharon Helman, incoming director of the Phoenix VA Health Care System, that the Phoenix ER is overwhelmed and dangerous. Mitchell now alleges she was told within days by senior administrators that she had deficient communication skills and was transferred out of the ER.
• Later in 2012: The U.S. Department of Veterans Affairs orders implementation of electronic wait-time tracking and makes improved patient access a top priority. In December, the Government Accountability Office tells the Veterans Health Administration that its reporting of outpatient medical-appointment wait times is “unreliable.”
(For the rest of my article, click the link.)