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January 23, 2006

Socialized Medicine Rocks

Kate writes:

The VA not only routinely out-performs the private sector, it arrived at that level of quality after years at the bottom of the barrel. When conservatives harp about Medicare Part D and conclude "government can't do anything right" -- here's another direction to point them. The only truly government-run system in the U.S., and it provides better care than all the others. Or, you know, we can keep playing "Bush's vision of health care" and let insurance go the way of the drug benefit.

Not only that, but she's got the numbers. Remember, too, that the VA is the only truly socialized health system in the US: they run the insurance side, sure, but also employ the doctors, build the hospitals, and administrate the care. All of which makes the VA a particularly fertile example for liberals because, unlike the French or German or Canadian systems, the VA exists within the America lifestyle context, short-circuiting the weird well-we-eat-more-cheeseburgers retort to arguments about lower medical spending and better health outcomes in foreign countries. The VA is cheaper, more efficient, less error prone, and boasts higher patient satisfaction than any system in the US, and it does so without the reputation for rationing, waiting lines, and low-tech care that erroneously plague other countries. Now, if some of our conservative friends have an answer for that, I'd like to hear it.

January 23, 2006 | Permalink


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Remember too that the military to which the Republicans pay symbolic homage is a cradle-to-grave socialized institution with substantial affirmative action elements. The military also promotes values like:

* Accountability
* No one gets left behind
* The unit is responsible for the success or failure of every member of the unit
* Everyone has the same haircut -- no free passes because of who your daddy is
* Sacrifice for the greater good is necessary

Not really very Republican values at all.

Posted by: paperwight | Jan 23, 2006 4:13:03 PM

That's a question I'd like answered, but also: why haven't any Democrats used the VA as a platform for change?

Posted by: Brian | Jan 23, 2006 4:14:18 PM

Someone I know has a relative that once got bad care at a VA hospital.

All of the claims in the above post are therefore invalidated.

Posted by: Stephen | Jan 23, 2006 4:33:42 PM

As an Average American, median in all respects, Stephen's point makes sense to me. It gives rise to the question, why does the out-of-mainstream left hate America's veterans?

Posted by: Sandals | Jan 23, 2006 4:40:54 PM

As Stephen hints, the VA has a terrible reputation. The fact that it's no longer deserved is pretty immaterial. "Numbers" - what a joke!

Posted by: Allen K. | Jan 23, 2006 5:17:27 PM

Part of it is that they take care of the patients for a long time, justifying preventitive care and etc....

Posted by: Isaac | Jan 23, 2006 5:55:35 PM

My guess - that the VA population is sicker than general public (they have to care for plenty of disabled)

But no rationing? huh? I worked with them 20 years ago, and there was lots of wait times and run-around.

I dont know about now, though.

Posted by: foobee | Jan 23, 2006 6:18:56 PM

Yeah, VA's totally changed.

Posted by: Ezra | Jan 23, 2006 6:22:15 PM

foobee, 20 years ago is another planet in terms of the VA

Posted by: Kate | Jan 23, 2006 9:27:05 PM

It's important to consider exactly what "rationing" and "waiting" refers to in regards to each type of health care system. Those things will, of course, occur in a private system or a public system. The difference is how it occurs in each system.

Posted by: Brian | Jan 23, 2006 11:58:28 PM

Who cares if the VA works? The important thing is to provide few government services, so as to reinforce conservatives' sense of entitlement to their advantages.

Posted by: Kimmitt | Jan 24, 2006 2:52:44 AM

The important thing is to provide few government services, so as to reinforce conservatives' sense of entitlement to their advantages.

There's no point in having treehouses if there's going to be laws about pulling up the ladders, now is there?

Posted by: Davis X. Machina | Jan 24, 2006 11:16:11 AM

Yeah, VA's totally changed.

How and when did they change?

Posted by: Fred Jones | Jan 24, 2006 11:33:53 AM

With the Power of Magic. 1785. (During their Battle Throughout Time.)

Posted by: Sandals | Jan 24, 2006 11:46:47 AM

Are you sure it wasn't the Power Of Love, Circa 1985?

Posted by: Adrock | Jan 24, 2006 12:30:10 PM

It's a serious issue. Ezra says and Kate say it's changed, and it may have. However, are they just looking at their numbers or was there a push to improve the VA system. If so, who was responsible for it?

Posted by: Fred Jones | Jan 24, 2006 12:36:43 PM

Ten years ago when asked for an example of a gov't program that I would get rid of, I would always answer the VA Health care system. Just give vets a voucher and let them go where they want, was my prescription. I've had to rethink that.

"However, are they just looking at their numbers or was there a push to improve the VA system. If so, who was responsible for it?" Fred asks.

Yes, there was a big push to improve the VA health care system. It occured under Clinton. Here's an excerpt from a Wash Post article in 1999: "(Kenneth W.) Kizer, 48, took charge of the VA's far-flung network of 172 hospitals in 1994 and devised a controversial plan to move patient care out of the hospitals and into hundreds of community-based medical clinics. When Kizer arrived in Washington, the number of veterans was declining rapidly and soaring medical costs had taken their toll on the quality of VA hospital care. At the same time, private hospitals were pioneering the use of cheaper outpatient care.

Kizer's plan, initially resisted by some VA officials, fundamentally reshaped the federal government's largest hospital system. "He did nothing less than save the veterans health care system," said VA spokesman James Holley, reflecting a widespread sentiment in the department."

There's a longer article on the VA at the Washington Monthly, The Best Care Anywhere

Posted by: SteveH | Jan 24, 2006 12:48:18 PM

As a patient of the VA, allow me to say that there was a dramatic improvement in the '90s, but over the last three years, many improvements seem to be falling off. The worst of the issues seemed to start after the restructuring and closing of some facilities a couple years ago.

I have switched to obtaining my service connected medications through my non-VA doctor, and my employers health plan for about the last year because getting them through the VA was not reliable, and I spent most of a month off my meds getting it converted. It has also been more difficult to get appointments, and a worstening of my condition was pretty much ignored by my VA doctor.

The staff at the VA seem to still want to good work, but one of them once hinted that they were not to be as "thorough" as they used to be.

Posted by: William Bollinger | Jan 24, 2006 1:18:34 PM

Okay - I worked in psych for about a decade and saw the inside of many a VA facility. And mental health departments are generally the most neglected in any hospital, private or otherwise. Our clients were usually very sick in addition to being psychotic or brain damaged. Maybe some of the most difficult cases in the system.
VA changed alot over that time period, and I mean alot. In the 80's the doctor/patient ratios were abysmal, wait times were a joke. Facilities looked old, dingy, and outdated. What made it even sadder was that most of the elderly patients (WWII and Korea vets many) just stoically sat it out and rarely complained, unless they were in some sort of terrific pain.
Into the mid 90's it began to change. One of the best changes was a better system of prioritizing patients and getting the patient into the right treatment plan right away. Record keeping improved too. Even transportation for disabled patients improved. The VA began to bring in younger, more upbeat and modernized doctors and technicians too. Another thing that changed was that fewer staff people got sick or injured at work (a big problem in psych units) thanks to better training and procedures.

Posted by: sprocket | Jan 24, 2006 1:19:38 PM

Which is to say that as with many things, execution matters a lot. Is there a fire-breathing socialist running Bolivia? Yeah, but I'm not excited since his skill set appears to begin and end with political mobilization and agitprop. If he starts hiring some talented technocrats, telling them what he wants done and backing them, maybe I'll get interested.

Our pet Stalinist clearly wants to hear some success stories from the right that don't emanate from Bill "Eisenhower Republican" Clinton. He should, it would appear, be agitating for some reality-based hiring by his favorite unitary executive instead of desperately trying to figure out how any socialized government program could possibly ever have worked, even only for a few years.

Well-run systems are worth ideological compromise.

And on private care, ptui. I just got another bill for a crown for which I'd already paid $500. And I "have" insurance. I am ecstatic that my family history indicates this will be my only big medical bills for the next few decades, because I'd rather not go bankrupt.

Posted by: wcw | Jan 24, 2006 2:28:01 PM

I would like to thank SteveH for the info and the link.

...as for wcw and his stupid, stupid statement.

Well-run systems are worth ideological compromise.

I would like to ask him if he now backs the eavesdropping issue with Bush.

Posted by: Fred Jones | Jan 24, 2006 2:37:53 PM

Socialized medicine doesn't work. The VA is a terrible example. You would be hard pressed to find many who believe they got good care there over any period of time. There is no country with socialized medicine that works. Maybe financially you think it will cost you less but anything that isn't life threatening has a huge waiting list. That is why they all flock here for care. Ever see a tv episode about americans going to a foreign land for MRI's ?

Posted by: ken | Jan 24, 2006 6:36:11 PM

ken, LOL. Power to the corporations!

Socialized medicine is like democracy. It's the worst form of healthcare, except for all the others that have been tried.

Hell, the key feature of socialized medicine, docs who are employed rather than contract, works better in the private sector. Kaiser-type systems and places like, um, the Mayo Clinic and the Cleveland Clinic, that employ their docs provide much higher quality care more cheaply than the bazillions of solo practitioners scattered all about the nation.

It appears that the VA is starting to go downhill again because, as it turns out, money matters. One can't cut already tight VA budgets in the middle of a war (when patient volume increases) and expect that it won't have an impact on the quality of care. Becuase of a better administrative structure, healthcare in the VA is far, far cheaper and more effective than in any other sector of the American healthcare system, but it turns out it isn't free. Shocking, I know.

Posted by: theorajones | Jan 25, 2006 9:16:02 AM

Those that are pushing the VA model, clearly haven't really spent time in those facilties.

The medical community (including me) would laugh at the suggestions that the VA is the right model.

While there are many technological innovations at the VA that are leading edge, overall patient care is abysmal.

If you're not a health professional- don't just disagree with me based on no data- ask someone you know and respect that has worked at the VA and other facilities.

Posted by: Rick Latshaw | Jan 25, 2006 3:49:21 PM

You don't understand, Rick. People like theorajopnes sit at the keyboard and, in true elitist fashion, tell you what is good for you whether you want it or not.

You need to get with the program!

Posted by: Fred Jones | Jan 25, 2006 4:18:49 PM

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