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Republican Assault on VA Reflects Fear of Cutting Healthcare Waste

The Republicans' current attack on the Veterans Affairs health system presages a more general assault on moves by Medicare to reduce the over-use and misuse of resources in the U.S. healthcare system. As shown by the GOP's desire to eliminate the new Independent Payment Advisory Board and defund the Centers for Medicare and Medicaid Innovation, Republicans are responding to pressure from the very same special interests in the healthcare and insurance industries that have created the crisis we face today.

The reason why Sen. John McCain and several Tea Party candidates proposed partial or full privatization of the VA in the run-up to the election is that it shows that a single-payer system can be more successful than private-enterprise healthcare. In fact, the VA is widely praised as the highest quality, most cost-effective part of the U.S. healthcare system, except for a few centers of excellence like Kaiser Permanente and Geisinger Health. Conservatives can't abide this fact, because it challenges their most cherished concepts: that government doesn't work and that "socialized medicine" inevitably rations care.

Michael Tanner, a senior fellow at the Cato Institute, a right-wing think tank, took this line in a recent blog post suggesting that the VA should be privatized because it rations veterans' healthcare. He cites research showing that only one-third of the drugs available to Medicare beneficiaries are on the VA formulary (its list of approved drugs). He also points out that veterans with psychiatric problems get one-third fewer visits with specialists than they would have received a decade ago. To show that government doesn't work, Tanner contends that the VA has a five-month delay in delivering some benefits and a high error rate in processing claims.

Well, the VA isn't perfect. But some studies show that it's delivering higher-quality care than what most people receive outside of the VA system. The main reasons are a tightly coordinated system of care and a universal electronic health record system that, while somewhat antiquated, is light years beyond the paper records that most non-VA physicians use. If Medicare has its way, private organizations will try to replicate the VA model of care delivery via accountable care organizations.

A 2003 paper in the New England Journal of Medicine showed the results of the VA's approach:

In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994-1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators.

Another study showed that the VA system's reduction of hospital capacity in the 1990s -- its number of hospital beds fell by 55 percent -- did not lower the quality of care. While hospital admissions were halved, doctor visits rose about 10 percent, urgent-care visits fell by 35 percent, and there was no compensatory increase in veterans' use of private hospitals. More important, "survival rates were unchanged during the study period."

This is what the Republicans and their backers really worry about: If the system becomes more efficient, and there's less need for the more expensive forms of healthcare, less money will be pumped into the system. In a $2.5 trillion industry, that's not chump change.

Dr. Maggie Kozel, who wrote an eloquent defense of the VA system on Huffington Post, recalls what universal health coverage was like when she served in the U.S. Navy:

Health care priorities were set by health care professionals, based on clinical evidence, rather than what insurance company executives decided in strategy meetings. Drug formularies were driven by pharmacists working with physicians, not by marketing executives. There was no incentive to create medical conditions just so we could implement expensive tests and treatments. And no money ever changed hands; just show your ID and you were in.

Before we listen to those who would dismantle the VA system, let's remember that this is one of the best parts of U.S. healthcare. Instead of destroying it, we should learn from it.

Image supplied courtesy of Wikimedia Commons.