THE BEST CARE ANYWHERE….Thanks to innovations introduced during Bill Clinton’s administration, VA healthcare is now among the nation’s best. It’s cheaper than either private healthcare or Medicare, the quality is top notch, and it operates according to strict performance standards. Sounds like a great model, doesn’t it? So how about saving the feds money by allowing vets on Medicare to switch over to the VA? Time magazine says it’s no dice:

Conservatives fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector. Congress has no plans to enlarge the scope of veterans’ health care ? much less consider it a model for, say, a government-run system serving nonvets. But it’s becoming more and more “ideologically inconvenient for some to have such a stellar health-delivery system being run by the government,” says Margaret O’Kane, president of the National Committee for Quality Assurance, which rates health plans for businesses and individuals. If VA health care continues to be the industry leader, it may become more difficult to argue that the market can do better.

It might indeed become difficult. But not impossible! Give ’em time and I imagine that Bush will do the same thing to the VA that he did to FEMA, another Clinton bureaucratic success story.

It turns out that the reasons for the VA’s success are pretty straightforward: there are inherent advantages to managing all of a patient’s healthcare needs over a long period, something that simply doesn’t happen in the pseudo-private market that most of us deal with. Phil Longman wrote about the VA miracle for the Washington Monthly last year and explained the problem with our current healthcare model this way:

As Lawrence P. Casalino, a professor of public health at the University of Chicago, puts it, ?The U.S. medical market as presently constituted simply does not provide a strong business case for quality.?

….Suppose a private managed-care plan follows the VHA example and invests in a computer program to identify diabetics and keep track of whether they are getting appropriate follow-up care. The costs are all upfront, but the benefits may take 20 years to materialize. And by then, unlike in the VHA system, the patient will likely have moved on to some new health-care plan. As the chief financial officer of one health plan told Casalino: ?Why should I spend our money to save money for our competitors??

….For health-care providers outside the VHA system, improving quality rarely makes financial sense….Investing in any technology that ultimately serves to reduce hospital admissions, like an electronic medical record system that enables more effective disease management and reduces medical errors, is likely to take money straight from the bottom line. ?The business case for safety?remains inadequate?[for] the task,? concludes Robert Wachter, M.D., in a recent study for Health Affairs in which he surveyed quality control efforts across the U.S. health-care system.

As it happens, the VA model isn’t the one I’d choose if I were inventing a national healthcare system for the United States. But it would probably be one component of it. And it demonstrates pretty conclusively that even in an older, sicker population, a national healthcare system can provide low-cost, high-quality service. We could do the same for every person in the country if we only had the will.

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