BEST CARE ANYWHERE….The Washington Post’s recent series about the crappy care at Walter Reed Hospital has been a real eye-opener. But the culprit probably isn’t money. The hospitals operated by the Veterans Administration had a similar reputation 20 years ago (remember Tom Cruise in Born on the Fourth of July?), but as you’ve probably read in dozens of articles recently, they’re now among the best in the country — and the VA budget is no more generous now than it was a decade ago. It was management changes during the Clinton administration, not money, that have made the entire VHA medical system among the best in the country, and the first person to point that out was Phil Longman, who wrote “Best Care Anywhere” for our January 2005 issue:

An outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures….And who do you suppose this year’s winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.

….If this gives you cognitive dissonance, it should. The story of how and why the VHA became the benchmark for quality medicine in the United States suggests that much of what we think we know about health care and medical economics is just wrong. It’s natural to believe that more competition and consumer choice in health care would lead to greater quality and lower costs, because in almost every other realm, it does….But when it comes to health care, it’s a government bureaucracy that’s setting the standard for maintaining best practices while reducing costs, and it’s the private sector that’s lagging in quality.

Examining the turnaround at the VHA system tells us a lot about what works and what doesn’t in healthcare. Some of the answers are surprising, and some of them are common sense. (Preventive medicine, anyone?) And the print edition of the Washington Monthly was the first place to tell you the story.

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