Phillip Longman
Phillip Longman, then a senior research fellow at the New America Foundation, gestures as he testifies on Capitol Hill in Washington, Thursday, May 15, 2014 (AP Photo/Cliff Owen).

(The following is Washington Monthly Senior Editor Phillip Longman’s opening statement before the House Committee on Veteran Affairs on May 27, 2021.)

Good afternoon Chairman Takano, ranking member Bost, and other members of the committee. Thank you for your invitation to testify on this vitally important topic.

My name is Phillip Longman. I am currently the policy director for the Open Markets Institute, where I focus on the growing problem of corporate monopoly in the health care sector. I am also a senior editor at the Washington Monthly and serve on the advisory board of the Veterans Healthcare Policy Institute.

I am testifying here today strictly on my own behalf.

My involvement with veterans health issues begins with the death of my wife, Robin, to breast cancer, in 1999. I never blamed her doctors for her demise. But the chaotic and poorly coordinated care we experienced at one, very prestigious academic medical center here in the nation’s capital set me on a journey. I wanted to find who might have ideas for improving the safety and quality of U.S. healthcare.

I wrote up the surprising results of my research in a book called Best Care Anywhere. In it, I describe how a large and growing peer-reviewed literature showed that, on metric after metric, the much-maligned Veterans Health Administration has been outperforming the rest of the U.S. health care system.

The book, which is now in its third edition, led to my being appointed in 2015 to serve on the Commission on Care. This commission was charged by Congress and the White House with developing a strategic plan for the future of VA health care.

Based on this background, I would like to offer the following observations:

  • First, in dealing with the VA, never forget to ask: “compared to what.” In 2014 the VA suffered enormous reputational damage following damning national headlines about unacceptable wait times at some VA facilities. But as I argued at the time, and as subsequent studies have confirmed, wait times at the VA were no worse in the aggregate than those found throughout the rest of the health care system. Since then, research shows that in three out of four specialties evaluated, access to care at the VA now surpasses access in the private sector. Yet perversely, many people are still under the impression that we need to privatize more VA health care because otherwise veterans will have to wait too long for treatment. The reality is closer to the opposite.
  • Second, beware false thrift.The VA, despite all the upheavals it has been through in recent years, continues to offer care that, as a rule, combines higher quality with lower cost. Recently, for example, researchers compared veterans who received emergency room treatment at the VA with those treated at non-VA hospitals. The VA patients not only had a 45 percent survival advantage, but the costof their care was 21 percent below what private sector hospitals charged.Meanwhile, the kind of coordinated primary and mental health care offered at the VA is generally not available at any price in the private sector. Such findings underscore the reality that, while it is appropriate for the VA to outsource some specialty services in some locations, in general outsourcing will lead to poorly coordinated, lower quality care that ill serves veterans and is far more expensive to taxpayers.
  • Third, learn the lessons of the pandemic. Covid revealed and aggravated vast, long-standing racial, class, and regional inequalities in our health care system. After years of closing and downsizing hospitals, particularly in rural and low-income urban areas, more and more Americans now live in places that have become “medical deserts.” At the same time, even rich hospitals have put margin over mission, with the result that they have virtually no surge capacity left and have cut back on routine services that don’t offer high financial returns. Far from shrinking VA health care, we should be expanding its public health mission and giving more people access to it
  • Finally, consider using the VA to combat the growing problem of health care monopolies. The majority of Americans now live in areas dominated by one large, monopolistic health care system, such as Partners in Boston, or UPMC in Pittsburgh or Sutter in San Francisco. In such places, the local VA hospital often provides the only remaining effective competition in the local health care market. Shut the local VA hospital down in these areas, and what will happen? Not only will veterans likely face lower quality care and more problems of access. But also, everyone seeking care in the community will be exposed to just that much more monopoly pricing—for everything from dialysis to lab work to hospital stays. The widespread cornering of local health care markets by predatory corporate health care giants makes expanding the VA role in the U.S. health care system all the more urgently in the public interest.

Thank you. I look forward to your questions.

Phillip Longman

Phillip Longman is senior editor at the Washington Monthly and policy director at the Open Markets Institute.