What the VA system did is what we can all expect under single-payer

As we noted before Memorial day, the Veterans’ Administration Hospital scandal does not surprise us in the slightest. But, naturally, the scandal keeps growing. From The Daily Beast:

Last week, President Obama pledged to address allegations of corruption and dangerous inefficiencies in the veterans’ health-care system. But before the president could deliver on his pledge, the scandal has spread even further. New whistleblower testimony and internal documents implicate an award-winning VA hospital in Texas in widespread wrongdoing—and what appears to be systemic fraud.

Emails and VA memos obtained exclusively by The Daily Beast provide what is among the most comprehensive accounts yet of how high-level VA hospital employees conspired to game the system. It shows not only how they manipulated hospital wait lists but why—to cover up the weeks and months veterans spent waiting for needed medical care. If those lag times had been revealed, it would have threatened the executives’ bonus pay.

What’s worse, the documents show the wrongdoing going unpunished for years, even after it was repeatedly reported to local and national VA authorities. That indicates a new troubling angle to the VA scandal: that the much touted investigations may be incapable of finding violations that are hiding in plain sight.

“For lack of a better term, you’ve got an organized crime syndicate,” a whistleblower who works in the Texas VA told The Daily Beast. “People up on top are suddenly afraid they may actually be prosecuted and they’re pressuring the little guys down below to cover it all up.”

“I see it in the executives’ eyes,” the whistleblower added. “They are worried.”

The current VA scandal broke in Phoenix last month, when a former doctor at a VA hospital there became the first whistleblower to gain national attention. The doctor’s allegations of falsified appointments—and veterans dying while they waited for treatment—unleashed a wave of similar claims from VA employees nationwide. In Cheyenne, Wyoming, Chicago, and Albuquerque, more VA whistleblowers came forward claiming that the same fraudulent scheduling was being used in the hospitals where they worked. At last count, the VA inspector general’s investigation had expanded to 26 separate facilities.

More at the link.

Now, let’s get real here: if the same methods are being used at VA Hospitals so widely spread across the country, then it’s more than the actions of a couple of rogue administrators; the probability that this wasn’t known about, and encouraged, by the Department of Veterans Affairs leadership in Washington is getting lower and lower with each report.

After retiring in January of this year Spann sent a letter to VA investigators accusing a VA employee of manipulating patient wait lists to hide treatment delays for veterans. The rigged reporting scheme Spann described in his letter, which threatens veterans’ lives by delaying their treatment, is the same method that has been exposed in Phoenix, Cheyenne, Albuquerque, and scores of other VA hospitals across the country.

According to Spann, Dr. Gordon Vincent, chief of radiology at Olin E. Teague Veterans Medical Center in Temple, Texas, didn’t just break VA policy by manipulating veterans’ appointments himself. He ordered VA employees across central Texas to engage in the same fraudulent practice.

The VA said it investigated Spann’s charges, and, after, finding nothing to substantiate the claims, cleared Vincent and the Texas VA.

But documents obtained by The Daily Beast appear to show Dr. Vincent doing precisely what Spann accused him of—the activities the VA said it could not substantiate.

In the above document, taken from the VA’s internal record system, you can see Dr. Vincent cancel an ultrasound appointment for a veteran suffering from cirrhosis. Vincent tells the doctor who submitted the original order to change the desired date—the day the provider selected for the procedure based on their diagnosis and clinical judgement—citing the facility’s patient backlog.

Veterans are supposed to be seen within 14 days of their desired date, according to VA policy.

Again, more at the original.

Now, why wasn’t The First Street Journal surprised?  Because this is precisely how single-payer health care systems across the developed world do things!  Delaying or stretching out appointments and treatments is a cost-saving measure, one widely practiced; why would anyone expect the single-payer VA system to be any different?

And that’s the crux of the matter: Americans do expect it to be different, because those of us who have private health insurance are used to much better service from the private, for-profit health care system.   Physicians and hospitals compete with each other, attempting to maximize profits.

On the old site, the New Zealander who identified himself as the Phoenician in a Time of Romans told us that he went private to get ingrown toenails cut out, and had two podiatrists working on him, rather than wait four months for the appointment that New Zealand’s single-payer system gave him. Four months, suffering through ingrown toenails?  At the rate that toenails normally grow, they would have grown completely out the end of his toes by that time.  He chose to get it taken care of privately, paying out-of-pocket rather than suffering for four months — and ingrown toenails just flat out hurt! — but what he also did was save the government the costs of paying for the treatment. The stretched-out appointment schedule did exactly what it was meant to do.

More, the Phoenician even told us that the two podiatrists he paid, privately, to take care of his toenail problems were the same podiatrists who would have performed the procedures during the government-scheduled appointment. They were working on the side to supplement their government salaries, in effect demonstrating the same profit motive that enables Americans to get much more prompt treatment in our for-profit system. We had a supporter of socialized medicine, one telling us how great it was, but unintentionally confirming to us exactly what we already knew about economics and the profit motive.

The Veterans’ Administration health care system is one in which the profit motive has been removed, one which cannot make money — though some top administrators can make hefty bonuses if they get the numbers looking good — and one which has been behaving just like socialized medicine systems in other countries.  There’s simply no getting away from the need for health care administrators to hold down costs; they have budgets which have to be met.

When you go to single-payer — and House Minority Leader Nancy Pelosi (D-CA) believes that single-payer is the solution to the problems of the Patient Protection and Affordable Care Act — these are the kinds of problems that you are going to have, because they have already happened in every other large single-payer system.

Americans should not be surprised by this at all, and need to be told — hopefully by publications more widely read than this one — that what the VA system did is what we could all expect under single-payer.


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