A Problem Unique to Private Medicine?
This New York Times' investigation of a rogue cancer unit within a Philadelphia Veteran's Administration hospital is disturbing stuff. In essence, it seems that Dr. Gary Kao has been performing bradychardias -- a treatment for prostate cancer -- with a terribly high error rate, and using a variety of clerical tricks to cover his mistakes. No one has died, but dozens have suffered.
It's a particularly striking tale because the VA hospitals have been a tremendous success story in recent years. A few decades ago, the system was a mess: underfunded, poorly-managed, and the epicenter of a seemingly continuous number of horror stories. But under the Clinton administration, the trend changed radically. By the end of the decade, the VA was arguably the single best system in America. Most people find that hard to believe. But Phil Longman, who has written comprehensively on this subject, makes the point nicely by running through the independent evaluations:
Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be "significantly better."
Here's another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.
It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. 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.
Because the VA is a socialized oasis within the American health-care system, this success has become a bit of a political football. And so it's unsurprising that Megan McArdle jumped on the New York Times story. "I suspect this is also one of the things that can only happen at the VA," she wrote.
It would be surprising if incompetent doctors covering up their mistakes was a problem specific to the VA. Megan's argument is that any private hospital would be terrified of being sued, and so would never allow such shenanigans to continue. I'm curious, then, to hear her explain the case of California's Redding Medical Center, which specialized in cardiac surgeries. The Heart Institute there was headed by Dr. Chae Hyun Moon and Dr. Fidel Realyvasquez Jr., both of them well-respected surgeons.
At least, they were until the FBI raided their offices.
The Redding Medical Center, it turned out, was performing profitable operations on patients who didn't need them. A full half of their surgeries were found to be unnecessary, A quarter were foisted on patients with no serious heart problems whatsoever. Thirty-eight-year-old rancher Steven Hunt made the mistake of setting foot into their unit in late 2001. He was opened up for a bypass operation two days later. Not long after, the incision developed a hernia, and his upper-body strength deteriorated, ending his work as a rancher. The tragedy of it all was that Hunt suffered from nothing more than high blood pressure, easily controllable through medication and diet.
You could say, of course, that this sort of scandal could only occur within a private health-care system. Indeed, you'd probably be right about it: Doctors at the VA don't make extra money for performing more surgeries, and so they have no incentive to foist unnecessary treatments on healthy patients. But that's probably not a helpful way to conduct this debate.
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