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The Smackdown That Wasn't

Bruce McQuain writes:

Dale and I once interviewed Ezra Klein about health care on our podcast. Klein held the VA system up as a shining example of good government health care. Of course that was before the shameful condition of Walter Reed had been discovered.

Walter Reed is an army hospital, not a veteran's hospital. The two systems have nothing to do with one another. That's why the problems at Walter Reed led to the resignation of the Secretary of the Army and not the Secretary of Veterans Affairs.

By Ezra Klein  |  June 23, 2009; 12:49 PM ET
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You know, I wondered why we suddenly saw two news stories in the past week about problems in the VA hospitals. I figured it was part of the anti-healthcare campaign.

Posted by: uberblonde1 | June 23, 2009 12:52 PM | Report abuse

Facts? We don't need no stinkin' facts

Posted by: PPhilly | June 23, 2009 1:08 PM | Report abuse

Once again, I don't think the measures you're using are adequate when you say that care in VA hospitals is good. They're well-known for incompetence and carelessness in execution of treatment, and particularly for their atrocious nursing staff.

A friend of mine who trained in part at a VA had a patient die overnight. Hours after the patient died, the nurses were still recording vitals -- obvious fabrication, and a sign that nobody even cared enough to look at the patient.

Another friend who trained at a VA hospital was talking to a gentleman who was recovering from bypass surgery and was complaining that he couldn't move one leg. It turned out that the surgeon had managed to sever a bundle of nerves -- something which only happens if you're paying no attention whatsoever -- and hadn't bothered telling anyone. The patient may not have use of his leg again.

Same friend ordered a routine test from the nurses to determine if a patient had had a heart attack. The test is time-sensitive and obviously important. The next day, when he asked for the result, it turns out the nurses simply hadn't done it. Because the test was time-sensitive, they had no way of figuring out what had happened to the patient.

These are just stories I can remember. Seriously, Ezra, if you're interested in finding out what the quality of care is actually like in VA hospitals, please please please actually go and talk to a bunch of people who've worked in them instead of just reading results from what is essentially school testing for hospitals. Because people who've experienced the VA system first-hand tend to be absolutely appalled.

Posted by: davestickler | June 23, 2009 1:30 PM | Report abuse

Two of my relatives are elderly and very staunch conservatives. One is on medicare, the other in the VA system. They both love to complain endlessly about each system. Once, I asked them why, if it was so horrible they didn't just get private insurance instead. They answered, "Its doubtful we could even get coverage on the private market, and if someone did offer it, it'd probably be way more than we could ever hope to afford."

The point isn't necessarily that a public option will be the best possible option, its just that for many people, it may be the only option, and better than nothing at all.

No one seems to be seriously proposing that we outlaw private insurance and force everyone into a government program, but rather, we simply add another option for people who currently have none.

Posted by: nylund | June 23, 2009 1:59 PM | Report abuse

VA also ranks extremely highly on veteran satisfaction surveys. From Phil Longman's article:

"Not convinced? Consider what vets themselves think. Sure, it's not hard to find vets who complain about difficulties in establishing eligibility. Many are outraged that the Bush administration has decided to deny previously promised health-care benefits to veterans who don't have service-related illnesses or who can't meet a strict means test. Yet these grievances are about access to the system, not about the quality of care received by those who get in. Veterans groups tenaciously defend the VHA and applaud its turnaround. "The quality of care is outstanding," says Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion. In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients."

Posted by: Ezra Klein | June 23, 2009 2:12 PM | Report abuse

Dave Stickler, you have your anecdotes, and I have mine. My father died in 2005 of lung cancer and was treated by the VA system for more than two years -- this after many years of regular checkups at the VA.

We were really happy with the level of care we received, this at several different facilities, mind you. We were impressed most of all by two things: nobody ever mentioned cost at any point -- my dad was in the system so it just wasn't an issue.

And second, the VA uses an intelligent computer system such that every new medical professional you encounter has instant access to the patient's medical history. Worked great.

Of course there were waits, but not normally too bad, an hour here, an hour there. Big deal. I've been spending a lot of time in the Austrian system recently and you have to wait there too sometimes.

Posted by: wovenstrap | June 23, 2009 2:14 PM | Report abuse

Yeah, like we know public transportation doesn't work because if you are at the corner of San Rafael & Girard Boulevard in Albuquerque, New York, you wait FOREVER for a bus in the hot, hot desert sun.

Oh, wait, that's New Mexico, not New York.

Posted by: theorajones1 | June 23, 2009 3:01 PM | Report abuse

But ... but ... SOCIALISM!

Posted by: jlundell | June 23, 2009 3:36 PM | Report abuse

VHA is not perfect, nor is care in the private sector. I think that rather than deal with anecdotes we should try to deal with broad based reality. Even Bruce McQuain's seems to be jumping on the anecdote bandwagon.....note in the responses to the scathing comments he gets to his post he refers to some very old experiences.

Ezra is right, look at the satisfaction ratings. 87% is very high. And VHA has very sick patients as compared to the average private sector doc. And they have electronic medical records. And they actually look at care on an episodic, lifetime basis as compared to a unit of service basis. There is a lot to be said for this admittedly imperfect system.

Posted by: scott1959 | June 23, 2009 3:38 PM | Report abuse

Judging by his reply to a number of comments, apparently the guy hasn't seen the error of his ways.

Let's face it -- that's typical among the right-wingers. We're going to have to get this thing passed by shoving it down their throats (we being the majority of the American people, natch).

Posted by: leoklein | June 23, 2009 4:02 PM | Report abuse

So how do we know that Obamacare will provide VA quality and not Army quality?

Posted by: tomtildrum | June 23, 2009 5:35 PM | Report abuse

Tomtildrum....seriously? Reform is centered around (a) employer based coverage like you have now, (b) individual insurance like what exists now but with no underwriting and pre-existing conditions rules, and maybe (c) a public option. Read: option. Don't want it, don't take it. That would be the beauty of forces both the public option and the other forms of insurance to compete. Something Walter Reed does not have to do.

Posted by: scott1959 | June 23, 2009 7:18 PM | Report abuse

Veterans are happy with care at VA hospitals because it was SO terrible before, their basis for comparison is skewed. They are also a group that is not entirely representative of society overall.

The VA healthcare system is already backsliding on its gains in the past decade. The influx of new patients is putting enormous pressure on the entire VA system.

VA is excellent at making numbers and surveys look good--you cannot entirely trust them. I would not dismiss the growing anecdotal evidence concerning problems at VAMCs lightly. And I would also not use the success of the VA health care system to support my position if I were you, as it is an example that will almost certainly be used against you in the next 2-5 years, as the current problems accelerate and become more apparent to the general public.

Posted by: joromo703 | June 24, 2009 1:59 PM | Report abuse

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