The government’s not-so-dirty, not-so-little secret
By John Whittlesey
(Part one of a two-part blog)
When I was in grad school – oh so many moons ago – I learned the history of the early healthcare system in the United States. There was the Hill-Burton Act to build hospitals in rural and under-served areas; the social safety nets of Medicare and Medicaid; the evil for-profit models; the even scarier “DRG” classification and reimbursement models about to be implemented; and the then-emerging managed care products, etc.
The one fact that completely surprised and dismayed me was that there were two separate and parallel health delivery networks outside of the general private health system: the Department of Veterans Affairs (VA) system, and the military health system. Over the past 25 years, my mantra has been that if I were in charge of the national health system – and it’s a good thing I’m not! – the first thing I would do would be to get rid of the VA and integrate it into the private health systems we all use. We’d use vouchers or whatever to make sure that veterans still get the full service they deserve.
Now, I’m not so sure.
Two recent developments caught my eye and have made me think differently about the situation (yes, it is possible for me to change my mind). We’ve all heard the horror stories about the mistreatment of veterans (remember Tom Cruise in Born on the 4th of July?), along with big access and quality problems, have created a general impression that the VA system just isn’t as good as the private health system. Well, over the years it seems that the government and VA leaders have stepped up their game, and cleaned up many of the structural, facility, and clinical messes.
Phillip Longman, senior fellow at the New America Foundation and author of a book about the VA called “Best Care Anywhere,” discusses how the VA has been developing a model of integrated care delivery along the continuum of care (primary, outpatient, inpatient, aftercare, and preventive medicine). He holds that the VA is now the model of choice for the country to follow under healthcare reform. “The rest of the health-care system doesn’t have a business case for quality,” Longman says.
Most of this is being accomplished through one of the largest and most comprehensive electronic medical record projects to date. It’s a way of capturing longitudinal patient information and integrating it into patient care practices. This uniform, standardized, integrated, and theoretically efficient system will sound like a good business to some; to others it may sound like socialized medicine. Score one for the VA.
(Read a related article MarketWatch article by Kristen Gerencher here.)
John Whittlesey is a Principal at HMC
