Success Breeds Failure

The Veterans Administration health care system took quite a publicity hit with the Walter Reed scandal in early 2007. That’s too bad – Walter Reed is not part of the VA. It’s run by the Department of Defense, specifically the Army. Furthermore, Walter Reed was one of the privatization targets of President Bush’s competitive sourcing initiative, and was actually managed by IAP Worldwide Services, which is managed by Al Neffgen, a former senior Halliburton official who testified before Henry Waxman’s Committee on Oversight and Government Reform in July 2004 in defense of Halliburton’s exorbitant charges for fuel delivery and troop support in Iraq. IAP is also the outfit that had trouble delivering ice in the aftermath of Hurricane Katrina.

That’s all old news. Here are some snippets from an essay entitled “Just How Good Is American Medical Care?”, by Elizabeth A. McGlynn, David Meltzer, and Jacob S. Hacker. It’s a long essay, not available on the web, comparing quality outcomes in our health care system with other countries. (We don’t do that badly – as always, our problems center around the millions who don’t have access to quality care.) These particular passages are from the section entitled “A Surprising Story of High-Quality Care”, about the VA.

No single statistic better illustrates [the] remarkably good performance [of the VA] than the share of VHA system participants who receive recommended care. In the rest of the American health system … adults and children receive only about half of the care that they should. The figure for VA is just over two-thirds.

…Beginning in the early 1990’s, VHA leadership instituted both a sophisticated electronic medical record system and a quality measurement approach that holds regional managers accountable for several processes in preventive care and in management of common chronic conditions. Other changes included a system-wide commitment to quality improvement principles and a partnership between researchers and managers for quality improvement.

…the reforms have worked. The VHA has substantially better quality of care than found in the rest of American health care. Although present research does not indicate exactly why VHA is so much better, it appears that the VHA’s promulgation of specific performance measures and emphasis on accountability are at the heart of the system’s success. The use of computerized reminders and electronic records, the emphasis on standing orders, improved interprovider communication, facility performance profiling, leveraging of academic affiliations, and accountability of regional managers for performance; and creation of a more coordinated delivery system – in tandem, all of these reforms have allowed VHA medical care to create and uphold very high standards of quality.

An American success story. If there is a good idea out there, others will surely steal it. We should soon see promulgation of VA accountability standards and electronic record keeping across our medical system.

Maybe. Then again, this is Bushworld. Perhaps success of the VA system explains a late-term Bush Administration initiative to “shift away from renovating or constructing health-care facilities, in favor of leasing facilities or purchasing care from outside providers.”

In other words, to privatize. We have a public sector success story here – the best health care in America.

Can’t have that.