Best Care Anywhere: Why VA Health Care Is Better Than Yours by Phillip Longman (2nd edition, 2010)

It is a daunting task to critically evaluate the delivery of health care in the United States.

Some try to masquerade U.S. health care delivery as a “system”, but this is entirely false. Health care delivery in the United States is based on capitalism, which is the basis for all social organization in this country.

Health care delivery is not immune from the disease of capitalism. Capitalism dictates the mode of production and this is true of the delivery of health care as well as any other social relationship in this country. This translates into a built-in profit motive that drives U.S. health care delivery in the private sector.

Longman has written a very interesting advocacy paper, which proposes that the current anarchy and chaos of American health care delivery be replaced by a model based on the Veterans’ Administration health care system (usually referred to as the VA).

It is remarkable that there exists an organized health care delivery system in the USA, which stands apart from the crazed, profit-driven health care delivery in the private sector. The VA is not based on profits, but rather based on providing quality health care to a special sector of the population, namely veterans. They do this very well and with great efficiency.

The VA is also already union-organized. Every employee including doctors and attorneys can join the American Federation of Government Employees (AFGE).

There is no doubt that the VA system of care offers many advances over the current state of health care delivery in the USA. I know this well on a personal basis. I worked as a VA psychologist for eight years in Houston.

I was impressed by the ability of the VA to provide services to veterans unmatched in the private sector. The VA’s Vocational Rehabilitation Services, for example, are far superior to anything available for civilians.

Longman lauds the virtues of electronic medical records in the VA system. I used that medical records system as well as the MUMPS system to which he refers repeatedly. There are immeasurable advantages to these systems. They facilitate health care as well as research. I used these data in studies of homeless veterans as well as provision of psychological assessment and treatment while I worked at the Houston VA Medical Center.

It is invaluable for a doctor in Minneapolis to be able to access the medical records of somebody in Walla Walla, Washington with the click of a mouse. The reduction in duplication of services, elimination of unnecessary medical services to malingerers and drug seekers is a great advantage for the VA system.

It should be noted that the Michael E. DeBakey VA Medical Center in Houston, Texas  is ranked as the 11th best hospital in the country.

Longman advocates replacing health care delivery in the USA with a system he calls the VistA system (named after the VA computerized records system).

He notes that current health care delivery is reimbursed according to treatment provided. This means that providers are paid only according to the treatment they deliver to the individual patient. Therefore, if a patient presents complaining of “feeling bad”, the doctor gets paid if they provide treatment. So, even if the patient has no blood pressure problem, the doctor gets paid if they write a prescription for blood pressure medicine.

Similarly, the doctor gets reimbursed if they prescribe antidepressants even if the patient’s malady can be treated by psychotherapy. The dark unknown is what sort of kickback or privilege the doctor in the private sector receives from the drug company for prescribing the newest, most expensive blood pressure medicine, antidepressant or antipsychotic medication. I have treated patients who have been victimized by such unnecessary treatment.

He maintains that implementing a Single Payer health care system would only perpetuate the problems of current health care delivery. In other words, doctors would still be reimbursed according to the treatment provided.

Longman discusses the health care threat that diabetes poses to the general population. He points out that diabetes is an illness that cannot be contracted from other people. He implies that diabetes is a function of lifestyle. Many of the newer, more expensive medications have adverse side effects, which include diabetes. These medications include the atypical antipsychotics. These medications also can result in many other adverse side effects such as obesity and cardiac problems.

It is clear that rewarding doctors for the treatment they provide is not a good model. It would be better to provide treatment with a view to prevention within a system that would ensure ethical, reasonable, medically necessary treatment accessible to all. Such a system would be a tall order, to be sure.

Could such a health care delivery system be built on a “VA for all” model? Mr. Longman makes a strong case that it can.

Some would argue that the VA health care system is more advanced than a “Medicare for all” health care delivery system and emulates the British national health care system.

Currently the federal government is able to regulate unscrupulous practitioners to some extent. There have been many arrests of Medicare providers in Houston recently for fraudulent activity. With an organized health care system, presumably such regulations could be policed more efficiently and could put an end to the graft and corruption in private health care delivery.

Kickbacks would become a thing of the past in an organized health care delivery system.

Longman notes that the Bush Administration, during its execution of the invasion and occupation of Iraq, attacked accessibility of the VA to veterans. Now, non-service-connected veterans who do not meet the means test (in other words, whose incomes are too high) are not eligible for VA care.

This restriction is unfair to those who have served their country, and Longman calls for these restrictions to be removed. He makes the case that opening up the VA to all veterans would be a step in the right direction towards a universal health care system. One could argue that the VA should be opened up to veterans as well as their family members and this would also be a positive development.

By restricting VA health care to veterans with service connected disabilities and low income non-service-connected veterans, the right wing has reduced the political punch of veterans and their organizations by splitting them up. By eliminating the higher income veterans from eligibility, they have diminished the political strength of a sector of veterans. Such splitting tactics should be exposed and thereby used in the fight against the rise of the ultra-right wing.

Prior to the Bush administration, the right wing considered the VA to be an “untouchable” since it was an earned benefit for those who fought the bloody imperialist wars that furthered the interests of the 1%. However, the Bush administration did not support universal health care for veterans. President Obama has been more vocal in speaking about and advocating for veterans benefits.

In conclusion, Longman opens a discussion about health care delivery in the USA. The most important point is that we don’t have a health care delivery system, but only an anarchic, disorganized health care delivery that benefits those providers who provide the most and most expensive treatments.

Health care delivery in the USA also benefits the insurance companies, drug companies, hospital corporations and their shareholders. Many people talk about the administrative costs in the delivery of health care.

It would be interesting to see a study evaluating the cost of stocks and dividends paid out to stockholders as part of health care cost. Of course, the wealthy can buy the services of the most distinguished providers, but they are subject to the delivery of unnecessary health care services as much as the poorer classes of people.

Longman’s conclusion is that the answer to our health care problems is the VA system which he maintains could be implemented universally.

Longman reports that health care in the US is ranked 36th in the world. This is a sad commentary about the world’s wealthiest capitalist country. It might be useful to examine other health care systems as this country develops a new model. This would make it possible to fashion a comprehensive system of health care that  incorporates the best elements of many diverse systems into a system which meets the needs of the working people of this country.

May 22, 2012