VA scandal: Fix just one portion of the VA healthcare system

Sen. John McCain has suggested in the wake of the VA healthcare fiasco that Congress consider privatizing some of the services offered by the huge care provider.

It's not an uncommon suggestion from a Republican politician to embrace free market alternatives, and given the woes that have been bedeviling the VA, it is certainly worth a look. Indeed, the Obama administration has already indicated that it would refer VA patients to private facilities if capacity becomes an issue.

However, there are many factors to consider against privatizing VA healthcare delivery. The most salient fact is that it still delivers far more cost-effective care than what is available in the private sector. That was the conclusion of the Congressional Budget Office in a 2007 report. And studies by researchers at the RAND Corp. and elsewhere conclude that the quality of care delivered by the VA is usually comparable, if not often better, than what is delivered by private sector providers.

So, for the sake of prudent healthcare finance, outsourcing the entire VA healthcare system is not a great idea.

The biggest issue is not the care the VA delivers or its quality, but access to care and how its patients react when they have trouble securing an appointment.

That the VA employees shuffled patient appointments around to cover up lapses in care isn't surprising-- they're part of a culture where their likelihood of patients personally challenging them is next to zero.

For all the outrage regarding the treatment of our veterans, we forget that they are trained from the moment they enter the service to never question authority. Even talking back to a superior is to risk imprisonment and a dishonorable discharge that would haunt them for the rest of their lives. Meanwhile, their families are inculcated into the routine of relocating every couple of years on a whim and keeping their gripes to themselves.

In such a culture, it is inevitable that the needs and comforts of those at the bottom would be ignored. The Walter Reed Army Hospital scandal from 2007 was an unsurprising result: Crumbling outpatient facilities, routinely misplaced paperwork and multiple-amputeee solders being forced to muster each dawn in uniform at a faraway location where they are talked down to by their platoon commanders. It's a tremendous dress rehearsal for being an unquestioning captive of the VA healthcare system.

Add to that the vast majority of those who seek care in VA hospitals are aged, enfeebled or both, the likelihood of their getting into the faces of the functionaries who put their needs on the backburner are nil.

That's among the reasons why veterans didn't blow the whistle on this scandal--it was a fed-up VA physician.

The VA does have a patient advocate system. However, advocates are posted at each facility--they don't make house calls--and they are a deeply entrenched part of the existing VA culture. If the government privatizes any portion of the VA healthcare system, this is the place to start. 

Hiring private law firms or patient advocacy agencies on a regional basis to handle patient issues and setting up a toll-free hotline for patients and their familes would likely cost less than $100 million a year. That's less than one-one thousandth of the current VA Affairs budget. And those attorneys and advocates should receive direct contact information to the VA caseworker handling their clients' casec, including their personal cell phone numbers.

It would indeed be a refreshing change to have outside patient advocates and private practice attorneys regularly harangue the VA functionaries who oversee appointments and benefits--pronto. Eventually, it would reach the tipping point where it would simply be easier for those functionaries to clear their backlogs than handling the constant calls. 

But it would also better as a country for us to stop lionizing our veterans in general and therefore be horrified when the inevitable outcomes of lives formed by autocratic institutions come to light. It's time to open our eyes a little and start empowering them a lot. - Ron(@FierceHealth)