The Veterans Administration has come under fire recently after CNN reported on allegations of patient deaths due to “secret waiting list” at an Arizona VA Medical Center. Having managed a large oncology unit at a fairly prestigious VA many years ago I can speak from the perspective of a provider. Back then we didn’t have hot running water on some occasions. We didn’t have air conditioning and my unit was on the 7th floor. (Heat rises, obviously.) When we finally had window AC units installed we couldn’t run them because doing so overloaded the electrical circuits: we could either be cool enough that patients weren’t routinely being sent to the ICU with chest pain or we could run our IV pumps. Administrators and certain Section Chiefs rotated out of their locations every 2 years so the system is set up for leadership failure. Having said that, the VA is the largest healthcare system in the world and pioneered EHRs, bar coding of medications and numerous other innovations in medication safety. The VA is also an international leader in Failure Mode and Effect Analysis (FMEA) - see http://www.patientsafety.va.gov/docs/hfmea/HFMEA_JQI.pdf.
As far as privatizing care for veterans, there’s a great deal to be said for the benefits of receiving care within a cohort group. I will never forget a late evening when I was escorting a young leukemia patient off the unit to smoke (no lectures here please!). He was emaciated, hooked up to 4 IV pumps through 3 different lines, and wearing a Marine cap over his balding head. When the elevator stopped on the 4th floor a WWII vet stepped on, immediately saluted the young man, and said “Semper Fi” to which the Gulf War vet responded “Do or die”. These two men had never met but established an immediate bond through shared service in the Corps. I salute them and all our men and women in uniform who have earned the right to the very best of care. I’m proud to have served them.
The VA system is overburdened with red tape, has many failing physical plants, and wait times are outrageous. Even those within the system can’t navigate it. But those are issues at many private-sector hospital systems too. The American health care system is broken. It is not an open marketplace where consumers have actual choices based on informed decisions. We haven’t even begun to establish for consumers what they should expect of the “product” they are “purchasing”. Consumers don’t purchase and providers don’t set minimum expectations for what is reasonable in terms of patient safety when 1 out of every 6 people will STILL be harmed by a medical error every year, 15 years after the IOM report To Err is Human.