It was difficult for me to watch my brother Phil testify before Bernie Sanders’ Senate Veterans’ Affairs Committee last week because he talked about the death of his wife, Robin, and how that experience led him to investigate the nation’s health care system. Robin was younger than I am now when she died of an aggressive form of breast cancer. Her loss was a brutal and unfair blow to both my brother and our entire family, and seeing him testify about her in front of the whole nation made me very emotional.
Phil’s journey into our health care system began with that tragedy, and he concluded that the Veterans’ health care system was the best-performing system in the country. He still feels that way.
Ezra Klein: You titled your book on the Veteran’s Health Administration “The Best Care Anywhere.” Do you still believe that’s true?
Phil Longman: To the specific issue at hand on whether or not there were secret waiting lists at Phoenix and possibly other hospitals, we just don’t know. There’s strong evidence that employees at those facilities engaged in some kind of gaming of their performance metrics. But we’re still waiting for the investigation to finish.
But the big question with these stories about the VA is, “compared to what?” This scandal wouldn’t exist if the VA didn’t have performance metrics on its employees. If it didn’t measure or care whether veterans get prompt appointments it could just do what the rest of the health-care system has done and not hold people responsible for these metrics. Now, certain people seem to have cheated on this metric. But that’s far better than what goes on in the rest of the health-care system where no one is accountable for this at all.
The Veteran’s health care system actually has an Inspector General. They have a degree of accountability that you won’t see in the private sector. It’s also a single-payer system that could serve as a model for the whole county.
In 2005, Phillip Longman, a senior fellow at the New America Foundation, published an article entitled “Best Care Anywhere” in the Washington Monthly. The article, which later became a book (which I blurbed), made an unexpected argument: the Veterans’ Administration’s health-care system had quietly become one of the best — if not the best — health systems anywhere.
Longman’s evidence was expansive. A 2003 New England Journal of Medicine compared the VA with Medicare on 11 measures of quality. “On all 11 measures, the quality of care in veterans facilities proved to be ‘significantly better.'” The Annals of Internal Medicine published a study that compared VA facilities with private managed-care systems in their treatment of diabetes patients. “In seven out of seven measures of quality, the VA provided better care.” The National Committee for Quality Assurance ranks health-care plans on 17 different performance measures. “In every single category,” Longman wrote, “the VHA system outperforms the highest rated non-VHA hospitals.”
Then there was the testimony of the veterans themselves. “The quality of care is outstanding,” Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion, told Longman. A survey found that 81 percent of VA hospital patients were satisfied with the care they received compared to 77 percent of Medicare and Medicaid patients.
According to Phil, the primary reason that Veterans’ hospitals outperform the private sector “is better adherence to the protocols of evidence-based medicine, and the lack of any motive to engage in unnecessary surgery and other forms of over-treatment.”
The current problem is caused not by lack of quality care but by delays in access to care. And that problem isn’t unique to Veterans’ hospitals.
EK: A point you made in testimony before the Senate Committee on Veteran’s Affairs is that this is a problem of access to care rather than quality of care. What do you mean by that?
PL: When you hear the Veteran’s Service Organization testify, as they all did last week, that the quality of care at the VA is excellent but access is a real problem, they don’t mean access the way most people think of it. They mean how long it takes to qualify for VA benefits generally. And that is a problem.
We have a system that reflects a deep ambivalence among the American people about what vets are owed. On the one hand there’s a consensus that any vet hurt in the line of duty should be put back together by the VA for free. But we’re conflicted about whether everyone in the military should get health care for free. So the way it stands now is most veterans have to prove is that the health-care complaints they have are the direct result of military service. And so if you look at what the bureaucracy at the VA is doing most of the time, it is trying to adjudicate questions like whether someone who’s 58 years old is losing their hearing because of the artillery fire they heard while deployed in Vietnam or because of all the Who concerts they went to in 1968. That’s a real example, by the way.
When you lose a family member early in their life, you want to make their lives have some meaning. If Robin’s death can contribute in some small way to helping the country understand what’s really at stake in the current debate about our Veterans’ hospitals, I think our whole family will be grateful for that.
To the extent this is a scandal… that some people cooked their performance metrics… it’s not that terrible. But why couldn’t they meet the metric? Was the result of failing to achieve the goal punishment or help… were people fired or was more staff hired and treatment space created?
My WWII vet father was treated at the VA during while in his 80’s for the basic ills of old age… heart disease, prostate cancer, and diabetes. His last year in a nursing home was paid for by the VA. 10 years after his death, my mother still receives $1000 a month in a VA benefit. This makes no sense. None of this was related to his service. He could have easily been treated by doctors billing to Medicare. Of course, that was before the wars created an influx of patients needing care for actual service related injuries.
Your WW2 father was promised it whenm he volunteered to serve,
The US Government keeping it’s promises might seem an anathema to some right wingers but it is the right thing to do, even if the extreme foaming at the mouth wingnuts hate it.
PS The VA took care of my Korean war dad in his old age after 28 years of service like they PROMISED him they would do, and take care of me after I became 100% disabled in desert storm.
The US government keeping it’s promises to vets …. what a concept, cannot comprehend why the extreme right wingnuts hate it but they seem to do.
The (extreme?) right wing hates the government doing anything beneficial for actual human beings…
Good performance metrics = bonuses (or bigger bonuses). The bonus culture that seems to have infected both the private and public sector over the past thirty years has likely contributed to more income/wealth inequality and personal finance illiteracy.
Like well-funded, well-managed public schools, the Veterans Administration health service provides the best delivery of health care services to Veterans. That is why GOP veterans scramble to VA and military hospitals to use their veterans benefits.
What has happened to the VA is what has happened to public schools all over the country. A ideological campaign to strangle the effectiveness of all public-provided infrastructure.
The Veterans Administration operating expenditures are considered “discretionary spending”. Nuff said as far as Paul Ryan is concerned. If it’s “discretionary”, it can be cut. If it’s an entitlement, it should be cut. If it’s funding private contractors, double it.
Short-sighted, wasteful, and bullshit. Really another Benghazi issue that goes back at root to the failure of Congress.
I’ve sent the copy of Phil’s testimony around to several of my vet friends. The VA cheaters have infuriated them but after reading Phil’s testimony they came away with a larger perspective and are now singling out the cheaters from the system.
On the cancer forum I frequent I oftentimes find spouses are moved to what I call acts of bravery to dig into life and use their pain to help sort through the experience for others. There is an intensity that rises to underscore the value of human life and we are all the better for it.
Also keep in mind that so far there is no evidence that long wait times killed veterans.
Oh, but it’s “out there” now- 40 people died in Phoenix! Too late- it is a “fact” to the public now.
Unfortunately, this scandal arrives in the middle of the non-stop misinformation campaign against the ACA. There are all sorts of “facts” about the health care system in the U.S., the specific policies and budgeting for the ACA, that are pure lies. I’ve spoken with people who are up the tree with those lies; when I try to talk them down calmly, the second I begin refuting one of the lies they treasure, it’s often shut-down time. The mistrust INCREASES.
It’s often very difficult to have a rational discussion at all. MikeInOhio and others have talked about this painful reality; it can cause despair if you let it.
Martin, I’m so sorry for this loss you, Phil and the rest of the family have suffered.
Your brother needs to be on the Colbert Report/Daily Show (for that matter, so does Ta Nehisi Coates).
Thank you for sharing this moving account of how loss has turned into caring for others. Your brother seems like an amazing human. This was very informative and helpful.
I applied for the VA in September 2013. I will be getting a PCP in June. During that time I have seen the vision clinic and Audiology at the VA.
Some do not realize that you can go to these services without having a PCP.Prior to this time I have medicare but the clinic that I was going to for my medical problems decided that they were going to cut patients by 25%. This has put a real jam for those seeking medical care. Thus when they first gave notice of their intent to cut patients I went to the VA.
The quality of the care I receive from the VA is far superior then the Private sector clinic I was using. If I had known this before I would of been to the VA sooner. They may have their problems but they in my opinion provide better service then anything else around my area.
I also want no part of a privatized VA service.
I worked for the VA for 10 years, and before that worked for a several different public and private health care systems. Of all the systems I had close knowledge of, the VA was the only one that was totally serious about delivering quality care and using objective measures to make sure its goals were met. The most corrupt health care systems I’ve known were the private ones, where policies existed only on paper, and everything was done by personal fiat of whoever was in charge, usually to the profit of that person. In the VA the culture was that of course you would do your job as described and if policies and procedures were put in place you would carry them out. The administrators who gamed the system in Phoenix were acting against the prevailing VA culture as I knew it, although with 250,000 VA employees it’s not surprising that there would be some gamesters in the mix.
I worked for the VA during the administration of Bush the Lesser and was high enough in the food chain to know the extent to which the VA was starved during those years. I particularly recall a time in 2005 when the top managers were going around ashen faced because VA finance office had told them the health administration was 4 billion in the red and they didn’t know how they’d be able to keep the doors open. Apparently against presidential orders, Secretary Principi told Congress about the shortfall, the VA got extra funds, and Principi was sacked. That’s Republican support for veterans right there.
thanks to your brother.
I have to agree with him about the VA. I believe it saved my father’s life. For all its problems, my father developed lung cancer in the early 1960’s. Lung cancer is pretty much a death sentence today, so think about it back then.
My father, who worked at the VA, was able to pick the doctor he had the most confidence in. So, my father was able to have the surgery and was taken care of by people he worked with for years. My father had one lung removed, and lived another 24 years after that surgery. To his final days, he had nothing but positive things to say about the VA. He would tell anyone that the VA saved his life.
without the surgery, I would have never been born, because I didn’t come along until years later.