Real Clear Politics Dennis Byrne March 10, 2007
The partisans who are scoring political points by gnashing their teeth over the outpatient failures at Walter Reed Army Medical Center are missing the point: The government did it.
It is especially aggravating because many of these same partisans want to turn the nation’s health care system over to…the government.
Or have they somehow missed the fact that the care of veterans is the responsibility of the government? Do they somehow believe that a single-payer health care system, or universal health care, or whatever else they want to call it will be immune to the kind of bureaucratic insensitivity, apathy and bungling that is integral to government?
Would the stampeding fault-finders please explain to the world how they would ensure that civilian outpatients, under a bureaucracy rivaling the military’s, would not be ignored in the same manner that the military bureaucracy abandoned the wounded veterans in Building 18? With hundreds of millions of civilian patients, instead of thousands of wounded veterans, would someone give us a clue how the government would keep track of them all? With outpatient veterans getting lost under mountains of paperwork and red tape, how would government be more responsive to the needs of hundreds of millions?
The failures at Walter Reed are the direct result of an ideological and political decision by the Bush administration to outsource and privatize services at that facility.
Privatizing of Walter Reed scrutinized, Some say move added to problems
If we review American history we see that one of the unfortunate legacies of the Andrew Jackson Presidency was the “spoils system“. The “spoils system refers to the “informal practice by which a political party, after winning an election, gives government jobs to its voters as a reward for working toward victory, and as an incentive to keep working for the party. The term was derived from the phrase “to the victor go the spoils.” It is opposed to a system of awarding offices on the basis of some measure of merit independent of political activity.
Over the years, laws and court decisions have gradually ended the spoils system, also known as “patronage”. In it’s landmark case ELROD v. BURNS (1976), the Supreme Court held that “patronage dismissals severely restrict political belief and association, both of which are individual rights protected by the First Amendment to the United States Constitution, and the government may not, without seriously restricting those rights, force a public employee to relinquish his right to political association at the price of holding a public job.”
Over the past six years the Bush administration and it’s right wing allies have used “privatization” and “outsourcing” to introduce a new form of patronage. While government workers can’t be fired outright, they can be made irrelavent by outsourcing their functions to private contractors who frequently are paid under lucative, secret contracts while operating under much less oversight.
Under Bush and the his minions, outsourcing and privatization have led to greater costs and less accounatibility in all spheres of government. A General Accounting Office report recently found that enrollment in private Medicare plans had added an addition $65 billion to the cost of the medicare program. In Iraq tens of billions of dollars paid to contractors like Halliburton remain in dispute and/or completely unaccountable.
The mercenary mentality of the today’s conservative movement and it’s relentless push for outsourcing and privatization has had a truly damaging and corrosive impact on our nation. It combines their ideological fear of any success by government with its corrupt desire to hold and consolidate power by rewarding supporters with government contracts. In “Why Conservatives Can’t Govern“, Alan Wolfe writes:
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We don’t have to simly imagine the corruption and abuses resulting from the author’s anti-government proposals – they’re already here:
I.R.S. Letting Tax Lawyers Write Rules ,
Notes 1 & 2;
Me thinks you are buying your own rhetoric. The left creates huge unworkable bureaucracies, and it is the rights criticism of them that is their cause? Hum…
What rhetoric? Unlike you, I provided plenty of examples.
During the Clinton Administration the government operated Veteran’s Administration hospitals improved to the point where they were regarded as providing better quality of care than most private institutions. (Walter Reed Medical Center is operated by the Defense Dept. and not part of the VA system)
The Best Care Anywhere: Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they’re producing the highest quality care in the country. Their turnaround points the way toward solving America’s health-care crisis.
I’m sorry, but the tired right-wing cliches and specious ideological stereotypes, are again, totally unsupported by the facts.
Dean,
Your middle school debate tactic (crib as much as you can from partisan sources and claim “truth”) only works, well on the middle school debate team. Have you not noticed it’s ineffectual use here? Your assertion, that critiquing bloated left wing bureaucracies is the “cause” of said bloated left wing bureaucracies is a non sequitur…
To et al,
I was a Naval Hospital Corpsman in the 1940s; the current descriptions of Walter Reed are a little beyond me. We held inspections at the hospitals that I served in everyday; you had better never, ever got below a 3.0. Of course the government ran those hospitals too, so it from the top down that must stink.
My wife and I have spent time in the German hospitals, surgeries and post-op medical care afterwards, and our quarterly doctor visits and they all fit very well into our medical insurance. We pay $20 for the GP visit and nothing for the needed specialist each quarter. The government runs a tight ship and there is constant adjustment as to insurance cost and our out-of-pocket expenses. There is never any fear of bankruptcies due to medical cost and the insurance company can not drop you unless you change companies. And yes, the total population is covered. I have had friends come over her to get flu shots on my dime.
Yes the government can be the problem but you have to have an honest government. The current ruling party is the CDU-Christian Democratic Union-they try to work from that point of view.
Sincerely yours,
J R Dittbrenner
Dean wrote:
Dean,
Don’t buy the propaganda. I was on active duty at the time and then later worked in VA facilities during the Clinton administration. And truth be known you don’t know what you’re citing. VA facilities and care didn’t get better under Clinton. What happened were a couple outdated hospitals were closed and a few high profile facilities were built because of pressure from the Congress. But the treatment of veterans and the bureaucracy associated with it remained the same. In fact it became a little bit more complicated when Clinton gave the homeless priority care at VA hospitals over veterans.
JBL: Did you even read the article? The VA system’s high ratings came from peer-reviewed academic sties conducted by the New England Journal of Medicine, and the Annals of Internal Medicine , as well as the highly respected NCQA (National Commission for Quality Assurance), which is the accrediting body for Health Plans in the United States.
The author sites other credible and reputable sources:
http://www.washingtonmonthly.com/features/2005/0501.longman.html
The key point he makes that shouldn’t be missed is this:
In other words, the return on investments in medical quality of care is often long-term. If you practice good preventative care today the payoff is that the patient doesn’t show up in the hospital ten or twenty years from now with diabetes or heart disease. A private for-profit health care organization whose patients are constantly shifted from one provider network to another are never going to see those returns on investment, but a health-care organization with a life-time relationship with the patient, like the VA, will.
Findings of the RAND Corporation:
Improving Quality of Care, How the VA Outpaces Other Systems in Delivering Patient Care
Dean I call BS on the “peer-academic sites”. Just because the VA has top notch “systems” doesn’t equate to the personal experience of veterans.
Note # 11
BS is an understatement. My wife is a physician: need a test in a real hospital, that day or next. In the VA, next week or the following. It is a horrible place to be sick and is the result of government trying to do something it can’t do well…
Christopher,
For me to register into the VA it took a year from that day I presented myself with my DD 214 to get the required initial physical.
Also because of the tier system for medical care that the VA has it would be easier for me to receive care as an indigent at a local hospital than try and get it from the VA.
Note 13
Yes, Dean’s citation that:
“it turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well–incentives that are lacking in for-profit medicine.”
Is so painfully contrary to reality it prompts me to assert that the author has to be making it up for the laughs…
Christopher writes: “Is so painfully contrary to reality it prompts me to assert that the author has to be making it up for the laughs…”
Where is your reality, exactly? As far as I can see it is entirely subjective and anectodal. I cited the New England Journal of Medicine, The Annals of Internal Medicine, The National Commision for Quality Assurance, The Institure for Health Care Improvement and the Rand Corporation as sources. You, on the other hand, were unable to cite one objective and authoritative study to support your position.
The disdain for objective reality in the post’s above, the preference for the gut over the brain, for “truthiness” rather than truth, is so powerful it could have come straight from a Stephen Colbert comedy skit.
http://en.wikipedia.org/wiki/Truthiness
How is it that the American people were conned into supporting the ill-conceived invasion of Iraq, despite the obviously flimsy and false pretexts offered as justification for war? It was because they wanted to trust their gut, rather than use their heads. If Americans continue to make important decisions based on an intellectually lazy reliance on dogma rather than a scientifically rigorous analysis of objective data we can look forward to the long slow decline of the United States into a second-rate nation.
Dean,
Why do you believe your insistence on “sourced authorities” more accurate than people who’ve actually had to use the system?
Note 15;
It is not gut, but my head. Yourself on the contrary take an ideological hard left position political position (i.e. Bush = bad, Clinton = good) and then find partisan articles and web sites that support your position and declare “victory”! Also, you have the nerve to label those who actually question assumptions as someone who “disdains reality”. It’s very sophomoric (actually, it’s middle school debate class stuff)….
Christopher writes: “My wife is a physician . . . .”
Quite possibly trained at a publicly-funded university hospital, as are many physicians. A government-run hospital, in other words.
Christopher: ” . . .need a test in a real hospital, that day or next. In the VA, next week or the following. It is a horrible place to be sick and is the result of government trying to do something it can’t do well…”
But many hospitals are publicly funded and run, not federal, but state or local. So the issue is not that all government hospitals are bad, but that some are. Why are some better or worse than others?
JBL writes: “For me to register into the VA it took a year from that day I presented myself with my DD 214 to get the required initial physical.”
Why do you think it took so long? From a process point of view, long waiting times often, but not always, indicate insufficient capacity in the system.
For example, if I frequently went into a VA hospital, and there were always long lines of people waiting outside the bathroom door, I would conclude that the hospital didn’t have enough bathrooms — whereas Christopher would conclude that it wasn’t the government’s role to provide bathrooms at all.
Jim you really don’t know what you’re talking about (in fact you’re really blowing it out your backside). My experience is just one that thousands of veterans deal with the VA daily. Many times there are problems with quality or limited care.
The VA’s problems are more than just not having enough to handle the problem. It’s a problem of an entrenched bureaucracy that is manipulated by political agendas.
JBL writes: “Jim you really don’t know what you’re talking about (in fact you’re really blowing it out your backside).”
Well, I worked for 21 years in a public teaching hospital located next door to a VA hospital so I have some idea of what goes on. We actually leased unused space from the VA. The office I worked in handled the contract for that.
JBL: “The VA’s problems are more than just not having enough to handle the problem.”
Ok, fair enough. I’m only saying that in my experience long waits tend to be (as I said before, “often, not always”) caused by insufficient capacity.
JBL: “It’s a problem of an entrenched bureaucracy that is manipulated by political agendas.”
How, in your view, does that bring about long waits and poor care? Not enough funding? Adequate but mismanaged funding? Poor processes? High staff turnover? Equipment shortages? (Dude, I’m not arguing with you here. I’m asking for your take on the situation.)
The basic problem is that governments have no genuine committment to taking care of the soldiers who fight at their behest. No governement, no administration. It is not really a partisan thing. Whether here in the US it is yet another fallout of the anti-war, anti-soldier attitude of the 60’s (nothing good came out of the 60’s) or whether it is just the fact that people don’t care it doesn’t really matter. The men and women who fight are expendable. Do we want to argue about who is to blame or change the attitude?
JBL, Chirstopher and Michael: Let me ask you a question. You are intelligent individuals. Suppose a Health care Foundation offered you a million dollars to conduct a study of the quality of care offered by the Veteran’s Hospital system compared to other private hospitals: What criteria would you use to to measure quality of care?
Would you measure how many patients had recommended health care screenings, such as blood sugar, cholesterol, colonoscopy and prostate exams?
Would you measure hospital admissions for preventable or poorly managed medical conditions?
Would you measure hospital re-admissions for complications arising from a previous admission?
Would you measure how many patients encountered financial barriers to care?
Would you measure patient satisfaction at the completion of care?
Or would you simpley define quality of care as the the number of days a person had to wait for an appointment and consider know other factors?
My point is that if you probably would respond that you would consider the full array of quality of care indicators and measures – and if you had done so you would have learned as did the the New England Journal of Medicine, The Annals of Internal Medicine, The National Commision for Quality Assurance, The Institure for Health Care Improvement and the Rand Corporation – that the quality of care at the government run VA hospital system stacks up pretyy well.
When I look at the poor conditions of Walter Reed, I can’t help but think this is what’s in store for us if we go with universal health care. Scary.
Jim,
It’s an inability by VA administrators to make necessary changes in staff for effectiveness because of government regulation in hiring, firing, and contract negotiations.
As an old military joke goes, those who can’t get a job with the DMV get hired by the VA.
Guest writes: “When I look at the poor conditions of Walter Reed, I can’t help but think this is what’s in store for us if we go with universal health care. Scary.”
Well, sure, if Bush-style Republicans were running the plan it would be a disaster.
Here in Oregon there are a couple of initiatives for reform in play that are very different from traditional “socialized medicine.” There is the “Archimedes Movement” led by former Oregon governor and emergency room physician John Kitzhaber:
http://www.archimedesmovement.org/
(By the way, as Kitzhaber says, we already have universal health care. It’s called the emergency room.)
There is also the health care reform plan offered by Oregon senator Ron Wyden:
http://wyden.senate.gov/media/2006/12132006_Healthy_Americans_Act.htm
Both of these proposals would be worth discussing. Of course in this venue all we’re going to hear is government is bad, the evil liberals, socialized medicine, can’t trust the Democrats, blah, blah, blah, making any serious discussion on systemic reform virtually impossible. I think a lot of conservatives would prefer that the health care system sinks rather than that the government were given any role in keeping it afloat. If health care reform involving government actually worked, that would destroy the conservative myth that government can’t do anything right. So it’s far better to let the system continue to crumble than to run the risk that conservative ideology might crumble.
So I will propose a two-phase health care plan that should be wildly popular here. Phase One: repeat after me — government is bad, government is bad, government is bad. Phase Two: end Medicaid, Medicare, and every other health-related government program, and replace them with — nothing. There, now everything is fixed! That was easy, wasn’t it.
Reform of veteran’s health care will be just as easy. We give all military folks a little pay raise, and suggest that they put that raise into a health savings account. Then, in the event that they are shot or burned or blown up, they can pay for their own care from the health savings account. If they run out of money, well, they should have saved more.
We can even implement that on the battlefield. When some soldier gets his leg blown off, all he has to do to get his stump sutured is to write a check for a few thousand dollars at the aid station. If he can’t afford that, well, maybe he can find some Iraqi or Afghan doctor who will do it for less. Let the free market rule, I say.
Man, this is great. I love being a conservative. Everything becomes so simple.
JBL – Your comments are shameful as well as malicious and ill-informed. There are a lot of good people who worked and work at the Veteran’s administration who care deeply about seeing that the men who sacrificed so much to serve our country get treated right. You insult people you don’t even know, which to me is the sign a true idiot.
My own father, a US Army combat veteran from WWII, took a job with the VA later in his career. His boss was a former tank commander who lost an arm in battle. They understood better than most what happens to soldiers in war and the bond of brotherhood that links soldiers who go through that experience. I remember my dad bringing reading home every night on the war experiences of the Viet Nam veterans to study so he could make better decisions regarding their disability and medical needs.
I challenged you to develop a comprehensive set of objective measures and indicators to evaluate the quality of care provided by the VA, because if you did I would be able to show you that the VA is already excelling in those areas. Instead you responded with more mean spirited blathering attacking people in civil-service, including people in my family. I’m done with you.
JBL – Your comments are shameful as well as malicious and ill-informed. There are a lot of good people who worked and work at the Veteran’s administration who care deeply about seeing that the men who sacrificed so much to serve our country get treated right. You insult people you don’t even know, which to me is the sign a true idiot.
What is insulting is your middle school debate style, hard left moral posturing. Have you not been listening to what Fr. Jacobse and others have been telling you for years now? This sort of rhetoric has no influence. The VA is a health care and moral disaster. Your support of it and attempt to expand it through socialized medicine is a true evil to be fought at every turn. You are channeling Satan again…
Now Michael, your not going to lecture me on this are you? How many times must Dean channel Satan before we acknowledge the darkness of his evil political, social, and religious philosophy?? 😉
Dean,
Your statements bring into question how in touch with reality you really are. Especially when you state to a veteran “to develop a comprehensive set of objective measures and indicators to evaluate the quality of care provided by the VA”. Your interpretation of life is like a cow staring at the barn door, seeing but not comprehending. You think that if you keep repeating that same tired message it must in someway make it a truth. Spewing regurgitated emotional rhetoric does not make a truth about an issue. It just shows you can memorize political catch phrases.
Until you have personally gone through the VA system your forced comments of righteous indignation are rather hollow. They’re the ramblings of a gadfly.
I also must agree with Christopher that your worldview is of a different spirit than that of the Church.
Christopher, each of us channels Satan when we put political and social ideology ahead of the Church. IMO given the lack of moral and social concensus in the United States and the extent to which all of us have sold our souls to the idea that money is important, any attempt to stop the free flow of efflugent waste into our lives by political means, however well meant, is impossible. We want all the goodies promised by our politicians, left & right because we have bought into the fundamental falsehood that only mass action can solve any problem. It does not matter where such ideas come from or how they are articulated, they are wrong. St. Paul said, “I am the chief of sinners…” Orthodox theology teaches that we each are responsible for the sins of all. The political approach is exactly the opposite: you’re OK, its those guy over there who are the bad guys. Democrat, Republican, Libertarian, Tax Feedom Party, Green Party, etc, all are equally corrupt and useless. To put any faith in any of them is a mistake.
Unless and until each of us is willing to face the evil in our own hearts and fight there, the rest is hypocrisy. I do not know the extent that you, Dean or Jim are engaged in that fight. I can only answer for myself that I am abysmal at it and sincerely ask the forgiveness of any and all I have offended or incited to anger by my arrogant words in the past.
JBL writes: “It’s an inability by VA administrators to make necessary changes in staff . . .”
Dean responds: ” . . . You insult people you don’t even know.”
Christopher replies with his usual personal attack: “What is insulting is your middle school debate style . . . a true evil . . . channeling Satan.”
I think there is probably merit in both Dean’s and JBL’s positions. In my years of working in a large hospital I saw good and bad managers, good and bad employees. I saw courageous people trying to work within bad processes. I saw good processes undermined by bad employees and managers. I saw an institution that regularly provided monumentally good care, but occasionally provided unbelievably bad care. I have friends who, if sick, would insist on being treated in that institution, and I have friends who wouldn’t go there if you paid them. All with the same public hospital.
What I never did see there was any evidence that a government facility is ontologically incapable of providing good medical care. We had some programs and physicians who were literally world-class, to the point that we had contracts with several Middle Eastern countries to provide specialty care to people they sent over. We had first-rate researchers and highly-respected academic programs. We also had some major failures and screw-ups. What large organization doesn’t?
Subjective and anectodal information drawn from personal experience is not worthless. However, in order to acertain whether those experiences are represenative of the norm or isolated and anamolous you need to collect objective, emprical data and measure it scientifically by means of statistical tests of significance. This is what’s known as the scientific method. You have a hypothesis, you collect data, you evaluate the results, and based on those results you either accept or reject the hypothesis.
The only meaningful claims regarding the quality of care provided by the Veterans Administration therefore are those supported by objective, empirical data which has been measured scientifically. A number of such studies have been undertaken by a number of respected research organizations to explore this question and they consistently affirm that the quality of care provided by the VA compares favorably with private sector alternatives.
Therfore it is logical to conclude that unfavorable subjective and anectodal reports are not representative, but the product of isolated incidents and/or disgruntled persons with a personal or ideological axe to grind.
Therfore it is logical to conclude that unfavorable subjective and anectodal reports are not representative, but the product of isolated incidents and/or disgruntled persons with a personal or ideological axe to grind.
Right. And your axe is (to quote from your post #26):
You insult people you don’t even know and My own father, a US Army combat veteran from WWII, took a job with the VA later in his career. and I remember my dad bringing reading home every night on the war experiences of the Viet Nam veterans to study so he and Instead you responded with more mean spirited blathering attacking people in civil-service, including people in my family. I’m done with you.
Soooo, the only meaningful science and experience (because people are not merely scientific subjects) for you is what supports you and your families desire to socialize medicine (and everything else for that matter).
I just have to say that I am saddened by the nastiness going on here. Please debate all, but in a respectful manner. Have a glorious day.
Do you think we are better off in the long-run allowing shameful lies* to gain popular acceptance? That’s how are nation has gotten itself into such a terrible mess these last six years. Better to call a spade a spade, I think.
* Mission Accomplished, Heckava Job Brownie, Shock and Awe, Evidence of WMD is a Slam Dunk, the war will pay for itself, Dead or Alive, Bring Em’ On!, Greeted as Liberators, the insurgency is in its last throes, the Smoking gun is a mushroom cloud, As the Iraqis stand up we’ll stand down, tax cuts for the rich increase revenue etc.
Note 34:
It’s not too long before you circle (or is it meander) back to the hard left’s “Bush lied” mantra (which is itself a lie), which is of course completely off topic. You know, even in middle school debate class this would hardly get you a ‘C’…..;)
Jim H asks: “We also had some major failures and screw-ups. What large organization doesn’t?”
Having worked for several large commercial firms for some time, I can tell you that waste, sloth and ineptitude are not peculiar to the government sector, and it gets worse depending upon the size of the corporation. I’ve seen millions upon millions of dollars thrown away by banking institutions on projects that were poorly planned and dropped with little thought given to the amount of money already invested. I’ve seen a lack of productivity within insurance companies to the point that employees could literally spend 4 hours of an 8-hour-day on actual “work”. These were all publicly-traded companies, by the way.
Now, if we’re suggesting that any government endeavor must be managed so that the scope of its efforts is limited to a reasoanable level, I’m in complete agreement. This is not to say that any government program is doomed to failure simply due to some intrinsic quality.
In the 12-months time between November 2005 and November 2006 Arnold Schwarzenneger, Governor of the largest state in the US, went from abysmally low public approval ratings to a landslide election victory by discarding conservative ideology and adopting more moderate political policies. Conservatives should note that one of Schwarzenneger’s major priorities during the next four years is universal health care for all Californians.
Although the Governor has rejected a single-payer solution, Schwarzengger’s plan in effect transforms private insurance companies into regulated public utilities.His plan would prohibit insurance companies from denying or withrawing coverage based on a individuals medical history, and it would set the minimum medical-loss ratio at 85% thus capping administrative costs and profit at 15% of revenue.
In poll after poll, Americans have stated their desire for some form of universal health care coverage and their willingness to pay higher taxes if they have to to get it.
The US health care system is clearly collapasing. The US health care system costs twice as much money, per capita, than health care than in Canada and Europe while producing outcomes and health indicators that are no better. 47 million Americans have no health insurance at all and millions more have policies that leave them under-insured and at great financial risk. Every years thousands of Americans are plunged into bankruptcy and poverty by crushing medical debt. Financial difficulties paying for health care operate as defacto barriers to access.
American conservatives need to wake up and smell the coffee and realize that in the next ten years there is going to be some sort of greater government role in health care. All proposals that lead to greater efficency and better quality are to be welcomed. But for conservatives to keep on repeating that government has no role at all, and what we should do instead is just sit there and watch the system collapse – that’s not an option.
Tell me how we fix this problem without government involvement:
Health insurance options dwindle for self-employed: Group plans are being dropped or becoming unaffordable to many., LA Times March 27, 2007
If small business owners and would-be new business owners cannot obtain health insurance than new business creation in the United States is going to shrink dramatically. In this case the ideological fixation on less government is clearly harming our economy.