Back in 2006, Krugman wrote “Health Care Confidential”:
American health care is desperately in need of reform. But what form should change take? Are there any useful examples we can turn to for guidance?
Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system — it runs the hospitals and clinics.
No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.
In the 1980’s and early 1990’s, says an article in The American Journal of Managed Care, the V.H.A. ”had a tarnished reputation of bureaucracy, inefficiency and mediocre care.” But reforms beginning in the mid-1990’s transformed the system, and ”the V.A.’s success in improving quality, safety and value,” the article says, ”have allowed it to emerge as an increasingly recognized leader in health care.”
For the lesson of the V.H.A.’s success story — that a government agency can deliver better care at lower cost than the private sector — runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today’s Washington.
Now we know why those reforms were “successful”: Make “confidential” lists:
That gets to the emotional heart of the Veterans Affairs scandal: at a V.A. hospital in Phoenix, veterans were not put on the lists for appointments where they belonged. They were shunted off to a secret waiting list, one that was a lie. The hospital did this to hide how long it was making patients wait for care. It blotted out their names and their needs; it struck them, dishonorably, from the rolls. And an interim inspector general’s report, released on Wednesday, said that the department had received complaints indicating a national problem. As bad as the situation, in the last few weeks, seems to have been, the report suggests that it may have been even worse. It is not just a matter of health care at a level lower than what veterans deserve, or a balky database: it is a fundamental insult.
How many names were on the secret lists? The inspector general found:
1,700 veterans who were waiting for a primary care appointment but were not on the [electronic waiting list]. Until that happens, the reported wait time for these veterans has not started. Most importantly, these veterans were and continue to be at risk of being forgotten or lost in Phoenix HCS’s convoluted scheduling process. As a result, these veterans may never obtain a requested or required clinical appointment.
Eric Shinseki resigned as secretary of the Veterans Affairs Department Friday after meeting face-to-face with President Obama about mounting evidence of widespread misconduct and mismanagement at the agency’s vast network of medical facilities.