Single payer is Root Cause of VA Deaths
General Eric Shinseki ‘falling on his sword’ won’t bring back a single veteran who died needlessly while waiting for approved medical care. Punishing specific hospitals or administrators won’t get our veterans the timely doctor visits they need. Blaming doesn’t fix anything, and tweaking the VA system won’t make things right.
The problem with the VA system is the system, a single-payer model. Newspaper headlines shrieked outrage over unconscionable wait times to see a doctor; inadequate operating rooms; and needed medicines not available. This should come as no surprise. That is the way single-payer systems work. That is the norm, not the exception.
Look to our north for proof, to the single payer system in Canada. Fifteen years ago, a Canadian surgeon named Dr. Ciaran McNamee sued the Alberta Provincial government claiming that patients were dying needlessly, while waiting for authorized (but not funded) care. He had good hard medical data to back up his claim, showing that there were not enough operating rooms, too few nurses or doctors, and insufficient medicines, all due to a government budget allocation process. The phrase applied to these patients, equally appropriate for our veterans, was death-by-queueing.
The current VA scandal comes as a surprise to many. It certainly shouldn’t. In 2003, a task force established by President G.W. Bush reported that at least 236,000 (!) U.S. veterans were waiting six months or more for a first medical appointment or initial follow-up. Nothing was changed in eleven years.
In 2011, a former VA administrator stated before Congress that our VA hospitals were “gaming the system,” cooking its books. Rather than solving the problem, the VA administration was simply spinning the data so that it appeared as though there was no problem.
Why did they cover up rather than implement a solution? Because solving the VA health crisis would force them to admit that the system is the problem.
A single-payer healthcare system is, at its most basic, a government-run monopoly over health services and goods. The government pays what it chooses, when it chooses. The consumer has no say. The care a patient receives is determined by bureaucratic rules and budget allocation, not by the doctor in concert with the patient. There are no free market forces in a single-payer system.
Supporters claim that single payer will dramatically reduce administrative costs and eliminate the obscene profits that commercial insurance companies make. I defy any supporter to show evidence of a government-run bureaucracy that is more efficient or effective than in the private sector. And we all know that government programs invariably much cost more than when the free market is allowed to function.
A recent New York Times headline blamed our veterans’ deaths-while-waiting-for-care on a doctor shortage. Why, you ask, is there a shortage of providers in VA system? For two reasons that apply with equal force to the non-veteran general populace (you and me): money and red tape.
“You can’t get more of something by paying less for it,” said the Heritage Foundation’s Robert Moffitt in testimony to Congress. What did Congress think would happen to the supply of physicians when ACA cut reimbursements by $716 billion over ten years? Did they think that U.S. doctors clamor to work more hours for less pay? As the government-controlled (single payer) system fixes prices, market forces drive suppliers of service -- doctors -- out of the market, whether VA or private sector.
To make the VA situation seem like a Bizarro comic, one solution proposed was to have veterans get their medical care in the private sector. Has no one in Washington noticed that you and I cannot get in to see the doctor?
In January 2014, my wife began searching for a new family doctor. In March 2014, she found one who was accepting new patients. She has an appointment for August 27, 2014, eight months after she identified her need for care.
The doctor shortage is less about money than it is about red tape. Excessive administration, reason-robbing regulations, mandatory time-wasting, intrusive oversight, and bureaucrats practicing medicine are what drive more and more doctors, including me, to quit clinical practice.
It is vital to understand that bloated administration, gross inefficiency, overwhelming regulatory burden, and cost overruns are the norm for all bureaucratic, government-run programs. The needs of the end-user, aka the “patient,” are unimportant in a single-payer system compared to the budget process and regulatory compliance.
Fifteen years ago, Great Britain’s vaunted National Health Service was rocked by a scandal similar to our current VA debacle. There, it was children with congenital heart disease at the Bristol Royal Infirmary. The British blue ribbon Panel Report ultimately concluded that the problems were systemic, rather than limited to Bristol. Government-controlled healthcare created a culture of complacency, rationalization and justification, with cover-up utilized when necessary. The Panel members specifically cited a bureaucratic mentality that was inappropriate in a healthcare setting. When rule-following and CYA are more important than individual patient welfare, guess who loses?
The VA system here and the national health systems of Canada and Great Britain are all single-payer systems. They protect the budget and the bureaucracy over the welfare of a sick patient. The evidence should provide a cold shower wakeup call to any who still want a government-controlled healthcare system. Advocates of single payer option and Kool-Aid drinkers everywhere, beware! There are rising costs, fewer doctors and nurses, less care, poorer health, and premature death in your future.
Deane Waldman MD MBA -- “Dr. Deane”-- is author of The Cancer In Healthcare; Host of The Hidden Enemy Newsletter-&-Forum; member of the Board of Directors of the NM Health Insurance Exchange; Adjunct Scholar for the Rio Grande Foundation; and Emeritus Professor of Pediatrics, Pathology, and Decision Science