Tag: patient-centered health care

If You Like the VA, You’ll Love ObamaCare

The Obama administration sold – well, it pitched ObamaCare to the public with this promise: “It’s time we put the health of American families back in the hands of consumers – not the insurance industry.”

The Veterans Health Administration shows how incompetent the federal government is when it comes to making medicine a patient-centered enterprise.  After decades of mistreating veterans, the VHA achieved some successes in the past decade or so, such as adopting electronic medical records and improving on some measures of quality.  Yet serious deficiencies remain.  Today’s Los Angeles Times reports that the VA’s disability system is a nightmare for soldiers and sailors disabled in combat:

John Lamie survived six roadside bombings in Iraq, only to have the Department of Veterans Affairs refuse to accept three months’ worth of medical tests he underwent for jaw and shoulder wounds — tests performed by VA-approved doctors at VA facilities…

Many veterans wounded in Iraq and Afghanistan are being buffeted by a VA disability system clogged by delays, lost paperwork, redundant exams, denials of claims and inconsistent diagnoses. Some describe an absurd situation in which they are required to prove that their conditions are serious enough for higher payments, yet are forced to wait months for decisions.

“You fight for your country, then come home and have to fight against your own country for the benefits you were promised,” said [Clay] Hunt, 28, who served in Iraq and Afghanistan as a Marine Corps sniper.

It took Hunt, who lives in Brentwood, 10 months to receive VA disability payments for his injuries after the agency misplaced his paperwork…

Some veterans wait up to six months to get their initial VA medical appointment. The typical veteran of the Iraq or Afghanistan wars waits 110 days for a disability claim to be processed, with a few waiting up to a year. For all veterans, the average wait is 161 days…

Lamie, 25, an Army combat engineer who risked his life uncovering and defusing roadside bombs in Iraq, declared bankruptcy in April. He is unable to work because of his combat injuries, he said, and VA delays have left him short of cash to support his wife and four children. He gets $311 a month in food stamps.”I did everything the VA asked of me, but they block you at every turn,” Lamie said from his home in Georgia. “They play with people’s lives…They drag their feet, hoping you’ll give up. A lot of people do. Not me.”…

When he volunteered for the Marine Corps, Hunt recalled, a selling point was lifelong medical care if he were wounded.“But then the time comes to get those benefits, it turns into a lifelong battle with the VA to get what you were promised,” he said…

The experience has left [Lamie] drained and disillusioned. He said he couldn’t even look at his old Army uniform anymore.

“I can’t stand the sight of it after what I’ve gone through with the VA,” he said. “I’m not proud anymore.”

ObamaCare will produce similar horrors, and for the same reason: all economic systems serve the people who control the money.  Under ObamaCare and the VA, patients don’t control the money.  The government does.

Returning that money to consumers would put patients first, whether they’re veterans or other civilians. But such reforms won’t mean a thing until we repeal ObamaCare.

A Little Less Poetry, a Little More Economics

A good friend sent me an article on “patient-centered health care” written by Dr. Donald Berwick, President Obama’s intended nominee for administrator of the Centers of Medicare & Medicaid Services. What an improvement an administrator like this will bring compared to his predecessors! Right? The article is called What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist (requires login).

I have no doubt of Berwick’s sincerity, but the essay gives me little hope for progress. It doesn’t mention, for example, parity in the tax treatment of employer-purchased and individually purchased health insurance.

Why don’t we talk about diner-centered restaurants or grocery stores? Because when consumers select restaurants and stores, choose their food, and pay for their choices, “diner-centeredness” is a given. To the extent non-diner-centered food outlets have come into existence, they’ve gone away again as a failed business model. Nobody has to discuss what it means or what artificial process they would use to deliver “diner-centeredness.”

“But health care is essential to life!” some might argue. ”Intellects and government officials must pay health care delivery special attention because without it people would die.”

Pray tell, good hearts, what is food other than an essential of life without which people would die? We regard food provision an “easy” problem because we haven’t made it hard by fettering the market for edibles the way we have health care.

Keep your eye on the ball. If you have to discuss how to get patient-centered health care, you’ve framed the problem wrongly. (The medical metaphor is talking about a symptom and not the disease.)

“Patient-centered” is implicit when the patient is actually at the center. Dr. Berwick should approach the health care delivery problem with a little less poetry and a little more economics.