A U.S. socialized medicine success story

Charles Gibson, anchor of ABC’s nightly news program, asked his Dec. 12 viewing audience the following provocative question: What national health care program in our country uses “socialized medicine,” and why do people like it?

Then he gave a clue: 'The system is well known to over 5 million U.S. citizens.'

The answer, you may have guessed, is the health care system run by the Department of Veterans Affairs, better known as “the VA.” In 2006 it served about 5.5 million veterans at 155 medical centers and more than 1,000 other sites of care, including outpatient clinics and nursing homes. In 2006, over a quarter million veterans received inpatient medical treatment; outpatient clinics registered about 60 million visits.

As part of the ABC news segment, one of its reporters at a VA medical center interviewed physicians, nurses and many veterans themselves. They all agreed that everyone in the United States should have this kind of system. Veterans praised the quality of care and its low cost.

The news story reported that the VA system delivers quality health care far more cheaply than does the other federal system of health care, Medicare. The reporter credited the VA’s superior data information system as the primary reason its care is so good and less costly. But there are deeper reasons why the VA’s “socialized medicine” works.

The VA hires predominantly salaried physicians, nurses and other health delivery personnel. The staff is on a government payroll with a defined wage scale and benefits package. This helps control costs.

Further, the system is able to negotiate with drug manufacturers and other suppliers on a level that allows it to get the lowest possible prices. These savings are then passed along to the system.

The Bush administration forbids Medicare from undertaking similar negotiations with the drug companies, so Medicare ends up paying market prices for pharmaceuticals. In addition, Medicare keeps getting privatized into what are now called “Medicare Advantage” programs, which drive the price of health care skyward. These programs are modeled after the failed HMOs of the 1990s.

The VA health care system deserves to be emulated. For example, what if the federal Medicare program were integrated with state-based Medicaid into a fully federal system with salaried doctors, nurses and other personnel? Just think of the savings! In fact, it would make sense, over the long run, to merge the VA system, Medicare and Medicaid into one comprehensive system.

Policy analyst professor Paul Krugman, a frequent contributor to the op-ed pages of The New York Times, has for months heralded the VA system, using the feared term “socialized medicine.” Krugman has called for the VA system to become the model for a national system of health care.

Krugman is not alone. The December 2007 issue of the American Journal of Public Health is devoted entirely to the subject of “Health Care for Veterans.” The articles try to analyze the reasons why the quality of care for veterans has been rising.

Dr. Elizabeth Yano of UCLA’s School of Public Health in Los Angeles, in her article titled “The evolution of changes in primary care delivery underlying the Veterans Health Administration’s quality transformation,” gives the clearest explanation.

In so many words, Yano says that veterans using the VA system are seeing the same team of physicians and other health care providers visit after visit, resulting in their increased confidence in the system. As a result, they are motivated to come back again and again for the appropriate follow-ups.

Dr. Said A. Ibrahim, writing an editorial titled “The Veterans Health Administration: A domestic model for a national health care system?” says the following: “Diabetes care in the VA has been reported to be better than that of the private sector; VA patients are reported to be more likely than even Medicare patients to receive life-saving treatment in cardiac care; VA performance of many processes of care measures across a spectrum of health care services [screening, diagnostics, treatment, and follow-up] is better than in non-VA health care systems.”

And finally, Ibrahim writes, “Patients receiving care within the VA report higher levels of satisfaction then do their counterparts receiving care in the private sector.”

Why don’t other health care “experts” want to hear this? Because it strikes at the heart of the private, for-profit system of health care in our country.

So here’s a question for the presidential candidates: Given that the VA system works so well, why not give everyone in our country the benefits of socialized medicine?