The VA hospital mess: Demographics, history, hypocrisy

  This piece originated on the Cambridge Management Group Web site.

Merrill  Goozner, editor of Modern Healthcare, has written a fascinating and provocative  editorial that well explains why the Department of Veterans Affairs, which for some years had a stellar reputation for care, now faces a mess. And,  sadly, it's become a political game mired in hypocrisy.

Consider Phillip Longman's  book about VA health care, called <em>Best Care Anywhere</em>, which, Mr. Goozner noted, praised "the 1990s transformation that turned a scandal-plagued, dysfunctional system into one that pioneered the adoption of electronic health records, improvements in patient safety and coordinated care.''

He and many others note that the current scandal involving care delays  reflects the VA's inadequate preparation to receive hordes of aging Vietnam veterans and veterans of Iraq and Afghanistan. But, he says, don't blame the folks who run it but the politicians who failed to adequately fund  the VA.

Mr. Goozner notes that the health status of the Vietnam vets "reflects the fact that they are somewhat poorer and less educated than the general population since that was the first conflict where college-bound young adults were largely exempted from frontline military service.''

As for the vets of Iraq and Afghanistan:

"Like Vietnam-era vets, the younger vets bring with them a special set of problems brought about by the miracles of modern battlefield medicine and logistics. Compared with previous wars, many more survive disfiguring bomb blasts and traumatic head injuries, which will require a lifetime of care and support.''

"Yet until last year, the VA's medical care budget hadn't increased any faster than the general rate of medical inflation, rising from $25.5 billion in 2003 to $45.5 billion in 2012, according to data from the VA.''

Mr. Goozner also notes the hypocrisy of politicians denouncing the  "high salaries'' of people running VA hospitals that are a small fraction of salaries paid to hospital execs at "nonprofit'' hospitals. "Maybe the real lesson here for Congress and the White House is they are getting what they pay for — from the VA executive salaries to the promptness of the health care services the VA offers our worthy veterans.''