COMMENTARY

The VA Healthcare System -- Can We Handle the Truth?

John M. Mandrola, MD

Disclosures

May 29, 2014

In This Article

Memorial Day and Veterans' Healthcare

Editor's note: This post originally appeared at drjohnm.org

Memorial Day weekend is an apt time to consider the recent accusations of wrongdoing in the VA healthcare system. It's an opportunity to face the truth.

As a free American, I am connected to veterans. It has always been remarkable that young people give their life or health for their country, but now, in this me-centric era, it is stunning that they do. It is truth to say that veterans deserve our respect and our care. Consider also that recent wars have been fought on the backs of the underprivileged, a fact that strengthens the calling to care.

I am also connected to veterans' healthcare. For it is in the VA system that I learned to be a doctor -- a feeling doctor, an imperfect doctor, a human doctor. It's ironic, and not often said, that the $48 billion VA healthcare system gives as much as it takes. It's impossible to put a value on the benefit to society from the legions of caregivers who emerge from years of training in the VA system. Algorithms be damned; wealthy Americans benefit from what young doctors learn in the VA system. Veterans give when they serve in battle, then they give again as patients, as teachers.

And it's not just the past that connects me to veterans' healthcare. My wife, Staci, works as an attending physician in hospice and palliative care at the Louisville VA. When we share stories, I mostly tell of relieving the palpitations of the rich, she of relieving the suffering of dying veterans. Another irony of the VA: You don't get Staci if you have private insurance.

That's the thing about veterans' healthcare. Buried deep within the maddening levels of bureaucracy are the Stacis, the angels. And don't think for a moment that it's just VA doctors who are special. There are armies of caring nurses, therapists, van-drivers -- the list goes on and on.

So, what about these stories of corruption? Veterans are dying on long waiting lists. Administrators are cooking the books to cover up the fact that you can't deliver the same care to many as you can to few.

We should set out 2 givens. One is that the accusations remain alleged, and the other is that no right-minded person advocates for dishonesty. That said, it is most instructive to view the response to this "scandal." Here we see real problems: a collective failure to note the obvious; the gaming of the story to simplistically knock down a single-payer system; or perhaps the dumbest of all, holding this up as an indictment of Obamacare.

Failure to See the Obvious

You simply cannot deliver suburban excesses -- the antithesis of efficient and honest healthcare -- to the growing numbers of veterans. Thank goodness. Both Dr. Harlan Krumholz and Dr. Kevin Pho remind us that if evidence, not hype, is considered, the VA system performs either better than, or comparable to, the private sector.

Yet this should be obvious to anyone who reads anything about US healthcare. It's clear that the private system is broken. If you hold up the US private system -- with its humanity-extracting EHRs, expanding layers of bureaucracy, conflicts of interest, expense, inequalities, and geographic and racial differences in care -- as a model that the VA should aspire to, you are not mastering the obvious. My colleague at theHeart.org, Dr. Melissa Walton-Shirley, suggests that veterans should be moved to the private system. I wouldn't do that; veterans deserve better than our mess.

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