The allegations regarding awful performance of the Veterans Administration health system are the subject of news reports and articles during recent months. http://www.frontpagemag.com/2014/arnold-ahlert/dying-in-the-hands-of-veterans-affairs/
I suspect that these reports are just the tip of the iceberg of nationwide difficulties, and that, although the current administration’s responses to them may be sorely inadequate, these difficulties didn’t begin when President Obama won the presidency.
The purpose of this essay is to discuss the nature of the problems within the American health care system in general using the Veterans Administration health system as an example.
Did you know that the V. A. health system is the purest form of Socialized Medicine, which refers to a health system in which the government owns and operates both the financing of health care and its delivery? http://economix.blogs.nytimes.com/2009/05/08/what-is-socialized-medicine-a-taxonomy-of-health-care-systems/?_php=true&_type=blogs&_r=0
How many of these allegations about mismanagement or worse in the V. A. health system are true, I do not know. But something is going on. What is the result of this something? Apparently, some veterans are dying and others suffering some other type of harm due to improper care possibly related to delayed or withheld treatments. If this turns out to be true, then how could it occur? One answer could be that V. A. administration officials, who wield more power than individual doctors, are directly interfering with the sound, ongoing, non-conflicted functioning of the doctorpatient relationship. This type of general interference is a recurring theme both on this blog and in my book, Socialized Health Care Reform.
Questions I have are, Where are the patients’ individual doctors in all this? Are they mute? Did they fail to learn or simply ignore the physician’s duties for a sound, ongoing, non-conflicted doctorpatient relationship?
Or is it more that because they work for a massive government bureaucracy which pays their salary they have been systematically, persistently and pervasively kowtowed into submission under fear of retribution, dismissal and pursuant damaged reputation.
The next questions are for me to answer: Is the central payer system, which I describe on this blog, any better? Could it fall prey to the same kind of difficulties the V. A. health system is plagued with? The answers are as follows:
- My system does not meet the economic definition of socialized medicine noted above because there is no change of ownership or transfer of ownership to the government of any hospital, clinic, practice or other health care business.
- However, a central payer could still socialize (manipulate, obstruct, control) doctorpatient relationships, for example by refusing to pay for certain procedures, disallowing procedures, threatening the doctors with continually lowering reimbursement, forcing hospitals to accept lower reimbursement, bonuses for physicians, clinics and hospitals for directing patient management a certain way, etc. These type of events can be greatly curtailed if the Congress sets up up a central payer with legislation, which prohibits the payer, the Executive branch and the Congress from, in any way, interacting with the doctorpatient relationship. Of course, this would require thoughtful, clear, unambiguous language and intent. I really don’t know if politicians are capable of that.
- For my system to really work, there is another very important event which must take place: Doctors must come to the fore, accept and fulfill the demands placed on them by the sanctity of the doctorrelationship and demand completion of their orders in a timely fashion without the fear of retribution from the central payer or from any hospital or clinic which pays their salary. In fact, I believe that doctors shouldn’t be in the employ of hospitals, clinics or health systems, that they should have their own unique, independent private practices in which it is much easier to recognize that each patient is their employer.
- Significant changes in the essence of how our health care system functions must occur, if we are to have true health care reform. Regarding the Veterans Administration, the V. A. health system clearly demonstrates what we must avoid. Maybe the V. A. health system should be completely privatized including the ownership of the V. A. hospitals and clinics, and the entire V. A. health system budget be directed to a central payer, the make-up of which I have described.
R. Garth Kirkwood, MD