The V. A. Health System is the purest form of socialized medicine, i.e., a health system in which the government owns and operates both the financing of health care and its delivery. In America, this particular system of socialized medicine is reserved for our nation’s veterans.
The problem is that it doesn’t work. Actually, it can’t work. Why? Because health care, which is defined by sound, ongoing, non-conflicted doctorpatient relationships, is not considered its primary goal. Administrative bureaucracy by operating as if its own survival was most important has paralyzed the doctors who, in my view, should be ashamed of themselves for putting up with it.
There can be no fix until the administrative bureaucracy separates its functioning from the functioning of the doctorpatient relationship and not only views the latter as more important but also creates the platform upon which this relationship can evolve to its full potential. The quagmire of ineptitude, fear, and cover up will remain unchanged until the president appoints a true clinician with many years experience in private practice outside the VA System as the chief of its operations. And this person will have to have the following outlook: The goal is to get our veterans diagnosed and treated within the confines of sound, ongoing, non-conflicted doctorpatient relationships. And she/he will also have to have the mentality to plow the road to accomplish this goal.
The corollary for this in the American health care system in general is that the same type of true clinician be appointed chief of a central payer, which functions to accomplish the same goal for our non-veterans by separating the business of medicine from the medicine of medicine and views the latter as paramount.
Even better may be to eliminate the V.A. System and have one system for everybody which functions in the manner described.
A comment about this essay is that you will still need people who understand how systems operate to create the type of change called for. I guess that’s true. But what I see now is a whole lot of people who understand systems obstructing the delivery of health care. How’s that working out for us?
R. Garth Kirkwood, MD