With the recent revelations about the disgraceful treatment of patients by the Veterans Affairs hospitals, the public is discovering what the majority of doctors in this country have long known: The VA health-care system is a disaster. Throwing more money at the system, or demanding the scalps of top bureaucrats—Washington’s reflexive response to any problem of this sort—won’t repair the mess. What’s needed is a fundamental rethinking of how to provide medical care for America’s veterans.
The federal government runs two giant health-care programs—Medicare and the VA system. Medicare is provided by private physicians and other providers. Its finances are a mess, but the care that seniors receive is by and large outstanding. The VA health-care system is run by a centrally controlled federal bureaucracy. Ultimately, that is the source of the poor care veterans receive.
U.S. doctors are well aware of the problems with VA hospitals because many of us trained at them. There are 153 VA hospitals. Most of them are affiliated with the country’s 155 medical schools, and they play an integral role in the education of young physicians. These physicians have borne witness to the abuses and mismanagement, and when they attempt to fight against the entrenched bureaucracy on behalf of their patients, they meet fierce resistance.
Most doctors have their personal VA stories. In my experience at VA hospitals in San Antonio and San Diego, patients were seen in clinics that were understaffed and overscheduled. Appointments for X-rays and other tests had to be scheduled months in advance, and longer for surgery. Hospital administrators limited operating time, making sure that work stopped by 3 p.m. Consequently, the physician in charge kept a list of patients who needed surgery and rationed the available slots to those with the most urgent problems.
Scott Barbour, an orthopedic surgeon and a friend, trained at the Miami VA hospital. In an attempt to get more patients onto the operating-room schedule, he enlisted fellow residents to clean the operating rooms between cases and transport patients from their rooms into the surgical suites. Instead of offering praise for their industriousness, the chief of surgery reprimanded the doctors and put a stop to their actions. From his perspective, they were not solving a problem but were making federal workers look bad, and creating more work for others, like nurses, who had to take care of more post-op patients.
At the VA hospital in St. Louis, urologist Michael Packer, a former partner of mine, had difficulty getting charts from the medical records department. He and another resident hunted them down themselves. It was easier for department workers to say that they couldn’t find a chart than to go through the trouble of looking. Without these records, patients could not receive care, which was an unacceptable situation to these doctors. Not long after they began doing this, they were warned to stand down.
There are thousands of other stories just like these. .
In my experience, the best thing that a patient in the VA system could hope for was that the services he needed were unavailable. When that is the case, the VA outsources their care to doctors in the community, where their problems are promptly addressed. But these patients still need to return to the VA system for other services and get back on a long waiting list.
Proponents of the Affordable Care Act have long used the VA to showcase the benefits of federally planned and run health care. Doctors know otherwise—and it is no surprise that a majority of them have opposed a mammoth federal regulatory apparatus to control health care in this country. The systemic problems with the VA bureaucracy are a harbinger of things to come.
The best solution for veterans would be to wind down the VA hospitals. The men and women who have served in our armed forces should be supplied with a federally issued insurance card allowing them to receive their care in the community where it can be delivered better and more efficiently.
The veterans who receive their care at VA hospitals are the kindest and most grateful patients that I have had the privilege to care for in my career. Unfortunately, they are getting shortchanged. The time to repair this national embarrassment is long past.
Dr. Scherz is a pediatric urological surgeon at Georgia Urology and Children’s Healthcare of Atlanta and serves on the faculty of Emory University Medical School.
