Over the past several months, there has been a growing focus on the horrific neglect of patients within the Department of Veterans Affairs health care system, especially reports of veterans dying while on “secret” treatment waiting lists. Tragically, such stories are inevitable when government is running health care.
Of all the world's health care systems, the VA's regime most closely resembles Britain's National Health Service, the subject of an October cover story in the Washington Examiner. Like the NHS, the VA medical system is a centralized bureaucracy with a network of government-run hospitals overseen by public officials and employing doctors who are paid by the government.
The scandal facing Veterans Affairs involves evidence that officials manipulated performance metrics to create a false appearance of efficiency. In February, the Examiner's Mark Flatten reported backlogged orders for medical care were being mass-purged at hospitals in Los Angeles and Dallas to make wait times seem less than they really were. In early April, the House Committee on Veterans Affairs reported that 40 veterans died waiting for treatment at the Phoenix Veterans Affairs medical system, and that many were put on a secret waiting list to mask the fact that 1,400 to 1,600 veterans had to wait months for doctors.
Though the department has touted improved wait times, a Los Angeles Times article quoted Dr. Jose Mathews, chief of psychiatry at the VA St. Louis Health Care System, as saying, “The performance data the VA puts out is garbage -- it's designed to make the VA look good on paper.”
Similarly, the NHS is notorious for setting targets based on criticism for poor care, only to see those targets gamed with results ranging from absurd to tragic. For instance, several years back, the government responded to complaints about waiting times at hospital emergency rooms by instituting a target for NHS hospitals to treat patients within four hours.
Because the clock didn’t technically start ticking until patients arrived in emergency rooms, in 2008 the Daily Mail reported that patients were being kept in ambulances for hours before being brought into the ER. This made it easier for hospitals to meet the four-hour targets on paper. But in reality, many patients still weren’t being treated in a timely manner and, additionally, ambulances weren’t available for emergency calls.
In the 1990s, the British government established a set of guidelines for providing care to patients at the end of their lives. In practice, patients were being treated harshly, and even being taken off life support without their relatives being informed. Last July, the government decided to phase out the guidelines, concluding that, “Caring for the dying must never again be practiced as a tick-box exercise and each patient must be cared for according to their individual needs.”
That gets to the malignant heart of government-run health care systems. Centralized bureaucracies will always manipulate administrative targets to protect the system. As a result, the delivery of medical care becomes impersonal, and individual needs are cast aside. It’s system first, patients whenever it's convenient.