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Model Veterans

What the VA can teach us about government-run health care.

President Obama will deliver a historic speech tonight. Standing before both houses of Congress and the American public, he’s expected to clearly outline his vision for government-run national health care and explain how and why such a plan is tenable in the United States. One way he could help make his case is by showing that a successful plan of that description is already in place: the one administered by the Department of Veteran Affairs (VA).

Actually, Obama has already pointed to the VA hospitals, albeit briefly. Back in July, a small-business owner at a town-hall meeting asked, “What current long-term social program created and run by the government should we look to as a model of success?” Part of the president’s longer response: the VA hospitals, which “have very high satisfaction rates.”

Indeed they do. The VA, which oversees the Veterans Health Administration (VHA), runs the nation’s largest integrated health-care system. In order to meet the diverse and complicated needs of veterans, the VHA operates 153 hospitals, 909 outpatient clinics, 232 Vet Centers, 135 nursing homes, 47 rehabilitation treatment programs, and 108 home-care programs. According to the VA, nearly 8 million veterans were enrolled in the VA health-care system in 2008, while 5.5 million individuals used a VA health-care facility.

Despite its broad mandate and difficult mission, the VHA’s quality indicators have gone up, not down, in recent years. A 2003 studyby the New England Journal of Medicine found that the quality of care at veterans’ health facilities was “significantly better” than Medicare, which is a fee-for-service model. A 2005 survey by the National Committee for Quality Assurance, an independent health-care watchdog, found that veterans’ facilities consistently outperformed the nation’s top private hospitals.

Furthermore, a report by the RAND Corporation concluded that “VA patients were more likely [than patients in a national sample] to receive recommended care,” and had “received consistently better care across the board, including screening, diagnosis, treatment and follow up.” Finally--perhaps more telling and certainly most important--veterans themselves rate their overall satisfaction with VA health care at high levels: In a recent survey, 81 percent of VHA hospital patients expressed satisfaction with the care they received.
The VHA’s broad success is due to a variety of factors, including top chronic-disease-management programs, state-of-the-art electronic recordkeeping, and a savvy emphasis on long-term preventative care--many of the same initiatives contained in the administration’s public-option plan, as it turns out.
Of course, no system is perfect, and the VA’s is not without problems, particularly structural inefficiencies. These include redundant disability evaluations with the Department of Defense (or DoD, which is a separate entity from the VA, and responsible for the well-documented 2007 failings at Walter Reed Army Medical Center), inadequate information sharing with DoD, and outdated disability-evaluation criteria. Yet one can attribute the majority of these problems to supply being overtaken by demand. According to the VA, the number of patients it treated increased from 4.2 million in 2001 to nearly 5.5 million in 2008. This growth spurt, due to an increase in veterans from Iraq and Afghanistan as well as aging Vietnam veterans, has overwhelmed the system. Meanwhile the VA’s annual budget has not kept pace, rising only nominally from $67 billion in 2003 (adjusted for inflation) to $82 billion in 2007--an average of $3 billion per year. The result has been poor patient case management and a backlog of claims. The VA, however, has recognized its ills and has begun taking steps to remedy them, including prioritizing unresolved claims and soliciting recommendations for improvement from VA staff.
Given proper resources and leadership, a public option--if that is indeed what President Obama calls for tonight--modeled and sold on the strengths of the VA system, could serve as a viable framework for quality, affordable, and yes, tenable, government-run national health care.

Lawrence J. Korb, a senior fellow at the Center for American Progress, served as Assistant Secretary of Defense in the Reagan administration. Sean E. Duggan is a research associate at the Center. The two are co-authors of the forthcoming book, Serving America’s Veterans.