Sadly there has been some backslide at VA hospitals under Bush--Walter Reed notwithstanding, it's not a VA hospital. Clinton proved that government could work--he brought in a change agent who turned the system upside down, and by the time he left office it outperformed the private sector on nearly every clinical measure of quality.

I was actually going to suggest that you or Ezra address this point -- since we're all for universal health care coverage of some sort (single payer, whatever), does what happened at Walter Reed kinda kill the idea that the VA system be used as an example?

Or is it just an isolated incident, with lessons learned at other places much better examples of how a national health care system could work efficiently?

I would think opponents of universal coverage would use Walter Reed as an example of why the gov't should NOT be involved in the process, but not sure that one example is representative of the whole.

Okay ... kinda wandering in my thoughts, but do you see what I'm getting at? Anyone> Bueller ... ?

But the culprit probably isn't money.

You're right. The problem is that the VA is run by the government. It would be much better if Walter Reed was privatized and run by the private sector. Then there wouldn't be any problems at the hospital because disabled veterans could then use the free market to choose the best hospital.

"Does what happened at Walter Reed kinda kill the idea that the VA system be used as an example?"

No. First, Walter Reed is not VA. Secondly, while VA is not perfect, it is better than many not-for-profit and for-profit private hospitals.

Al, don't be silly. (I know, it's like telling the sun not to shine in San Diego.)

Veterans CAN get care anywhere they want. Many, increasingly, choose VA.

When you elect people who believe that gvmt can work, gvmt works. When you don't, it doesn't. It's really that simple.

Why did the VA hospitals improve? Because Republicans in Congress threatened to shut them down and give vets vouchers for private hospitals. If there were no private hospitals, there would have been no credible threat to the VA hospitals' existence, and they would not have improved.

Actually, private hospitals could be improved by intelligent government regulation. There is a "natural monopoly" in health care--the MDs. If MDs think something isn't worth doing--like putting their perscriptions etc. in a computer themselves--a computer that would even review the correctness of the prescription--it isn't going to happen unless the government leans hard on them, for years.

it may not be about money right now, but, one imagines that in coming years the VA system is going to find itself overwhelmed by the costs and demands of caring for Iraq War vets unless it gets more money.

i have a real fear that we're not going to get the VA health care system the resources it needs for all of this. a second-order, but, still real, casualty of all this (the first-order one being the well-being of the vets themselves, of course) will be the reputation of the VA system as a model for the benefits of publicly financed, integrated health care.

josh bivens

"Why did the VA hospitals improve? Because Republicans in Congress threatened to shut them down and give vets vouchers for private hospitals. If there were no private hospitals, there would have been no credible threat to the VA hospitals' existence, and they would not have improved."

I disagree. VA hospitals improved because they were led to improve from within--for the most part, by veterans themselves, including the VA Under Secretary for Health. Yes, there was political influence from Congress, as there always is under a healthy political environment (and I can't believe I'm calling the relationship between the Clinton Administration and the Gingrich House a "healthy political environment") but the above analysis discounts the very hard and very serious work that was performed at the highest levels of the executive branch of government.

Many of the topics in which Mr Drum is conversant, I am uninformed. I sometimes wonder how he becomes interested in such a breadth of interests.

I did study health management in college though, and can say that healthcare is the oil to free marker's water. Nothing Adam Smith said will prepare you to run a hospital. Supply & Demand are meaningless there.

Some solutions: single-payer coverage; health information systems; incentives to healthy lifestyles; universal insurance instead of the unstated de facto universal insurance we have today (E.g., the E.R.)

BTW: clean water, immunizations, & infectious disease control have done more for health than all the hospitals, doctors, & pharmaceuticals combined. How Africa, SE Asia would benefit if we spent a few billion installing these systems for them. And how fewer wars we'd have to fight.

Disputo:When you elect people who believe that gvmt can work, gvmt works.

Exactly! Why's this so f*cking hard for people to figure out?

Kevin -- I gave in on the subscription... now remove the blue banner from my computer, won't you please ;]

I did study health management in college though, and can say that healthcare is the oil to free marker's water. Nothing Adam Smith said will prepare you to run a hospital. Supply & Demand are meaningless there.

So true.

mhr -- this is such a crock of shit that gets repeated everywhere. No mainstream liberal is on record saying "all soldiers are like Nazis." No mainstream liberal spat in the face of returning Vietnam veterans. (Most antiwar activists were very supportive of returning veterans, which is more than you can say for most Republican buttwipes like Rumsfeld who refer to us as "poor material." Jane Fonda made a mistake -- don't damn a whole political wing for one person's missteps; that is no more rational than to call all soldiers "like Ghengis Khan" because a few of them misbehave.

I'll wager that none of you liberal experts has ever been in a VA hospital- what would you do there? Pray that assholes like you aren't running the place.
Pardon me for ranting, but I get so sick of this shit.

mhr the liar and libeler returns to lie again.

it's wrong to contrast the VA hospitals with the "private sector". hospitals not government owned are, nevertheless, under so much regulation -- directly or via restrictions placed on reimbursement through insurance regulators -- that they aren't true benchmarks of what free market oriented solutions have to offer in health care.

I'm guessing that, other than Fonda, mhr has absolutely ZERO proof that any liberal of note did any of those things.

As far as the gov't screwing up all that it touches -- it seems that happens more when those who think gov't doesn't work are in charge. Kind of a self-fulfilling prophecy.

Ghengis Khan subjugated more land in 25 years than the romans did in 400. He introduced military organisation, and modern cavalry blitzkreig tactics in the dark ages. He also outlawed torture, introduced paper money, invented diplomatic immunity for ambassadors, practiced religious tollerance, and created a very large postal service.

If anyone is being slandered, it's poor Ghengis.

"...but as you've probably read in dozens of articles recently, they're now among the best in the country."

Actually I've only ever encountered it here in the Monthly. And while I put a lot of stock in (it is THE reason I applied to Champaign for law school) I became suspicious when I never saw any corroborating evidence.

roalblue_tom writes: If anyone is being slandered, it's poor Ghengis.

Interesting observation royalblue. Someone send a a note to Kerry!

If anyone is being slandered, it's poor Ghengis.

Not entirely wrong... but his sons were worse leaders, and re-introduced torture. Ring a bell, anyone?

Most antiwar activists were very supportive of returning veterans, which is more than you can say for most Republican buttwipes like Rumsfeld who refer to us as "poor material."

Amen to that. My uncle was never spat on, by pinkos are anyone else, when he returned from VN. He and all the other VN vets were, however, ostracized by the local VFW.

Bush to tour Georgia and Alabama tornado victims beware of his promises to you remember Katrina, and as for as his investigation into the Veterans hospitals it is truely sad when a president sends your sons and daughters into war and they come back home injured to the point they have to go to therapy everyday and live in the conditions they live in for serving their country, this whole administration is a slap to the face of the American public, Remember all Republicans in 2008 for their so called "job well done" MY ASS!

mhr: Liberals greeted veterans returning from Vietnam with spit in the face . . .

In the following, Iraq should be taken to mean both Iraq and Afghanistan.

Conservatives greeted dead veterans returning from Iraq by disrupting their funerals and calling them fag-lovers.

Conservatives greeted dead veterans returning from Iraq by hiding the return of their bodies from the public.

Conservatives greeted wounded veterans returning from Iraq, many of whom were wounded because conservatives spent tax dollars on tax cuts for the wealthy and no-bid contracts for Halliburton instead of body and vehicle armor, by sending them to hospital hell.

Conservatives greeted veterans returning from Iraq by sending them back. Again and again and again, because conservatives lied about the number of troops necessary and the length of the war and failed to properly plan for the "post major combat operations" period. Not to mention lying to the soldiers about why they were being sent to Iraq in the first place and about how imminent the threat from Iraq was.

Conservatives greeted veterans returning from Iraq by using them and asking them to violate military law by appearing at GOP campaign events.

Conservatives greeted wounded veterans returning earlier from Iraq than their tour of duty called for and having to leave the military because the wounds were so severe, because they were you know wounded serving their country, by sending bill collectors after them for the return of enlistment bonus pay.

Conservatives greeted veterans sent to Iraq with attempted cuts in their hazard pay.

Conservatives greeted veterans sent to Iraq with vehicles that had no armor and supplies that did not include body armor.

You forgot:

Conservatives greeted veterans returning from Iraq who chose to run for public office on the Democratic ticket with swiftboating fury.

Al: "Then there wouldn't be any problems at the hospital because disabled veterans could then use the free market to choose the best hospital."

Ah, the sacred virtues of Polyanna Inc.

From CNN via Talking Points Memo: "Army Secretary Francis J. Harvey has resigned in the wake of the Walter Reed hospital scandal, Defense Secretary Robert Gates said Friday."

About damn time.

How many times do we have to say it? Walter Reed is NOT a VA hospital. It is run by the DOD. In case you guys didn't notice, it was a general in charge of the hospital who was fired, not a civilian.

As far as the guy who said there was no supporting evidence of the quality of VA hospitals - re read the article & notice link there. I know several people using the local VA clinic, and the 2 regional VA hospitals. They tell me the care is usually pretty good, but more importantly, they are taken care of there while Private hospitals turn them away because their care will not be fully reimbursed. While not proof, it is supporting evidence of the quality of VA hospitals.

They tell me the care is usually pretty good, but more importantly, they are taken care of there while Private hospitals turn them away because their care will not be fully reimbursed. While not proof, it is supporting evidence of the quality of VA hospitals.

Amen. You can't divorce quality from access when discussing the health care system in the US, as much as the wingnuts would like to.

"like the hordes of Genghis Khan."

Try reading 'Genghis Khan' by Jack Weatherford. Genghis has been the victim of character assassination for centuries, even though prominent figures of the early Renaissance acknowledged the role of the Mongol empire in opening up the world from China to Europe. The Mongol appreciation for new ideas, regardless of their source was unparalleled.

Bush called the devastating twisters in the south "tornayduz."
Like the first time the word left his lips.
Too late to start acting like he cares. Neglect, neglect.
Katrina exemplifies it. Walter Reed solidifies it.
The perception of neglect by this elitist administration cannot be changed.

I was watching Tucker on MSNBC and he said that the Walter Reed debacle is a demonstration that government/bureaucracies are bad at producing positive results. As a liberal and an American, I reject this. The numerous examples of our government setting a goal and accomplishing it completely exposes this philosophy to ridicule. Government is not always the answer, in fact most of the time its not the answer, but it is a foolish opinion to say that government can't do anything right.

Getting back to the point though, I think that Walter Reed, Katrina, Iraq and numerous other examples of this administration's incompetence is an attempt by the conservatives of this nation to prove the opinion of Tucker and other conservatives. I think that they are not proving their point. They are instead proving that conservatives can not manage government and thus should not be put in charge of government.

Caught this earlier today:
http://www.cnn.com/POLITICS/blogs/politicalticker/2007/03/months-before-media-reports-memo.html

Is the management of Walter Reed separate from the rest of the VHA system? Was this going to be a showpiece of the wonders of privatization? When did the privatization start vis-a-vis the sampling period for this study?

I would not be at all surprised to find the causes of the turnaround lying right at the feet of Rummy/Cheney.

You're right. The problem is that the VA is run by the government. It would be much better if Walter Reed was privatized and run by the private sector. Then there wouldn't be any problems at the hospital because disabled veterans could then use the free market to choose the best hospital.

And to follow up (with my correct name), Al, you're a flippin idiot.

Well said, Noah and Patriot Guard Riders. Indeed it was privatization sleeze.
Max Cleland, who came thru there as a patient, confirms we are reaping the horrors of privatized care. Not only horrible, but " a holding company--are we going back to Iraq? What is going to happen to us, soldiers think." 30,00 wounded could not have been a surprise. It cannot linger, and it is tearing up the morale of our soldiers, Cleland notes-- it is a microcosm of the problems we have, and can you believe this president wants a SURGE.
Says three planeloads a week come in, sending patients to Walter Reed and Behesda. In the quiet of the night. They put people in holding status. This is a real problem. Good for Cleland. On CNN now.

This really-screwing-America administration loves the conservative Grover Norquist. That bastard.
Hurricane Katrina, Thomas Friedman wrote an op-ed in the New York Times stating "An administration whose tax policy has been dominated by the toweringly selfish Grover Norquist ... doesn't have the instincts for this moment. Mr. Norquist is the only person about whom I would say this: I hope he owns property around the New Orleans levee that was never properly finished because of a lack of tax dollars. I hope his basement got flooded. And I hope that he was busy drowning government in his bathtub when the levee broke and that he had to wait for a U.S. Army helicopter to get out of town."[27]

When asked by Alain de Botton, "Why shouldn't the state help the needy?", in the television adaptation of Status Anxiety, Norquist replied, "Because to do that, you would have to steal money from people who earned it and give it to people who didn't. And then you make the state into a thief." Botton follows with, "You're suggesting that taxation is theft?" Norquist continues, "Taxation beyond the legitimate requirements of providing for justice is theft, sure."

"Screwing America"
Norquist was ranked 24th in the book 101 People Who Are Really Screwing America (ISBN 1-56025-875-6), by author Jack Huberman.

I'd love to see someone with access follow up on the connection:

http://www.google.com/search?q=%22IAP+Worldwide+Services%22+%22Walter+Reed

Apparently Waxman is on it. But some 4th estate work is well overdue

The goldmine that is google:
http://www.govexec.com/story_page.cfm?articleid=33462

The American Federation of Government Employees, which provided funding to back the protest, said the impetus to appeal came from Walter Reed managers who were disappointed to see how the competition process played out. While the initial employee bid was $7 million less than that of IAP Worldwide Services, a mid-stream solicitation change resulted in a recalculation of the bids by all parties and in IAP's bid coming in $7 million lower, said John Threlkeld, a lobbyist for AFGE.

Threlkeld said the process for recalculating the employee bid was flawed, resulting in the inflation of the estimate that rendered it uncompetitive with IAP's bid.

---

Yeah, Al, the INVISIBLE HAND will fix everything. And by "fix," we mean "neuter."

Last I looked Walter Reed is being operated by ACTIVE DUTY. That means Department of Defense not Department of Veterans Affairs.

It's a small fact - but one that belies the very predicate of this particular blog. So please spare us all the Tom Cruise - Born of the Forth of July analagies!

You may wish to find a 3rd party to verify or condem the efforts by the VA of late. Let's take - the typically liberal oft judgmental folks at Hardvard who recently lauded the VA as being one of the best HealthCare ssytems in the nation - AS DID TIME MAGAZINE in a recent article.

Not my opinion - not yours -- 3rd parties. Oh and I think they looked into the FACTS of who runs what and who they're serving and who is qualified to receive care.

I'm retired military - we used to call it ATTENTION TO DETAIL. I'm also a retired military journalist - in "J" school we would call your premise a "Major error in fact," which would have qualified you for a failing grade.

Your call; but to have an outstanding blog, it might be best to adhere to the fundamentals of journalism 101 - like fact checking.

I guess P'Cola didn't learn reading comprehension skills in J school or the military, otherwise he might have picked up on the key point that Kevin is comparing Walter Reed and VA hospitals, not equating the two.

Anderson Cooper cnn reported much of the work at Walter Reed has been outsourced,privatized,to many different companies, not many GS employees left and Walter Reed is to be closed down.
Why would they close down such a facility in the middle of two wars going on and a long time need in future? Who are the people on the commission that recommended the closings of so many VA hospitals?

Maybe privatization is the cause of the troubles?

Caught this earlier today:
http://www.cnn.com/POLITICS/blogs/politicalticker/2007/03/months-before-media-reports-memo.html

Is the management of Walter Reed separate from the rest of the VHA system? Was this going to be a showpiece of the wonders of privatization? When did the privatization start vis-a-vis the sampling period for this study?

I would not be at all surprised to find the causes of the turnaround lying right at the feet of Rummy/Cheney.
Posted by: Mu on March 2, 2007 at 7:28 PM

Excerpt from above link:

...But in a memo signed by a deputy to Weightman in September 2006, five months before reports of the problems at Walter Reed came to light, concerns were raised about care at the facility after the Army's decision to privatize support services there...

Did not read all the posts, sorry to repeat.

As usual Bush has not let out one peep, the story broke two weeks ago and not one word from the liar in chief. He is bussy campaigning and playing with Barney, I guess.

mhre, if you exist, you are a pathetic imitation of a human being. Hurry, Walter Reed is calling: they have a bed for you!

Disputo,

Think they retired his brain as well.

As to the privatization of Walter Reed, is it not interesting that their fearless leader came from, And The Envelope Please, ta da, Halliburton.

Given a recent flurry of reports spurred on by the revelation of the wretched state of affairs at Walter Reed Hospital that poor conditions are common throughout the Veterans Administration hospital system, the claims and reporting of "The Best Care Anywhere" are quite seriously called into question and perhaps damned, especially given that it was made only two years ago.

Either the system has decayed drastically since January of 2005, or Phillip Longman erred.