The ignorance of Republicans on all things stopped amazing me a long long time ago.

As long as you think that your wife's or your child's cancer condition is a money making opportunity health care is doomed. Is the VA a capitalist enterprise? No. I'm not saying the workman is not worthy of his hire. Pay the drug maker. Pay the doctor. Pay the equipment manufacturer. But do not regard the life and death of my loves one's as your ticket to fabulous wealth and capital accumulation. If we can't get past that notion--then no reasonable solution is possible...why has it been SO easy for other countries to comprehend this simple predicament? What is so unique about America that makes us so blind to the obvious?

The worst thing that could happen to health care in America would be to go to a single payer program, and then put Republicans in charge of it. Walter Reed was not just a fluke.

Coburn may have some apologies to deliver when he gets home. He lives in Muskogee which has the regional VA accounting center and one of Oklahoma's two VA hospitals.

http://www.vba.va.gov/ro/muskogee/
http://www.muskogee.va.gov/

It's stupid to make anybody responsible for a mission they do not support. But when did Republicans go from the party of limited government to the party of NO government. When did they go from the party of efficient government to the party of any government cannot work. Are they proposing Anarchy instead? No. Just corporate fascist absolutism.

I wish liberal blogs would cut out such claims about the VA. Citing flawed reports such as this only undermines the validity of more truthful arguments for health care reform, especially among those who are aware of all the flaws in the VA system.

Evaluations of quality in health care are very primitive, and typically come down to what is reported as opposed to measures of actual quality. The VA's computer system gives them a huge edge in such quality measures which has nothing to do with actual quality.

When you move beyond such flawed measures, care from the VA is highly mixed. Their treatment of diabetes is many years behind the times, at least at the VA facilities where I have seen examples of it. The problems with their care is one reason why many people, including Democrats, have been arguing that the VA system should be changes so that vets can receive reimbursement for receiving treatment elsewhere in private practices.

Such government-run plans are not even on the table. There is no need to confuse valid arguments for reforming the insurance system with such arguments which only play into the right wing's scare tactics about government taking over health care.

I discussed this topic in greater detail here:

http://liberalvaluesblog.com/?p=8717

much of the attacks from the Right are often based on confirmation-biased evidence.

Purely anecdotally, and a N of 1, the VA vastly outperforms not only Medicare/Medicaid, but my Blue Cross/Blue Shield coverage. My husband recently left the VA as a physical therapist with 16 years experience because of the pay; he's now working for a private provider of Medicare and is consistently frustrated with the care he can/cannot provide to his patients compared to what he did in the VA. As a vet, whenever I can I go to the VA rather than use my private insurance. Coburn's an idiot stuck in a Catch 22 world.

Hear, hear for the VA - And, thanks for reminding me I had forgotten to take my Metformin, supplied by the VA, this morning. I receive better care than my wife was receiving from a large in city hospital. She, recently, had to switch to a medical school hospital, due to the lack of quality control she had received at the so-called "Name" hospital.

Plus, just loved Grassley's comment about the possibility of 119 million jumping the private ship for public option. Although, he confused the consulting firm which prepared the report for a major medical insurance giant with a "think tank". Yeah, Grassley, if all of those millions jump, you want to protect the costs for remaining few in the private sector. Nah, you want to protect the bottom line of the insurance companies, so they will have more of which to line your corn cobbed ethanol soaked pockets.

Attacks [snip] from the right are demonstrably false.

Fixed for brevity and accuracy.

Notice that once again, it's a blogger pointing out that Senator Coburn is lying to the American people. Meanwhile, the Senator is obviously confident that the so-called "liberal media" will let his lies pass unchallenged. And what do you know know, they did.

Didn't Newt "The Idea Man" Gingrich say in his speech the other night that health care is a god-given RIGHT? How can these people take action to deny us our god-given rights?

Much health care from the VA may well be outstanding, but remember all the static 2006-2007 from the horrible flubs in veterans' care? Those facilities, etc. It is likely that poor administration and not it being a government program per se is the major cause, but all that has to be taken into account.

Perhaps more to the point about the general HC issue, remember the irony of some opponents of public option saying, it's superior benefit/cost would draw people away from private insurance.

The R squared (Republican rump) senator from Oklahoma and his ilk should be forewarned: treading on the VA and other services which are life saving for veterans will self destruct in their faces.

Coburn couldn't do better for the Dem agenda. Atta boy, Tom!

"But when did Republicans go from the party of limited government to the party of NO government. When did they go from the party of efficient government to the party of any government cannot work."

That was the brain-child of Ronald Regan.

If you want to know who started the whole "liberal media" canard, that was Richard Nixon.

This description of the VA does not accord with anecdotal evidence I have of VA quality of care from physicians I know - and the use of "quality of care indicators" and patient satisfaction surveys leaves lots of room open for biased results (as Chusid notes above). It would be nice to read a nuanced, unbiased, and current look at the VA system - any suggestions?

What is so unique about America that makes us so blind to the obvious?

It's probably the same thing that has people constantly het up that some guy somewhere in a union job is earning a wage high enough to support two people in living a middle-class lifestyle...modest home, health coverage, a couple of non-fancy automobiles, food, non-extravagent clothing, and a little left over for cable TV and perhaps an annual vacation.

THAT guy is the problem, NOT the health insurance company CEO who several years ago put 1 out of every 700 dollars spent on care in this country in his own pocket.

Go back just 40 years, and you find no one batting an eye that a family of four is being supported by a guy doing that same job...no screeching about how he's being paid "too much" for his daily work.

Add to that the severe retardation of some of the people saying it, who don't seem to realize that their insistence that others work for slave wages translates into less business for themselves. You'd think a realtor would know that the lower wages go, the less business he'll have. Think again.

As a nation, we've not only become just a loose confederation of greedy co-bags, but also quite a few IQ points dumber.

The Reagan revolution succeeded, after all.

CFG and Ron Chusid, I respectfully submit you're off base. The "quality of care indicators" are not exactly measures to be gamed. They're things like aspirin at arrival for heart attack, proper infection control procedures, and the like. If Longmann's article doesn't float your boat, Harvard Business School used VA as a case study and I recommend it highly. The VA example is well accepted within the healthcare quality field (in which I work, and no, I don't work and never have worked for VA) as an example to be followed. Chusid's right that VA's EMR system gives it a huge advantage, but that's kind of the POINT, isn't it? Better systems leading to better care?

Danp: important to distinguish between single payer and single provider. Chusid's right again that nobody (other apparently than Tom Coburn) is talking about creating a new government-run health provider system, so really the question is moot; we have VA, DoD, and Indian Health Service and that's enough, and VA proves that a government-run system can do it well and the Walter Reed example and IHS prove that a poorly funded (in the case of IHS) or poorly run (Walter Reed) system can do it poorly. In other words, government, just like the private sector, can succeed or fail based on its performance.

Steve Benen wrote:

Matt Yglesias caught Sen. Tom Coburn (R-Okla.) on C-SPAN this morning, and heard the far-right senator make the case "against a government-run insurance plan on the strange grounds that a government-run health care delivery system would be ineffective."

With all due respect, the "strange grounds" that the far-right senator argues are perpetuated in nearly every discussion of this issue, in every sort of venue including this blog, by folks of every political persuasion.

The issue is consistently described as "health care reform" or even worse, with the meaningless phrase "health reform", when in fact the issue is not health care but medical insurance.

Sure, there is some discussion about actually "reforming" health care. Computerization of medical records, and the elimination of unnecessary tests or ineffective treatments would be examples of "reforming" health care. The excerpt from Longman's article does actually address health care, since it compares the outcomes of medical treatment under different systems rather than the question of who pays for it.

But the main issue at hand is not about "health care". It's about who pays for "health care" (and in most cases it's about who pays for medical treatment, not "health care").

And this confusion is deliberately exploited by opponents of universal, single-payer, nonprofit medical insurance under open, accountable, efficient public administration, who try to frighten the public by conflating government-run medical insurance with government-run medical care.

So, I would urge the authors of this blog as well as the commenters to eschew the use of misleading terminology like "health care reform" and the vacuous "health reform" when they are actually referring to medical insurance reform.

Otherwise, you are inadvertently aiding and abetting the deceptions of people like Coburn.

Thanks, Michigoose, for your comment. Reluctantly, I am adding Medicare B, next month. The only reason I have opted to add medicare is due to the lack of bed space at the VA. The VA is still underfunded; many hospitals, such as the large Portland, OR facility are dated. They need major expansion. At one time, most of the patients at either the Portland or the Vancouver, WA facility had gray hair. Now, I see more and more younger men and women, many of whom are returning Reservists and Guardsmen and Guardswomen from the Middle East. I dread the day, when I will have to use my new medicare at private hospitals. However, Medicare B will pick up the tab for transportation to and from the VA, should I have to use that system. And Kudos for those who work within the VA and that applies to you Blue Girl, as well.

I want to find good pop music. Help me please.

Excuse me. I misspoke above about VA's quality measures. I don't believe they report aspirin at arrival for AMI.

For more on VA's quality initiative you can do the research yourself at http://www.queri.research.va.gov/.

Kalebarkab: Rhapsody.

Animist, surely you wouldn't argue that medical insurance isn't part of health care reform? Agreed that it's not the totality of it, but certainly it's part of the whole.

Attacks on the VA from the right are demonstrably false.

And how does this make them different from other attacks from the right?

-Z

Chocolate Thunder,

The point is that the VA is able to do well on certain measurements which are being monitored. In other areas the care I have seen from them is awful.I'm referring to real world experience treating patients also seen at the VA, not studies which cherry pick a few parameters.

The main benefit of the computer system is to allow them to get credit for everything they do. In private practice doctors do not have the time to report every time they meet a quality measure. Such reports measure how often a system reports what they have done, not what is actually being done.

Systems which grade based upon a handful of parameters but which are labor intense to report work to the benefit of the VA but do not represent the actual quality of care.

Franken was right when he named his book "Lies and The Lying Liars Who Tell Them", These guys would lie to and sell their very mothers if it meant more money and power for them. Greedy, selfish, petty, nasty, dishonest little white men, elected to a place of power by corporate money and the masses. How are the masses of people thanked? Why the politicians work tirelessly to place them into an indentured servile role to feed the corporations that feed the politicians. The elite few % of Americans, the (mostly) corrupt politicians, and the mostly sleazy owners/upper mgmt of the major corporations prosper; destroy whatever is in their way,including our only planet; lie; cheat; steal; kill (Bhopal, Tuskegee, the mining industry in general, the killing of workers by corporate goons and police, etc) ...while the rest of us get the crumbs that we are supposed to be oh so grateful for.

Change we can believe in. It can't come too soon. And it won't come unless we push for it. Hard. Get active. Blogging at a computer is great to get the word out, but only action, beyond blogging, will get the job done. It really is up to us.

You forget that Coburn and others don't care whether the comments are true--they're banking on people remembering things like the Walter Reed Hospital mess, or various sad situations where veterans have had high-profile problems getting care (usually mental health care) from the VA.

The people he's talking to--most of America--will never read anything about this. The news they pay attention to, if any, is the junk they see on TV, preferably with pictures. And the bad stuff is what gets on TV with pictures.

Ron C, while I agree that quality measurement is in its relative infancy and can be in its totality a crude measure, I fundamentally disagree with your assertion that these "do not represent the actual quality of care." If that were the case then the entire performance measurement enterprise would be invalid.

Besides, one doesn't report EVERY time when meets a measure. For those providers who don't have EMRs, it's done through chart or claims review, often by looking at one window in time (e.g., a one week period once a quarter, randomly selected). So don't give me this about the VA setting up a game in which the rules are such that it's guaranteed to win. Private not-for-profit and for-profit hospitals and physicians in group practices can and do submit to quality measures. They just don't do it as well as VA.

What if we had the option of joining the VA system and paying our health insurance premiums to them? If there were many more people in their system, they could open many more hospitals, which would address one of the drawbacks experienced by current members of the system. I, for one, would try it. I am also willing to agree to a system of compensation for proven malpractice that would use a set schedule rather than awards decided by juries as a means of reducing costs.

I like your point, SecularAnimist. It has always bothered me that the right has been able to win battles where most people in the country DON'T support their position by carefully shaping the language of the debate. I think "medical insurance reform" would be a great way to describe what we're shooting for, for several reasons.

1) Insurers are an inherently less sympathetic target (they profit at the expense of both doctors and patients), and someone being introduced to this debate for the first time would be less inclined to feel sympathy for the existing system - whereas "health care reform" is more ambiguous. Anyone who has insurance has been burned by their supplier; my company self-funds their insurance, but the provider we pay to administer it still fights & denies legitimate claims.

2) In addition to being more accurate about the desired outcome, the term "medical insurance reform" would be untainted by the failed attempts of the past - specifically the Clinton era. It isn't a big deal for me, but conservatives hate those guys and labeling it "health care reform" brings along an instantaneous opposition, as well as a reminder of previous failures.

What do you think? There have to be some readers of this blog who can send this up through the feeder system and get this into the public discourse!

-Jamobey

I've never dealt with the VA, but all of the doctors and veterans I know are constantly complaining about how slow, callous, and ineffective it is.

why do republicans continually show how much they hate the troops?

why do they continue to show how little they regard their fellow Americans?

Why are these people being given a voice in anything? I wouldn't vote for a Republican for anything -- not even a sewer inspector.

I've had a good deal of interaction with the VA system and I'm not real impressed. It may well be better than Medicare for some but its problems are huge. Eight hour waits at VA Philadelaphia's ER are not uncommon. VA Philly has its good sides but also its awful sides. Three to four months to get an appointment with your primary for a referral to see your therapist? Who is backed up a month or two? Understaffed? Underfunded? Service is OK when it happens. Drugs are handled well. And what if you don't happen to live near a good VA hospital? Forget the near useless clinics staffed by folks I have no idea where they find? Go to a gathering of older vets from a wide area. Topic A is what the care of their local VA facility is like and where the good ones and where the ones to avoid are. Medicare sucks in many places, forcing older vets to the VA where the nearest hospital is 70 or 100 miles away. Appeal to you?

when did Republicans go from the party of limited government to the party of NO government. When did they go from the party of efficient government to the party of any government cannot work.

As I've pointed out before, P.J. O'Rourke quipped back in the '80s that the Republican Party campaigns on a platform that government doesn't work, then gets elected and proves it.

My husband is very thankful for the VA medical care, of course the Walter Reed scandal was another Bush debacle because when my husband was there prior to that, the care was great.
Of course we all remember the Bush people having the VA offices shred veterans applications for VA compensation! I understand that Obama also inherited a backlog of about a million applications for help from veterans. How long before the GOP blames Obama for this?

There aren't VA hospitals and clinics in a majority of cities but most of us aren't asking for gov. "run" HC, just gov. HC "ins". but good on the VA for their quality standards. Isn't the VA free to bid on drugs also...unlike Medicare part D?

Also, since when do republicans ever check facts before spouting off what they "think" is true? Alas, if only someone were there to "correct" Mr. Coburn on C-span as he was spouting such nonsense.

"...he worst thing that could happen to health care in America would be to go to a single payer program, and then put Republicans in charge of it. Walter Reed was not just a fluke.
Posted by: Danp on June 10, 2009 at 10:11 AM | PERMALINK

That's like saying Bush was in charge of the Post Office. Once established...they can't just screw it up...oh, wait...

Whatever the merits of Coburn's arguments (and I assume that there are very few, given the source), the immediate question that came to my mind was -- "So, Senator, during your eleventy-twelve years in the Senate, and especailly during the period 2001-2008, what specifically have you done to make the VA system better?" I'm assuming that he didn't get asked that.

Steve Bobker addresses some of the problems facing the VA. Yes, they do need more money to both refurbish existing hospitals and to expand the medical staffs, so, the waiting time for primary care appointments can be cut. When, I entered the system, I had to wait for over six months to be assigned a PC doctor. I was able to use the emergency room and could receive any prescriptions written at that visit. Without being assigned to a PCP, I could neither receive other medications or be seen by a specialist. They need more funding to correct these problems.

However, when you mention the lack of care in the rural areas, how does this differ from the current medical scene in rural America? Yesterday, Secretary Kathleen Sebelius and Senator Pryor were discussing, at the Senate Health Care Hearings, the problems with the lack of doctors for rural America. Live there at your risk.

The comments on this thread are confusing VA health care with DOD health care. They are not the same.

Walter Reed is NOT a VA facility.

See: http://www.npr.org/templates/story/story.php?storyId=7738488

Chusid and others might ask why many veterans such as myself are seeking or are using VA health care even though these veterans have private health insurance. And I'm talking about people with degrees and successful careers who are not poor. Any large organization will have its share of problems. But if you talk to veterans on a regular basis who use VA, you find that there is a high level of satisfaction with VA services.

Walter Olin

Why is Senator Coborn against our hard-working and likely undercompensated but extrememly dedicated doctors and nurses and support staff at the VA? Why does he hate Americans who are working hard to provide outstanding care to our Veterans? Why does he hate America?

As a veteran with no service connected disability, I used the VA while I was finishing my degree (no job, no health insurance, and I skated under the means test). In 2003, I developed a tumor in my neck. Within two weeks and three appointments, I had a biopsy performed, test results (negative), and surgery scheduled to remove a benign tumor from a salivary gland.

Total cost to me? $0.

Steve Bobker:

"Eight hour waits at VA Philadelaphia's ER are not uncommon."

Here in Tucson, an 8 hour wait at our Trauma One Hospital, the University Medical Center, would be regarded as a miracle. I have waited in the ER over 12 hours to get admitted to a hospital ward; friends of mine have waited THREE DAYS. Part of the problem is that this is the only Trauma One unit for all of southern Arizona, with an agreement to take care of Sonora (Mexico) serious traumas as well.

Waits like this are also common in other Tucson hospitals, although in a couple others, during weekdays, during the day, you may get treatment after only an hour or two.

I like the idea of calling what we need "health insurance reform", as most people have been burned by their insurance cos at least once. And the biggest obstacle this country faces to any real reform is the insurance companies. I sometimes think that our only hope is that their CEOs and other top brass will run them into the ground.

Much health care from the VA may well be outstanding, but remember all the static 2006-2007 from the horrible flubs in veterans' care?
Posted by: Neil B

Those were actually facilities for SERVING members of the military who had not been discharged and handed over to (sent adrift at) the Veterans Administration.