VA changes show the way to affordable care
Faced with censure and threat of dissolution, the U.S. Department of Veterans Affairs responded with striking changes that earned widespread praise. By 2004, a RAND corporation study implied that VA care had become America’s best.
...the big problem — the one that soon will bankrupt Medicare — is a billing system called fee-for-service. Health care providers who charge a fee for every service often overtreat their patients, driving up costs. President Barack Obama’s Affordable Care Act addresses the fee-for-service problem, but too feebly to save Medicare. Therefore, lawmakers will need to revisit health reform soon.
When that time comes, many Republicans will suggest we end Medicare and give all Americans vouchers to help them buy their own insurance. This plan is tantalizingly simple but ignores the fee-for-service problem. It’s not the answer.
Then, what is? Here’s an idea. We can reform Obamacare the same way the Veterans Health Administration reformed itself in the 1990s. Faced with censure and threat of dissolution, the U.S. Department of Veterans Affairs responded with striking changes that earned widespread praise. By 2004, a RAND corporation study implied that VA care had become America’s best.
How? Phillip Longman tells how in his book, “Best Care Anywhere.” According to Longman, the VA operates like a nonprofit HMO. It operates within a fixed budget rather than getting fees for services — a constraint that discourages costly overtreatment. On the other hand, as a nonprofit, the VA is not accountable to shareholders to make money. Therefore, it has no incentive to undertreat.
The heart and soul of the VA is a computerized recordkeeping system called VistA. VistA saves money by cutting errors and unnecessary treatments. It helps doctors practice evidence-based medicine. That, in essence, is the VA model. Sound promising? If so, the key question is this: What changes should we make in the Affordable Care Act to convert America’s system to the VA model?...
Hanson is on to something here. As noted by Physicians for A National Health Program in a press release titled Health law upheld, but health needs still unmet, "the unfortunate reality is that the law, despite its modest benefits, is not a remedy to our health care crisis: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs."
We discuss this solution in our article VA To Invest Billions in Open Source Transition. The "VA Model," as proposed by Phillip Longman, is an ideal solution to the crisis as it achieves the effect of a "Single Payer" model without the downside of being a "government-run" program. The VA Model is in a way a private sector replica of the success of the VA. This model is already partially being replicated by private and state sector hospitals that have implemented VistA. More details on this model can be found in Longman's book, “Best Care Anywhere: Why VA Health Care Would Work Better For Everyone,” now in its third edition.
There will be a golden opportunity to discuss the VA Model this fall as the open health community gathers in Washington, DC, on October 17 to 18 for the 1st Annual OSEHRA Open Source EHR Summit. OSEHRA, the Open Source Electronic Health Record Agent, is the community organization that is bringing all parties to work together around enhancing the VA's VistA Electronic Health Record (EHR) system and developing the next generation open source EHR. -- Roger A. Maduro, Publisher and Editor-in-Chief, Open Health News.
- Login to post comments