Veterans aren’t the only ones waiting for health care

Ezra Klein | Vox | May 23, 2014

In 2005, Phillip Longman, a senior fellow at the New America Foundation, published an article entitled "Best Care Anywhere" in the Washington Monthly. The article, which later became a book (which I blurbed), made an unexpected argument: the Veterans' Administration's health-care system had quietly become one of the best — if not the best — health systems anywhere...

The VA's reputation isn't nearly as good right now. Secret waiting lists in Phoenix are alleged to have contributed to the deaths of 40 veterans. VA hospitals across the country are under investigation for similar malpractice. Some are calling for Department of Veterans' Affairs Secretary Eric Shinseki's resignation. (Read Vox's explainer on the VA scandals here.) So I asked Longman: was he wrong about the VA then? Or are we getting the story wrong now? A lightly edited transcript of our interview follows.

Ezra Klein: You titled your book on the Veteran's Health Administration "The Best Care Anywhere." Do you still believe that's true?

Phil Longman: To the specific issue at hand on whether or not there were secret waiting lists at Phoenix and possibly other hospitals, we just don't know. There's strong evidence that employees at those facilities engaged in some kind of gaming of their performance metrics. But we're still waiting for the investigation to finish.

But the big question with these stories about the VA is, "compared to what?" This scandal wouldn't exist if the VA didn't have performance metrics on its employees. If it didn't measure or care whether veterans get prompt appointments it could just do what the rest of the health-care system has done and not hold people responsible for these metrics. Now, certain people seem to have cheated on this metric. But that's far better than what goes on in the rest of the health-care system where no one is accountable for this at all...