White Knight
In 1994, Ken Kizer became head of the VA and transformed the system from worst care to best care--demonstrably better, because they had measurements to prove their excellence. He defined the value equation as including technical quality AND customer satisfaction divided by cost. He saved money in part by closing underused facilities and still provided the least expensive care in the country. This, in spite of the fact that the VA patients were sicker and needed more healthcare than those in any HMO.
There are some footnotes, and the dice were somewhat loaded, but nevertheless, they did a good job at a low cost per patient. You’d think that the government would want to move patients into this system from, say, Medicare which buys care on the commercial market. But no, they tightened the eligibility rules, so people like me can’t go there (I’m a vet). Then they cut the budget, then Ken Kizer left.
But, that’s the way it is with government sponsored health plans. Politicians who know or care nothing about patient needs take money out of the health system budget to spend on wars and tax breaks and graft and corruption. And that’s the defining argument against government run healthcare. Lines up to six weeks for a CAT scan. People are leaving their eligibility for surgery to their children in their wills.
In the last chapter we’ll review, Longman also talks about the worst care. In a quest for the best, we often wind up with the worst. On page 84, he writes, “Generally, the more prestigious the hospital you check into, and the more eminent and numerous the physicians who attend you, the more likely you are to receive low-quality, or even dangerous and unnecessary care.” Something of an exaggeration, even for a cynic like me, but there is an element of truth there. An anecdote: I encountered a 16 y.o. male with a broken femur in the ER. His anxious parents were trying to decide whether to leave him in the small community hospital or transfer him to the Mecca. I pointed out the this hospital was within a mile of their home, had competent orthopedic surgeons who could easily handle a femur fx, and that treatment could begin within the hour. The helicopter trip would not be comfortable, and no one at Mecca U would see him on a Sunday nite. They stayed. And later thanked me for the advice. Sometimes you need sophisticated care, but sometimes you need a simple job done well.
Longman goes on to discuss Wennberg’s work on geographic variance in health care services. This was partially explained by Milton Roemer, who pointed out that the demand for healthcare is essentially infinite. The amount of healthcare provided is limited only by the number of providers. This, of course, is the reason that Canada doesn’t buy more CAT scanners and limits the number of physicians in the country. (RI tried that once, but lost a restraint of trade suit.)
The rest of the book should have been left out of the book.
There are some footnotes, and the dice were somewhat loaded, but nevertheless, they did a good job at a low cost per patient. You’d think that the government would want to move patients into this system from, say, Medicare which buys care on the commercial market. But no, they tightened the eligibility rules, so people like me can’t go there (I’m a vet). Then they cut the budget, then Ken Kizer left.
But, that’s the way it is with government sponsored health plans. Politicians who know or care nothing about patient needs take money out of the health system budget to spend on wars and tax breaks and graft and corruption. And that’s the defining argument against government run healthcare. Lines up to six weeks for a CAT scan. People are leaving their eligibility for surgery to their children in their wills.
In the last chapter we’ll review, Longman also talks about the worst care. In a quest for the best, we often wind up with the worst. On page 84, he writes, “Generally, the more prestigious the hospital you check into, and the more eminent and numerous the physicians who attend you, the more likely you are to receive low-quality, or even dangerous and unnecessary care.” Something of an exaggeration, even for a cynic like me, but there is an element of truth there. An anecdote: I encountered a 16 y.o. male with a broken femur in the ER. His anxious parents were trying to decide whether to leave him in the small community hospital or transfer him to the Mecca. I pointed out the this hospital was within a mile of their home, had competent orthopedic surgeons who could easily handle a femur fx, and that treatment could begin within the hour. The helicopter trip would not be comfortable, and no one at Mecca U would see him on a Sunday nite. They stayed. And later thanked me for the advice. Sometimes you need sophisticated care, but sometimes you need a simple job done well.
Longman goes on to discuss Wennberg’s work on geographic variance in health care services. This was partially explained by Milton Roemer, who pointed out that the demand for healthcare is essentially infinite. The amount of healthcare provided is limited only by the number of providers. This, of course, is the reason that Canada doesn’t buy more CAT scanners and limits the number of physicians in the country. (RI tried that once, but lost a restraint of trade suit.)
The rest of the book should have been left out of the book.
