News-Record.com

In view of my new gig and the fact that some of its governing coverage principles may be in flux, it's hard to know exactly what focus my blog should take. City Editor Teresa Prout, my new supervisor, and I have to talk about that, and we've got other stuff to do first as I make this transition. Accordingly, The Lex Files is going largely dark, if not completely dark, until we figure out what role, if any, my blogging in general and this blog in particular will play in the new assignment.

We might set up separate blogs for Rockingham County and the city of High Point, we might set up a regional blog, or we might do something entirely different. A number of internal dominoes must fall before we can see our way clear to defining that role, and until that happens I've got more urgent things to deal with as I make the transition. Meanwhile, thanks for reading and commenting.

BEST CARE ANYWHERE: Why VA Health Care Is Better Than Yours. By Phillip Longman. PoliPointPress. 136 pages. $14.95.

It's easy for a survivor to develop a jaundiced view of the American health-care system when his wife dies of cancer. It's especially easy when the period before her death was one long agony of bouncing from doctor to doctor, carrying pound after pound of paperwork
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But suppose that same survivor has written a book on the virtues of consumer choice in health care. Suppose he is then commissioned by one of the nation's leading business magazines to do an expose on the Department of Veterans Affairs' health-care system. And then suppose that his reporting turns him so far in the other direction -- from both the magazine's perspective and from his own experience -- that the magazine kills the assignment.

Perhaps we should sit up and take notice.

That has been the experience of journalist Phillip Longman. His "Best Care Anywhere" paints the big picture of how the VA's health care system is, by objective standards, the nation's best; how it got that way; and how its lessons might be put to use nationwide, using the free-market principles its critics claim to use in dismissing it as "socialized medicine."

Given the way the VA has been criticized in earlier books such as Longman's first, and mocked in such movies as "Born on the Fourth of July" and "Article 99," Longman's claim borders on unbelievable. I didn't believe it. So have a look:

• New England Journal of Medicine, May 29, 2003: VA "significantly" tops fee-for-service Medicare in 11 criteria out of 11.


• Annals of Internal Medicine, 2004: VA's diabetes care tops commercial managed-care systems in seven of seven criteria for diabetes care.


• RAND Corp. study, 2004: VA outperforms all other American health-care sectors in 294 areas of patient care.


• Medical Care, 2006: Patients in Medicare's Advantage Program had "significantly higher" mortality than corresponding VA patients.


• American Journal of Managed Care, 2004: VA topped both Medicare and best available non-Medicare programs in 18 of 18 criteria.

For one thing, a computer case-management program created and updated over the years by the very people who care for patients. That software makes possible -- even likely -- almost perfect continuity of care. That technological edge, in turn, provides lower mortality through better diagnosis and treatment of acute and chronic conditions.

Moreover, the VA health system stresses strict adherence to the results of disinterested research (and, sometimes, alerts from the software when those protocols aren't followed).
Protocols for patient care have been developed over many years based on observance of real-world outcomes, not by the profit motive or perverse market incentives. The protocols range from complicated treatment right on down to ensuring that heart-attack patients take an aspirin regularly.

And here's one place where the free market comes at you from the opposite direction: That emphasis on quality care leads to lower costs because of better outcomes.

To be sure, the VA has benefited from "luck" in its improvement: Among its aging veteran population, chronic problems such as heart disease and diabetes, the conditions most amenable to preventative and managed (treatment, not funding) care, are those most responsive to its approach.

But those trends also are growing among Americans in general, and other health-care systems haven't responded as well.

So if the VA approach is so good, why isn't the whole country using it?

For one thing, inserting any large government bureaucracy (200,000 or so people in the VA's case) into health care in any way is dismissed by politicians with the scare phrase "socialized medicine" without any examination of the facts.

Longman badly underestimates how hard overcoming this problem would be. But the whole country wouldn't have to adopt it for the whole country to benefit, he says. Even if introduced only in pilot areas such as Massachusetts, which recently began requiring its residents to purchase some type of health insurance, the quality of the VA system (or systems that strictly emulate it) would improve health care across the board. Other health-care systems would have to adapt and change to remain competitive. And if these systems make relevant statistics available, or at least indicated whether their doctors or hospitals are following the VA's protocols, we'd actually have the sort of informed consumer choice that Longman advocated in his first book 11 years ago.

Longman might not be right in every detail. Recent disclosures by The Charlotte Observer of inadequate patient care, leading to deaths at the Salisbury VA center, make clear that the system is not perfect. And lack of money can hamper care.

But the Salisbury deaths need to be held up against the context of the tens of thousands who die each year in the United States of hospital-acquired infections. Longman's evidence that the VA system works well overall is compelling (and, on the micro level, is consistent with what veterans have told me anecdotally about both the Salisbury and the Durham VA hospitals, both on and off the record). His proposals deserve a serious hearing at all levels of government and the health-care industry, and until they get one, anyone screaming "socialized medicine" should be whacked in the head with a catheter.