12 Jun 2014 Cohn’s Excuse For VA Failure

Jonathan Cohn of The New Republic has an interesting analysis of the Veterans Administration scandal that runs 12 paragraphs. He should have stopped at 11.

His final paragraph links VA failure to larger problems in the U.S. health care system:

Of course, it’s worth remembering that some of the problems veterans are having right now have very little to do with the VA and a whole lot to do with American health care. As Phil Longman, author of Best Care Anywhere, noted in his own congressional testimony last week, long waits for services are actually pretty common in the U.S.—even for people with serious medical conditions—because the demand for services exceeds the supply of physicians. (“It took me two-and-a-half years to find a primary care physician in Northwest Washington who was still taking patients,” he noted.) The difference is that the VA actually sets guidelines for waiting times and monitors compliance, however poorly. That doesn’t happen in the private sector. The victims of those waits suffer, too. They just don’t get the same attention.

The private sector has long waits similar to the VA? You mean there are health-care organizations out there that have something comparable to 57,000 people on a waiting list and 64,000 who can’t even get on the list? It’s hard to take that very seriously.

Here’s another reason it shouldn’t be taken seriously.  The most recent VA audit released just the other day states that “Critical insights came from asking front-line staff members to rate the degree to which certain factors interfered with timely access to care. The highest scored single barrier or challenge was lack of provider slots, closely followed by the peculiarities of the fourteen day goal.”

Lack of provider slots is likely the result of a lack of providers.  One way of determining whether VA’s lack of providers is due to broader health care forces or something endemic to the VA is to look at the ratio of enrollees to doctors in the VA compared to the U.S. population at large.  The VA ratio is 1 doctor for every 637 enrollees, while for the U.S. population it is about 1 to 381.  (The math for all of this will be put at the end for you to review.)

That’s not the type of difference that can be attributed to broader health care forces in American.  Rather, it is, the result of bureaucracy.  Of the 281,651 employees in the Veterans Health Administration, about 14,000, or barely 5 percent, are physicians.  Like any bureaucracy, it has surely become top heavy with administrators—that’s where the promotions, power and pay raises tend to be. Furthermore, a bureaucracy is probably not a place many doctors find a joyful place to work.  Upon completing four years of college and then four years of medical school, people don’t usually say to themselves, “You know, I’d love to work at a place with lots of rules and regulations.”  That likely accounts for why the VA has 400 vacancies for primary-care doctors.

Whatever access problems exist in the private sector pale in comparison to the VA.  The VA doesn’t get its money by attracting patients, leaving bureaucrats there free to pursue their own interests even if it comes at the expense of the care veterans receive.  To suggest that the VA’s problems stem for larger problems in the health system is silly.

MATH:  There are about 8.92 million enrollees in the Veterans Health Administration and just over 14,000 doctors.  8,920,000 divided by 14,000 is 637.  The population of the U.S. is about 318,223,800.  The number of practicing doctors in the U.S. is 834,769.   318,223,800 divided by 834,769 is 381.