Medicare's VA disease.

• Author: Orient, Jane M.
• Position: ECONOMIC OBSERVER - Department of Veterans Affairs

MOST VETERANS get most of their medical care from private doctors through Medicare or private insurance. Just think what those secret waiting lists would be like if they did not. Still, a Veterans Administration-like system for all has been proposed as a replacement for our unsustainable current system--at least until the recent scandals broke. One enormous difference between the VA and Medicare is that veterans are free to go elsewhere--if they pay privately. Some veterans use their VA doctor only to get free medications.

Medicare patients, on the other hand, are trapped. There is virtually no private coverage available to persons over 65 to replace Medicare--Pres. Lyndon Johnson wiped it out to prevent competition with "his" beloved system. There only are policies to "supplement" Medicare--and Medicare patients cannot just pay out of pocket for a "covered" service they cannot get otherwise, say because the Medicare-allowed price is too low--unless they see a doctor who has opted out of Medicare or disenrolled. For doctors, Medicare is all or nothing, so most doctors still are enrolled.

Most people do not care about that--not yet. Who would want to pay for something that is free? So, it is a good idea to look at those "free" (taxpayer-paid) VA services. In an online survey by the Association of American Physicians and Surgeons, less than two percent of 1,000 respondents said care at the VA was the equivalent of the care in the private sector or a model for the entire U.S. medical system. Only four percent said it was "generally good, but uneven." Some 53% said that VA care was "good in some areas, but fraught with many serious problems," and 22% responded that it was "okay if you can get it, but access is seriously limited." Nearly 20% checked "other" and suggested a term equivalent to "poor." One said "hard to tell how bad because they destroy or hide records." Nine percent of respondents said the problems could be "fixed" by firing people, and less than three percent by large increases in funding. The main problems, elaborated in the more than 7,200 comments, are a huge, rigid bureaucracy and the "VA way" at the "VA Spa."

The bureaucracy interferes with care and punishes anyone who calls attention to problems. The main concern of the unionized workers appears to be to leave...