Can government run a health care system?

USA Today (Society for the Advancement of Education), Jan, 1995 by Robert E. Bauman

Ninety-seven pages of Title 38, Part 4 of the Code of Federal Regulations and thousands of pages of internal VA departmental medical manuals describe what is, and is not, an officially VA-eligible disease or medical condition. VA medical boards hold thousands of individual hearings (veterans can appeal denials) on the question of eligibility for treatment.

Income status is a major factor; poor veterans are guaranteed what amounts to VA medical welfare. Fifty-two percent of all veterans who receive VA health care do so not because they were wounded in service to their country, but because they once were in the armed services and officially are defined by VA law and regulations as poor.

Just 45% of those who receive VA health care do so on the basis of medical conditions that are service-connected, but their care is, for the most part, free of charge to them--paid for by taxpayers. For those veterans, free treatment would have continued uninterrupted under the Clinton Health Security Act.

In October, 1993, the General Accounting Office (GAO) issued "VA Health Care--Restructuring Ambulatory Care System Would Improve Services to Veterans," a report to the chairman of the Subcommittee on Oversight and Investigations of the House Committee on Veterans' Affairs. It raises some interesting questions. For instance, what would the chances for Congressional approval of the Clinton health care plan have been if Americans peered into the future and discovered:

* More than half of the patients with routine medical conditions wait from one to three hours to be seen for a few minutes by an overworked physician struggling with increasing numbers of patients and piles of government forms, regulations, controls, and policy directives?

* One of nine patients identified as suffering "urgent" medical or psychiatric problems is forced to wait up to three hours to see a doctor?

* Because of lengthy waiting lists, patients in need of specialized care, such as cardiac or orthopedic diagnosis, even at the system's best medical facilities, can not be seen by a specialist for 60 to 90 days and wait months more if surgery or other special testing and procedures are required?

Those real-life scenes are neither scare projections by opponents of Clinton's plan nor descriptions of the historically inefficient British or Canadian government-run medical systems. They are the disturbing findings of the GAO study that covered 215 VA facilities, including 158 medical centers and 57 satellite and independent outpatient facilities, operated by the VHA during 1993.

The VA has more than seven decades of experience, is financed with hundres of billions of tax dollars, and has an immense professional medical staff. Yet, patients wait hours and even months for needed health care. From 1983 to 1992, American taxpayers bore the tab for $254,806,804 in damages under the Federal Tort Claims Act because of thousands of medical malpractice claims against VA personnel. (In 1993 alone, 801 new claims were filed and $41,000,000 was paid out for past claims, lawsuits, and settlements.)