- - Saturday, July 5, 2014


Sen. Tom Coburn, Oklahoma Republican, a physician who is himself the victim of prostate, colon and melanoma cancers, released a new report last week revealing that more than 1,000 veterans lost their lives over a 10-year period in the Veterans Affairs (VA) system owing to poor and inappropriate medical care. Mr. Coburn has the kind of experience and expertise in the medical field that we need to pay attention to. These deaths were often linked to overprescribed painkillers and delayed treatments and diagnoses, but the problems in the VA system run deeper, right to its core philosophy.

The Veterans Health Administration is a deeply flawed system of government-run socialized medicine. As opposed to Obamacare, which mandates that you buy insurance that only indirectly entitles you to health care, the VA hires doctors and nurses, builds hospitals and provides health care directly.

Like the British National Health Service (NHS) in England, which deals with more than a million patients every 36 hours, the VA is cumbersome, bureaucratic and insensitive to the needs of individual patients.

VA health care is unwieldy, with almost 9 million enrollees leading to more than 83 million outpatient visits and over 700,000 inpatient admissions per year. The number has increased by 23 percent from 2008, but the number of doctors has not increased to compensate.

According to the American Board of Physician Specialties, there are 1,400 unfilled positions for VA doctors because of narrow hiring practices, no formal criteria, lower pay across the board, and cases that are too challenging to attract a broad base of doctors, especially in primary care. The American Federation of Government Employees reports many doctors take care of more than 2,000 patients each, much more than the 1,200 target put forth by the VA handbook.

I have worked in VA hospitals my entire career, and I can personally report that the level of commitment on the part of physicians working there is variable. Some are workhorses and others are slackers. All are on salary, and there is no financial incentive to encourage harder work the way there is in a private hospital. Though I can recall instances of heroic cures and creative solutions, on the whole, veterans’ hospitals are not up to the standard of care of university or even community hospitals. Many veterans who can afford to, use the VA only as a backup for chronic care or for prescriptions when their private doctor isn’t available.

Keep in mind that more than 30 percent of veterans smoke, more than 15 percent are heavy drinkers, and more than 30 percent of veterans from Iraq and Afghanistan are suffering from post-traumatic stress or depression. These conditions complicate medical care and require a highly skilled physician to treat them. Unfortunately, VA doctors may lack these skills or be stretched too thin to handle these complex cases.

When people wait too long for essential services such as dialysis, intensive-care units, emergency cardiac stents or bypass surgery, they die. The more than 1,000 veterans who reportedly died over 10 years waiting for services or from receiving substandard care at the VA are just the tip of the iceberg. Thousands more have likely died in this country because of delay in care that was never reported.

Perhaps the worst problem involves emergency care, as many VA hospitals are not geared for it. According to the Centers for Disease Control and Prevention, the average wait time in hospital ERs here in the United States is about an hour and increasing, while Veterans Affairs admits that veterans wait at least twice as long for their emergency care as the average American. Ongoing investigations reveal that at many VA hospital centers, veterans wait for many hours, like they do in England.

Speaking of England, similarities between the VA and the British NHS failings are uncanny: In England, the number of patients who wait to be seen in the ER from four to 12 hours (called trolley waits) has almost doubled over the past two years, while those waiting up to four hours has increased by 43 percent over the same period. Like the VA, the British NHS doesn’t save money (costs have more than doubled over the past decade), and it doesn’t always save lives (someone having a heart attack is more than twice as likely to die over the next month as in Sweden). Chronic physician shortages, especially among general practitioners, has also long plagued the NHS in Great Britain, leading to rationing of services.

The inevitable endpoint of rationing is euthanasia. Across the pond, there are 450,000 deaths a year under NHS care, and 130,000 of those involve the Liverpool Care Pathway, which utilizes euthanasia on the elderly. The VA has also recently focused on mandatory end-of-life counseling and promoted a euthanasia-oriented book called “Your Life, Your Choices.”

The veterans who have defended our country’s freedom deserve more for their efforts than a system of rationed care and premature euthanasia that is reminiscent of the worst parts of England’s system of socialized medicine. No amount of overhaul will fix it. Our veterans have earned private solutions tailored to their needs. The goal should be to honor their lives and sacrifice, not hasten their death.

Marc Siegel, a physician, is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.

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