Can government run a health care system?

At Bay Pines, the peer review committee of physicians uniformly exonerated their medical colleagues regardless of the charges against them. Even the missing-sponge case mentioned earlier was not deemed malpractice and thus was not reported to the national data bank. Similar no-fault findings were adopted in all other malpractice cases during the time I represented the hospital, even when legal liability was established by VA lawyers and cash settlements were paid to mistreated patients. I was told by lawyers in the VA General Counsel's Office in Washington that the same "see no evil" data bank nonreporting was rife throughout the VA medical system.

Consider the actions of the long-time medical chief of staff at one of the nation's largest (and most trouble-prone) VA medical centers. Contrary to Federal and state law, he constantly pushes his personal policy dictating that all incoming patients be designated DNR (do not resuscitate). Simply put, that means that hospital staff are expected to avoid declaring a medical emergency, but if they must, they should not use any extraordinary means to save the patient. The chief doctor views his lethal expedient as a means of rationing scarce hospital beds and reducing budgetary costs at his VA facility.

As evidenced by the GAO report, one of the major problems with the VA system is growing demand for free medical services. Veterans with service-connected disabilities or conditions, and those at the poverty level, are eligible for free VA medical treatment. Others can receive free health care on an "as available" basis, depending on the case load of the facility (which contributes to the long waiting lines). The fewer than 3,000,000 veterans who were treated by the VA in 1992 made more than 23,000,000 individual visits to VA facilities.

Such highly inefficient multiple patient visits occur because the VA generally does not permit patient telephone consultations with medical personnel; usually does not allow refills of prescriptions without a personal appearance by the veteran; and, at most facilities, does not make scheduled appointments for general triage and treatment. That means "first come, first serve," with a glut of veterans showing up early each morning, then sitting in jammed waiting rooms for hours until they can be seen by physicians. Even before the first aspirin is administered, it usually takes VA staff an hour or longer just to complete the paperwork determining if the prospective patient is eligible to receive VA health benefits. "Be prepared to spend the day there," retired U.S. Army Maj. Elmer S. Erickson told a Miami Herald reporter at a Florida VA clinic. "You will eventually see a doctor."

Another reason for increased patient demand at VA facilities is the distortion of "service connection." The concept has become a political football, its elastic definition snatched away from medical experts by the politicians. A combat-wounded soldier or sailor suffers a definable medical injury that establishes his or her VA eligibility. However, what happens when the U.S. government sprays Agent Orange all over Vietnam and, 30 years later, thousands of veterans claim to be suffering various ailments as a result?