Last week, I got to do something I enjoy very much: saying “I told you so.” I am paying for that this week because I have to do something of which I am much less fond: admitting that I was wrong about an important subject.
For years, as we have debated an increased government role in providing medical care, I have cited the health care provided by the Department of Veterans Affairs as an example of how the government can do that very well.
My argument was very strongly empirically based. I was reporting the virtually unanimous sentiments expressed by veterans served by the VA. In fact, on those occasions when the federal government was considering changes in the delivery of medical care, I heard very firmly from veterans that they did not wish there to be any change in the system that serves them, and they did not want to be folded into other health care systems.
A combination of factors attracted them so strongly to this system. One was the sense of solidarity that veterans got – particularly older ones, who, when hospitalized, could spend time with people who had shared important experiences in their earlier lives, even if they were not direct comrades.
But there was also a clear perception, supported by evidence, that the care itself was first rate – as it should be – because the VA pioneered medical care in areas particularly relevant to those who had received the kind of wounds that one gets in combat.
Given my citing the VA medical care system as an example of how government could deliver this vital service so well, I’ve been particularly chagrined to read in recent weeks of the terrible abuses that had been apparently concealed within that system.
I do not need to retract entirely what I have been saying. It is clear that the quality of care – when delivered – is still first-rate, and veterans’ experiences continue to contradict the notion that the government is incapable of delivering good medical care.
But it is also clear that there have been serious problems in the extent to which that care was delivered to people who needed it. And honesty compels me to acknowledge that those problems are, to some extent, a result of the care’s being delivered through government.
Ironically, part of the problem has been caused by some of those who are the most critical of the notion of government doing things. That is, while there have been abuses that go beyond the question of adequate resources, the single biggest cause of the problem is that the VA, like virtually every other domestic federal agency, had been denied the appropriate level of funding. This is especially true given the sadly inevitable increase in patients generated by the two wars that America began earlier in this century, both of which were carried on far longer than anybody had hoped.
Conservatives who try to refute this point face a serious obstacle: The very audit they cite to show the size of the problem specifically notes that inadequate funding – by Congress – is the most important reason for the crisis.
It is also the case that VA physicians’ compensation lags behind what is earned in the private sector. No one expects public officials to make as much as their private-sector counterparts, but there is a level below which we cannot go on taking advantage of people’s public-spirited orientation without affecting recruitment and the quality of the service.
But it is undeniably true that this being a government enterprise contributed to some of the problems. I am pleased to see that one remedy being proposed by both parties is to give supervisory personnel greater power to fire officials within the system who are not performing.
Since my days working for the mayor of Boston, while I have strongly admired people who work for the public sector, I’ve felt consistently that civil service tenure protections are overdone. This seems to be especially the case where people are allowed to join unions because there are alternative grievance mechanisms there.
Obviously, this doesn’t pertain to physicians and supervisory people, who are generally not likely or even legally eligible to join unions. But it is clear in this case that there are people who should’ve been fired and that the ability to discipline people who do not do their jobs has been lacking.
Punishment should be especially harsh for those who covered up this situation. Dismissal should be the least punishment meted out, and I hope that appropriate officials look closely to see if further actions are appropriate. Deliberately withholding or worse, lying about information that veterans were not getting the medical care to which that they are entitled ought to be a criminal offense, if it isn’t one already.
Of course, the non-VA health care systems also have their own problems. And as distressed as I am that veterans have had care denied or delayed for an unconscionable amount of time, I continue to believe that the VA system is valuable. It is interesting to note that while there have been reasonable calls for the VA to pay for private care in those cases where the system is at capacity and cannot give direct help, there has been no call on the part of veterans to abolish the VA, or even substantially diminish it.
The quality of medical care dispensed by the VA is, in most cases, as good as that available anywhere in the country, and there is no basis for arguing that the federal government’s involvement in medical care does more harm than good. But it is also important for people like myself who do believe in an important public-sector role to understand the extent to which the problems that come with public-sector activity were a part of the difficulty here, and to be much more vigilant going forward to protect against these abuses.
Barney Frank is a retired congressman and the author of landmark legislation. He divides his time between Maine and Massachusetts.
— Special to the Telegram