[Gimpy]

I stay away fer a couple of days and LOOK what happens!

A perfectly good and informative post about the dastardly and underhanded behavior of the current administrations LACK of adequate attention and inadequate funding of the Department of Veterans Affairs turns into a 'bashing' of the 'Dems' and 'Liberals'????

Why am I not surprised!................

First, I want to thank Arrow for her honest and informative post about the TRUTH as it happens to be detailed in the two articles she has provided. Thanks Sis.

Now, if we can JUST get some folks around here (and elsewhere) to comprehend and ADMIT this truth, the better off we'll all be.

I've taken the liberty of copying a few portions of those articles below. Hopefully this will help eliminate any further DISinformation and MISinformation being proclaimed by those among us with nothing better to do than IGNORE THE FACTS!

From U.S. News & World Report Magazine:

"Recent evidence shows [that care at the VA system] is at least as good as, if not better," he says, than care delivered elsewhere. In the 1990s, for example, the VA began using a new way--since adopted by the American College of Surgeons--to evaluate surgical quality. It enabled VA surgeons to reduce postoperative deaths by 27 percent and post-surgical complications by 45 percent. Recently published studies have found that the VA rates much better than Medicare fee-for-service providers in 11 basic measures of quality, such as regular mammograms and counseling for smokers. Late last year, the Annals of Internal Medicine published a study showing that the VA had "substantially better quality of care" than other providers in many of nearly 350 indicators of quality, such as screening and treating depression, diabetes, and hypertension.

"evidence of a seismic shift, brought about not by high-tech breakthroughs but by a fundamental change in VA culture. A new emphasis, on patient safety and on a work ethic that stresses constant examination of the processes and procedures that go into caregiving, arrived in 1994 when Kenneth Kizer, former director of California's Department of Health Services, was tapped to run the VA health empire. His mission, as he saw it, was to remake the unwieldy system into one of the world's safest and finest. Kizer started holding doctors, administrators, and managers directly accountable for the quality of their patient care, linking, for example, how many heart-attack patients received recommended beta blockers and aspirin to job reviews. And the performance for each facility was made public, which turned out to be a major motivator. "People competed like hell," says Kizer, now president of the nonprofit National Quality Forum, which develops national standards for assessing the quality of healthcare.

Kizer was immersed in studies of patient safety years before the Institute of Medicine's jolting report in 1999 of hospital errors that kill tens of thousands of patients. To cultivate a "culture of safety" at the VA, he created a National Center for Patient Safety, and to head it up he brought in James Bagian, a former astronaut who had investigated the space shuttle Challenger accident for NASA.


Bagian's hire was "one of the smartest things [Kizer] did," says Leape. Both an engineer and physician, Bagian brought to the VA unique skills and a zealous commitment to safety. "

Bagian's greatest challenge was shifting the attitudes of VA staffers. Few people reported a gaffe, for fear that they or the person who made it would suffer. "The VA had the most punitive, hardest culture I had ever seen," says Kizer; he and Bagian wanted to change the VA's punishment-oriented ways to an open, nonpunitive environment. But the staff didn't begin to respond until top managers showed they were serious. In the new VA, for example, managers could be fired, fined, and even jailed for retaliating against workers who file mistake reports.

And other hospitals have noticed. Jennifer Daley, chief medical officer and senior vice president of clinical quality at Tenet Healthcare Corp., is using the VA as a blueprint to improve performance at the nation's second-largest for-profit hospital operator.

######


From Washington Monthly:

By the mid-1990s, the reputation of veterans hospitals had sunk so low that conservatives routinely used their example as a kind of reductio ad absurdum critique of any move toward ?socialized medicine.? Here, for instance, is Jarret B. Wollstein, a right-wing activist/author, railing against the Clinton health-care plan in 1994: ?To see the future of health care in America for you and your children under Clinton's plan,? Wollstein warned, ?just visit any Veterans Administration hospital. You'll find filthy conditions, shortages of everything, and treatment bordering on barbarism.?

And so it goes today. If the debate is over health-care reform, it won't be long before some free-market conservative will jump up and say that the sorry shape of the nation's veterans hospitals just proves what happens when government gets into the health-care business. And if he's a true believer, he'll then probably go on to suggest, quoting William Safire and other free marketers, that the government should just shut down the whole miserable system and provide veterans with health-care vouchers.

Yet here's a curious fact that few conservatives or liberals know. Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be ?significantly better.?


Here's another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care. It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.


Not convinced? Consider what vets themselves think. Sure, it's not hard to find vets who complain about difficulties in establishing eligibility. Many are outraged that the Bush administration has decided to deny previously promised health-care benefits to veterans who don't have service-related illnesses or who can't meet a strict means test. Yet these grievances are about access to the system, not about the quality of care received by those who get in. Veterans groups tenaciously defend the VHA and applaud its turnaround . ?The quality of care is outstanding,? says Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion. In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients.


Outside experts agree that the VHA has become an industry leader in its safety and quality measures. Dr. Donald M. Berwick, president of the Institute for Health Care Improvement and one of the nation's top health-care quality experts, praises the VHA's information technology as ?spectacular .? The venerable Institute of Medicine notes that the VHA's ?integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.?

If this gives you cognitive dissonance, it should. The story of how and why the VHA became the benchmark for quality medicine in the United States suggests that much of what we think we know about health care and medical economics is just wrong. It's natural to believe that more competition and consumer choice in health care would lead to greater quality and lower costs, because in almost every other realm, it does. That's why the Bush administration?which has been promoting greater use of information technology and other quality improvement in health care?also wants to give individuals new tax-free ?health savings accounts? and high-deductible insurance plans. Together, these measures are supposed to encourage patients to do more comparison shopping and haggling with their doctors; therefore, they create more market discipline in the system.

But when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality. That unexpected reality needs examining if we're to have any hope of understanding what's wrong with America's health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well?incentives that are lacking in for-profit medicine.

Hitting bottom


By the mid-1990s, the veterans health-care system was in deep crisis. A quarter of its hospital beds were empty. Government audits showed that many VHA surgeons had gone a year without picking up a scalpel. The population of veterans was falling sharply, as aging World War II and Korean War vets began to pass away. At the same time, a mass migration of veterans from the Snowbelt to the Sunbelt overwhelmed hospitals in places such as Tampa with new patients, while those in places such as Pittsburgh had wards of empty beds.

Serious voices called for simply dismantling the VA system. Richard Cogan, a senior fellow at the Center on Budget and Policy Priorities in Washington, told The New York Times in 1994: ?The real question is whether there should be a veterans health care system at all.? At a time when the other health-care systems were expanding outpatient clinics, the VHA still required hospital stays for routine operations like cataract surgery. A patient couldn't even receive a pair of crutches without checking in. Its management system was so ossified and top-down that permission for such trivial expenditures as $9.82 for a computer cable had to be approved in Washington at the highest levels of the bureaucracy.

So, it may have been politics as usual that kept the floundering veterans health-care system going. Yet behind the scenes, a few key players within the VHA had begun to look at ways in which the system might heal itself. Chief among them was Kenneth W. Kizer, who in 1994 had become VHA's undersecretary for health, or, in effect, the system's CEO.

A physician trained in emergency medicine and public health, Kizer was an outsider who immediately started upending the VHA's entrenched bureaucracy. He oversaw a radical downsizing and decentralization of management power, implemented pay-for-performance contracts with top executives, and won the right to fire incompetent doctors. He and his team also began to transform the VHA from an acute care, hospital-based system into one that put far more resources into primary care and outpatient services for the growing number of aging veterans beset by chronic conditions.


By 1998, Kizer's shake-up of the VHA's operating system was already earning him management guru status in an era in which management gurus were practically demigods. His story appeared that year in a book titled Straight from the CEO: The World's Top Business Leaders Reveal Ideas That Every Manager Can Use published by Price Waterhouse and Simon & Schuster. Yet the most dramatic transformation of the VHA didn't just involve such trendy, 1990s ideas as downsizing and reengineering. It also involved an obsession with systematically improving quality and safety that to this day is still largely lacking throughout the rest of the private health-care system.


Why care about quality?

Here's one big reason. As Lawrence P. Casalino, a professor of public health at the University of Chicago, puts it, ?The U.S. medical market as presently constituted simply does not provide a strong business case for quality.?


As the health-care crisis worsens, and as more become aware of how dangerous and unscientific most of the U.S. health-care system is, maybe we will find a way to get our minds around these strange truths. Many Americans still believe that the U.S. health-care system is the best in the world, and that its only major problems are that it costs too much and leaves too many people uninsured. But the fact remains that Americans live shorter lives, with more disabilities, than people in countries that spend barely half as much per person on health care. Pouring more money into the current system won't change that. Nor will making the current system even more fragmented and driven by short-term profit motives. But learning from the lesson offered by the veterans health system could point the way to an all-American solution.

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And, all the 'Clinton bashers & Dem bashers' need to be aware that it WAS Clinton who had the insight and foresight to HIRE Dr. Kenneth Kiser to begin with and put in place the mindset that the VA could become a "WORLD CLASS" health care system.

This current 'bunch' of misfits at the TOP of the VA have absolutely NO EXPERIENCE and obviously NO INTENT to do much to help maintain or improve the system as it has been under the previous 'watch'!


AND THAT"S A FACT...........JACK!