The Department of Veterans Affairs, long touted by experts as providing health care superior to most private providers, is suddenly engulfed in scandal.
Records on wait times for appointments were allegedly falsified at the Phoenix VA, and the department is investigating whether long wait times contributed to the deaths of 40 veterans at that facility. Similar stories about other VA facilities have been bubbling up for months. This is a ghastly problem involving potentially criminal behavior.
But while VA wait times for appointments are bad, private sector wait times aren’t appreciably better.
Conservative commentators have been quick to claim the VA scandal as decisive proof that the VA was never the model for excellence (and, by implication, the argument for socialized medicine) claimed by liberals like Paul Krugman, Ezra Klein, and yours truly, all of us citing reporting by Philip Longman, who later expanded it into a book. But the VA scandal does not raise questions about the quality of VA care, which continues to rank highly; it raises questions about the availability of VA care.
To conclude from the VA scandal that VA hospital care was poor would be like concluding from Harvard’s 6% admission rate that Harvard did a lousy job educating students.
The difference, of course, is that Harvard isn’t supposed to admit everybody, whereas the VA is supposed to book appointments for already-qualified veterans within 14 days. It isn’t doing that. News stories about the Phoenix VA and some other bad actors indicate the wait can be many months, but an internal VA estimate—one based on “hard” time stamps and therefore less vulnerable to manipulation than the records allegedly falsified — puts the average wait at about 21 days.
Directly comparable data for the private sector are unavailable. But a 2014 survey of physician wait times found the average private-sector wait time to be 18.5 days — two and a half days less than at the VA. In Boston, which has a high concentration of top-quality private-sector hospitals, the average wait time was 45.4 days.
This private-sector survey almost certainly skews low because it was conducted in 15 cities rather than the entire country, and because it was limited to five specialties (cardiology, dermatology, obstetrics-gynecology, orthopedic surgery, and family practice). Also, the survey was limited to Medicare and Medicaid patients, many of whom—a quarter of the Medicare patients and more than half of the Medicaid patients — the doctors declined to treat at all, reducing their wait times artificially to zero. Since everyone requesting a VA appointment comes pre-approved, VA health providers must make appointments for 100% of those who request one. Granted, Medicare and Medicaid aren’t the private sector, they’re government insurers. But that’s immaterial to wait times. Patients wait as long for a Medicare-insured appointment as they would for a Blue Cross-insured appointment. The survey data come from Medicare and Medicaid because comparable data from private insurers is much harder to get. It’s worth remembering that 13% of Americans still have no health insurance of any kind, making it extremely difficult for them even to contemplate scheduling a doctor’s appointment. Falsification of government records is a serious offense, and anyone caught doing it must be punished, and the investigation into such allegations is ongoing. Any instance in which a veteran’s health was threatened by the length of time he or she must wait to see a doctor is unacceptable. But there’s no reason to believe veterans’ wait times to see a VA doctor exceed, on average and to any significant degree, non-veterans’ wait times to see a private-sector doctor. Inadequate access to health care is a VA problem. But it’s a national problem, too.
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