Examples of Single Payer Health Care Systems

I guess I should have been horrified about the allegations that came to light these past two weeks in regard to the Veterans Administration Health Care problems. However, since I have worked in the VA system as well as see patients who have used the VA system and have needed my surgical care due to the inadequacies found within this health care system. So, I have included the latest article regarding the whistleblowers bringing to light more examples of revelations.

The allegations of wait times, delayed care for veterans and cooked books began in Phoenix, but new revelations by two more Veterans Affairs whistleblowers in two different states suggest the VA problems are endemic.

“What really bothered me was that this delay was a direct result of this extremely low sense of caring for the patient,” said Dr. Jose Mathews, the chief psychiatrist for the VA Medical Center in St. Louis starting in Nov 2012.

Mathews and another whistleblower in Texas detailed their concerns to Fox News.

According to Mathews, he noticed that the doctors he oversaw who were responsible for seeing veterans with post-traumatic stress and other acute mental health issues were working just a few hours a day. They were seeing about half the patients they could, Mathews alleged in a federal whistleblower complaint filed last year. Meanwhile, there were mounting suicides among veterans being treated at his facility — and officially, the St. Louis VA was reporting to its headquarters in Washington that its productivity was among the highest in the nation.

“They all got bonuses — that’s the sad part. Because in reality we were not really doing a good job, but it shows up on paper as if we are,” Mathews told Fox News.

When Mathews complained, he was removed from his job, assigned to an isolated office to oversee pensions and compensation. He was told not to contact the other doctors or patients.

“I think they have some form of moral blindness or something. They’re not able to see that this is not right, what they’re doing is not right,” said Mathews, a soft-spoken psychiatrist who says the veterans would have to wait a month or more for mental health treatment.

Spokesman Paul Sherbo, of the St. Louis VAMC, said in a written statement: “The St. Louis VA Medical Center leadership is aware of and is addressing the alleged issues. VA is committed to providing the best quality of care that all our nation’s Veterans need and deserve.”

A second whistleblower — from Harlingen, Texas – Dr. Richard Krugman accused the VA facility he oversaw in southeast Texas of delaying life-saving colonoscopies in order to cut costs. He provided a memo from his boss from 2011 outlining the shift in policy. He, too, was fired.

“I was treated like an animal. I was treated like a leper. I was treated like, how dare you attack me, or how dare you say what you’re saying,” said Krugman, a former associate chief of staff at the Veterans Affairs health care system.

He argued that his boss told them to require three successive fecal occult blood tests before sending the patient for a colonoscopy, a delay that could cause potential colon cancer to go from a treatable stage 1 to a deadly stage 4, if unaddressed.

His boss — now a VA director in Texas — pushed back, issuing the following response:

“Allegations such as the [VA] stopped sending patients for colonoscopies because the agency could not afford non-VA care and instead utilized a fecal occult blood test instead of colonoscopies was not substantiated” by the independent Office of Special Counsel that investigated Krugman’s charges and closed the case last November, according to the statement provided by Jeff Milligan, former director of VA Texas Valley health network. Krugman disputed the claim.

The Office of Special Counsel found none of Krugman’s claims to be substantiated. But when it closed the case, it admitted in a report and letter written to President Obama last November that it was forced to rely on an internal investigation carried out by the VA itself. It did not have the ability to independently investigate Krugman’s claims. The investigative panel assigned to get to the bottom of Krugman’s allegations was appointed by VA Under Secretary of Health Robert Petzel, who resigned Friday.

As first reported by Fox News last September, Petzel told congressional oversight committee members he had “no regrets” about awarding $63,000 in bonuses to hospital administrators in Pittsburgh after more than five veterans died of preventable Legionnaire’s disease contracted at a VA facility. 

“What I really got upset about was, over the last couple of weeks, everybody is now saying, ‘Oh, I never knew that. Oh, I didn’t see that,” Krugman said in an interview with Fox News. “The reports have been there since 2010, 2011, and each article, or each new material that I received, I purposely sent to those different gentlemen, with a backup copy, just so that they can’t say, ‘Oh, I never knew this, or I never knew that because every time that they say, ‘I don’t know this or I don’t know that,’ somebody else dies.”

Veterans’ groups met in Washington this week to call for secure hotlines so that more whistleblowers feel they can come forward and not face retaliation.

Jennifer Griffin currently serves as a national security correspondent for FOX News Channel . She joined FNC in October 1999 as a Jerusalem-based correspondent. 

I was approached by one of my patients who posed the question-If Kaiser Permanente can run a health care system effectively and efficiently, why can’t the government? This is an interesting question, which brings up a few points.

When I was training I found the VA system inadequate in health care delivery, but very cost effective for the patients, the veterans. However, the treating nurses and physicians were inadequate, either in their training, their qualifications or their dedications and concern regarding their patients. Very often, as a resident in training, I would stay after my rotation to care for the patients to make sure that they received their wound care or received their proper medications, etc.

Shift to my present experience where my practice consists of many cancer patients.

How do I experience the VA system and its inadequacies now? A number of my patients, who are veterans, proceed to the VA clinic or hospital when asked by their primary care doctors where they wanted to go for evaluation and treatment. Often they are referred to my office due to the waiting times to gain access to the system or due to inadequate treatment. Now I am faced with more advanced cancers to treat, challenging my surgical skills. Sometimes the malignancies are so advanced that radiation or chemotherapy are necessary, or even the patients showing up being now deemed untreatable.

This system, like the Medicaare system is a government health care run system. Unlike the Medicare program, the VA system is a true system consisting of delivery of health care through clinics, hospitals, employed delivery personnel such as physicians and nurses and finally the payment part of the equation.

I worry; looking at the government managed health care examples such as the VA system, Medicare and Medicaid programs, that the Affordable Care Act and all that it consists of will suffer the same poor quality and financial stresses leading to limitations or care delivery.

Let’s look at Kaiser’s history and examine their successes, failures, strategies, and organization. We should also compare it to other medical health care systems like Massachusetts and the European countries have worked out. Have they all been successes and what determines success? How are they financed and what limitations are “required” to make their systems sustainable?

Kaiser Permanente evolved from industrial health care programs for construction, shipyard, and steel mill workers for the Kaiser industrial companies during the late 1930s and 1940s. It was opened to public enrollment in October 1945.

The organization that is now Kaiser Permanente began at the height of the Great Depression with a single inventive young surgeon and a 12-bed hospital in the middle of the Mojave Desert. When Sidney Garfield, MD, looked at the thousands of men involved in building the Colorado River Aqueduct Project, he saw an opportunity. He borrowed money to build Contractors General Hospital; six miles from a tiny town called Desert Center, and began treating sick and injured workers. But financing was difficult, and Dr. Garfield was having trouble getting the insurance companies to pay his bills in a timely fashion. To compound matters, not all of the men had insurance. Dr. Garfield refused to turn away any sick or injured worker, so he often was left with no payment at all for his services. In no time, the hospital’s expenses were far exceeding its income.

Founded in 1945, Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving approximately 9.3 million members, with headquarters in Oakland, Calif. It comprises:

            Kaiser Foundation Hospitals and their subsidiaries

            Kaiser Foundation Health Plan, Inc.

            The Permanente Medical Groups.

At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.

Kaiser Permanente’s creation resulted from the challenge of providing Americans medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Among the innovations it has brought to U.S. health care are:

            1. Prepaid health plans, which spread the cost to make it more affordable

            2. Physician group practice to maximize their abilities to care for patients

            a focus on preventing illness as much as on caring for the sick

            3. An organized delivery system, putting as many services as possible under one roof.


As of January, 2014, Kaiser consists of 38 Hospitals, 618 medical offices and other outpatient facilities.16, 942 physicians (all specialties), 48,701 nurses and 174,259 employees, which represented technical, administrative and clerical employees. In 2013 they had operating revenue of $53.1 billion. It has since become the largest organization of its kind an HMO. In its modern form, the HMO combines a large group practice, contracts with employers to care for a group of workers, and a prepayment plan for both hospitals and group practices.

So, how can Kaiser be so successful delivering healthcare efficiently as basically a single payer system, which is sustainable, and the VA and Medicare reek with so many problems? The difference government control and management or better, mismanagement.

Consider the latest error of judgment by our President. He choses former White House Aide Kristie Caneegallo as the next person to oversee the health care law. What are her credentials and should she be in charge? Canegallo worked at the U.S. Embassy in Afghanistan in 2007 and served in Iraq in 2008 as a governance and budget adviser to Anbar provincial government.

When is this administration going to learn that we need someone experienced in health care to oversee the ACA?

The VA and Medicare will continue to have their problems in delivering health care, and so will our new Affordable Care Act.

Wake up America!

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