Wait Listed

Unless you were on a spring trip to somewhere remote like the boundary waters, you’ve heard, read, or watched something about the scheduling problems at the Veterans Affairs (VA) medical center in Phoenix, and allegations of similar issues at other VA facilities. Despite all this coverage, some of the basic facts about the VA in general, and about the “secret list” apparently maintained at the Phoenix VA in particular, have not been widely reported. Here are a few things to know about the VA, the current trouble in Phoenix, and why a fully funded single payer health care system remains the answer.

Care vs. access. Since undergoing a major transformation in the early 1990s, the clinical care in the VA system has been as good as or better than that provided in the private sector. This has been documented for chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease, etc), and acute conditions (myocardial infarction). Access to care, however, is another story. For over a decade, the VA has been struggling to see new patients eligible for VA care in a timely fashion. This task has been made more difficult by an influx of new veterans from Iraq and Afghanistan, the aging of Vietnam-era veterans, and difficulty in obtaining corresponding increases in clinicians and facilities. In the past three years, the VA system has seen a 50% increase in the number of primary care appointments, while the number of primary care doctors has grown by just 9%. The Department of Veterans Affairs reports a shortage of 400 primary care doctors needed to meet the growing demand.

Wait times and “secret lists.” All VA facilities were charged with seeing new patients within 14 days of the patient requesting a visit. Unfortunately, it appears that in at least one facility (Phoenix), this goal was not met. Additionally, instead of acknowledging this, it appears that personnel delayed placing patients into an official database (which would automatically calculate the true wait until the first visit), but rather placed them onto an unofficial list (aka, the secret list). It appears that this was done to make the calculated wait times look more favorable, but in the process it both hid the true extent of the problem, and placed patients into a potentially dangerous situation, in that the unofficial list did not notify personnel when clinic spots opened up unexpectedly (something the official wait list can do).

Patients within the VA system receive outstanding care, but the VA has struggled to bring new patients into the system in a timely fashion. It appears that in at least one facility, rather than admit to long wait times, personnel tried to minimize the extent of the problem by not placing patients onto the official list. The Office of the Inspector General is continuing to investigate the manipulation of wait times at the Phoenix VA, meaning that the VA will be in the news for much of the summer.

Public response. As those outside the system — politicians and commentators – begin to brandish their torches and pitchforks, calling for the dismantling and privatization of the VA health care system, none seem to have noted a recent study demonstrating that the US health care system as a whole has the highest rate of amenable mortality—deaths avoidable through timely access to health care—when compared to other wealthy democracies such as France, Germany and the UK (Health Affairs, 2012). When sick individuals lack access to timely health care, they die prematurely—be they civilians or military veterans.

Abandoning the VA system for one dominated by a complex labyrinth of profit-driven private insurance networks—and spending 31% on administrative overhead—is hardly the answer. Rather, our efforts should be focused on expanding primary care capacity, achieving administrative simplicity, and guaranteeing high-value, high quality coverage for all Americans—civilians and military veterans alike. Local VA physicians helped provide some the material for this piece