Longman - Best Care Anywhere

Best Care Anywhere

Why VA Health Care
Would Work Better for Everyone

THIRD EDITION

PHILLIP LONGMAN

Best Care Anywhere

Copyright 2012 by Phillip Longman

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Third Edition

Paperback print edition ISBN 978-1-60994-517-6

PDF e-book ISBN 978-1-60994-581-7

IDPF e-book ISBN 978-1-60994-582-4

2012-1

Designed and produced by BookMatters

Edited by Tanya Grove

Proofread by Janet Reed Blake

Indexed by Leonard Rosenbaum

Cover design by Nicole Hayward

Preface to the Third Edition:
After Obamacare

The cause of health-care reform has taken great leaps since the last edition of Best Care Anywhere went to press in late 2009. Yet we seem farther away than ever from achieving resolution to our health-care crisis.

After a prolonged and rancorous debate, the nation passed the landmark legislation known inevitably as Obamacare. Today, progressives continue to grieve its compromises. Conservatives, energized and empowered by populist suspicions and resentments of the bill, have meanwhile set furiously to work on its repeal in the courts and Congress.

Adding to the sense that passage of Obamacare has done little to resolve our health-care crisis, federal health-care spendingor more precisely, political brinksmanship over how to control ithas become the major cause of the nations long-term deficits, which now have compounded sufficiently to earn the United States its first-ever credit-rating downgrade. Responding to this reality check, mainstream opinion now holds that one way or another the nation must soon take strong action to rein in entitlement spending; and the largest drivers by far are Medicare and Medicaid.

Even a progressive Democratic president, whose signature Meanwhile, at a time of high unemployment and a burgeoning growth in the numbers of low- and moderate-income elders, the Republican Party has voted to end Medicare as we know it and so far lived to tell about it.

With lightning speed, the politics of health care are shifting in ways that were unimaginable only a year ago. Yet while it is a moment of unnerving divisiveness, it is also a moment that vastly expands the realm of the politically possible. Ideas for solving the mounting health-care crisis that once seemed too bold and unfamiliar to be politically viable, including the policy prescription contained in Best Care Anywhere, now have new currency, if only because of the exhaustion of plausible alternatives.

This is far different from the climate of opinion that existed when Best Care Anywhere first appeared in January 2007. That same month, for example, the Washington Post began an expos on problems at Walter Reed Army Medical Center in Washington DCa series for which it later won the Pulitzer Prize. The facility is a U.S. Army hospital, and as its name indicates, it is run by the Department of Defense, not by the separate cabinet agencythe Department of Veterans Affairs (VA)whose virtues I had described in my book. Nonetheless, this distinction was lost in much of the reporting on the scandal, leaving many Americans with the impression that the VA was neglecting grievously wounded warriors. As media and congressional investigations mounted, my first publisher and editor pretty well gave up on the book, as they later told me. Meanwhile, I endured blogosphere ridicule for having written one of the worst-timed books in years.

Slowly, by word of mouth, the book and its paradoxical message did, however, begin to gain some influence behind the scenes. For example, in an odd loop-the-loop, when reporters around the country started visiting their local VA hospitals looking for scandalous conditions like those described by the Post at Walter Reed, they often came away as impressed as I had been in researching the book. The VA received an unexpected burst of positive coverage, in which Best Care Anywhere was often cited. That coverage has continued to build; by now, most organs of the mainstream media have weighed in with stories extolling the virtues of the VAs model of care, including Fortune, CBS News, the Wall Street Journal, and USA Today.

And, to be sure, some people in high places also became aware of the quality revolution at the VA that I had described. For example, in the spring of 2007, I was twice summoned to brief the health-care staff of the leading Democratic presidential candidate at the time, Hillary Clinton. Afterward, her standard speech on health-care quality came to include two paragraphs on the transformation of the nations long-tarnished veterans health-care system and its lessons for improving quality in health care generally.

Through a well-placed friend and colleague, a copy of the book was also slipped to candidate Barack Obama before he boarded a long flight to Hawaii. Whether he read it, I do not know, but he, too, began making positive references to the VA in his health-care addresses. Peter Orszag, then director of the Congressional Budget Office (CBO) and later Obamas head of the Office of Management and Budget, began ordering up studies from his staff on the lessons of the VAs quality performance.

Interest stirred in some Republican circles as well. Michael Cannon, director of health policy studies at the libertarian Cato Institute, took exception to the idea that the VAthe nations one undeniable example of fully socialized medicineshould stand as a model of twenty-first-century health reform. But he acknowledged the VAs emergence as a quality leader in health care and wrote thoughtfully for the