Get Comfortable, There’s Gonna Be a Wait by Pat Conrad MD

govt care

All of you fans of Big Government medicine, single payer health care, institutionalized compassion, and subsidized hugs (you know who you are), listen up: here is another tribute to the goal you desire.

USA Today reports that the VA is falsifying wait time for vets at 40 different facilities (shocker!). “Supervisors instructed employees to falsify patient wait times … In some cases, the system encouraged manipulation even without explicit instruction from supervisors.” Investigators found that some employees kept lists of some waiting veterans outside of the scheduling system, in order to further improve reported wait times.

“The agency said it has retrained thousands of schedulers and is updating software to make it easier for them to book appointments properly.” Just like it did in 2005. And in 2010. And in a massive correctional initiative, the VA thus far has started to discipline 29 employees. Yep, 29.

Why did does this keep happening? “The manipulation masked growing demand as new waves of veterans returned from wars in Iraq and Afghanistan and as Vietnam veterans aged and needed more health care.” Which reminded me of another story from a few years ago…

… wherein the British government tried to deal with a conflict between promises and resources. The government mandated that no patient presenting to the hospital wait more than 4 hours to be seen and VOILA! The problem was fixed. Except in 2008, it was reported that ambulances with patients on-board were simply waiting in the parking lot for hours, until such time as the patient could be seen inside within the mandated 4-hour limit. Naturally those wagons in the holding pattern were not therefore available to take fresh emergency calls either. And despite that huge stink, the Brits are still slogging ahead, bragging that 90% of patients are being seen within 4 hours. The president of the College of Emergency Medicine, Dr. Clifford Mann, said part of the problem is that hospitals have no financial incentive to invest in emergency care: “We need sustainable staffing for our emergency departments, which will only happen when we stop penalizing acute trusts (hospitals) for treating acutely ill and injured patients … all acute care loses money and in times of austerity it is difficult for trusts to invest properly in an emergency department which they see as a loss-making part of the business.” Let’s face it, neither emergency patients or vets tend to bring in the dollars/pounds. Do you think the Brits are as broke as we are?

I wrote a decade ago that the purpose of Big Government health systems is not to provide universal care, but to provide the appearance of universal care. I’m a vet, and no I don’t think its funny that vets needing actual care are shuffled off to phantom waiting lists. But I think it’s funny as hell that so many want to expand the systems and promises of the VA, Medicare, and the U.K. national health service, despite decades of evidence.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  15 comments for “Get Comfortable, There’s Gonna Be a Wait by Pat Conrad MD

  1. Christopher Dobrose
    April 14, 2016 at 10:03 am

    I have to preface my comments by letting everyone know that I myself am a veteran. I have zero sympathy for veterans who cannot get an appointment for VA healthcare for what are non-service related illnesses (even though the VA classifies those illnesses as service related). After VietNam the VA decided to classify a whole bunch of illnesses that are not service related (like heart disease, hypertension and diabetes) as service related if you ever served in Viet Nam and used phony science to claim that they are service related due to Agent Orange exposure. I suspect this was done to preserve the bloated VA system after people with service related injuries started to diminish after the war was over. The result today is a system clogged with elderly vets with non-service related illnesses that are blocking access of vets with true service related injuries and illness.

  2. anonymous MD
    April 13, 2016 at 9:56 am

    As a VA surgical specialist, semi-retired to the VA because I love what I do and am not ready to quit entirely just yet. The bottle neck to timely access is lack of physicians. Why is that so? Poor pay and an attitude from the head administrators that screams, “we don’t trust you… you lie… you don’t know what you are talking about…” Somewhat similar to the attitudes of the CEO’s in the private sector health groups.
    Fortunately working for the feds, I knew my voice wouldn’t be heard before I started this gig, so it doesn’t bother me as it did in my prior life. The good thing is that I can help a population that truly NEEDS my services and is overwhelmingly truly appreciative.

  3. Ben Van Raalte
    April 13, 2016 at 9:18 am

    Notice 29 were “disciplined”. NOT FIRED.
    Until government workers get fired routinely, nothing will change. It is the same as my residency. Glorified secretaries get paid 70,000 a year, then retire at a generous pension and health benefits.
    The union will counter they are overworked and the solution is more government employees.

    My solution is all the government workers have to get their care, including congressmen, at the VA, and they have to get the work done, or they are fired and replaced by someone who will. And no raises for the next 20 years, just like Medicare.

    Doctors get punished more by the government.and they are not even employees.

  4. RSW
    April 13, 2016 at 8:58 am

    Linking “quality metrics” to payment ALWAYS leads to gaming the system, whether it’s done through the VA, CMS, or private insurers. That the morons at the AAFP, with their school girl crush on MACRA/MIPS, don’t grasp this basic concept is staggering in its stupidity.

    • Thomas Guastavino
      April 13, 2016 at 9:11 am

      I am not an FP but I am impressed at how much the AAFP is hated by its members.

      • Perry
        April 13, 2016 at 10:23 am

        I’m a member and I wouldn’t go so far as to say I hate it, but I think its leaders are terribly misguided and have allowed themselves to be led to the slaughter, taking their members with them.

        • RSW
          April 13, 2016 at 11:39 am

          I’m more and more convinced that the locus of evil in the AAFP is not the president and the board, who seem completely clueless about what they are doing, but the behind the scenes permanent executive staff, from Henley on down.

          • Perry
            April 13, 2016 at 1:35 pm

            Either way, our profession is going down the tubes.

      • Pat
        April 13, 2016 at 5:31 pm

        I just (re)took my FP boards today, run by the ABFM that’s obviously the other side of the AAFP coin.

        Hatred is a precise term, for lack of something stronger.

        • Perry
          April 14, 2016 at 7:03 am

          Good luck, taking mine next week, for the final time.

  5. Thomas Guastavino
    April 13, 2016 at 6:11 am

    Explain to me again why the VA system is not just shut down and the vets insurance subsidized? Could it be that if this was done it would be an admission that run health care is a failure?

    • Seneca
      April 13, 2016 at 8:20 am

      I would love to see a real cost accounting of what it would cost to buy the Vets with service connected disabilities a “Cadillac” health insurance plan in the market. I suspect it would be substantially less than what we are paying for care at the VA. I haven’t worked in a VA in decades, but I have clear memories of government paid janitors and lab techs making almost what the physicians were!

      • John
        April 14, 2016 at 10:40 am

        About 200 per month if they are on Medicare – and they would have only the Part B deductible each year.
        Go to any Dr that works with Medicare anywhere in the U S.

        – plus a drug plan – 30 – 75 per month.

        I sell the coverage.

    • Steve O'
      April 13, 2016 at 8:37 am

      And the US negotiated drug prices for the “Big Four” governmental buyers – VA, DoD, PHS and, Coast Guard – are the lowest in town – and that’s by law. They can legally undercut their purchase costs by 50% or more under AWP – far more of a discount than the national retail pharmacies.
      But why do they have the authority to resell the drugs to vets and service members for the same price – or more – than the retail pharmacies? Buy low, sell high, spend the profits on inefficiency.

      • Thomas Guastavino
        April 13, 2016 at 9:08 am

        Only the government could find a way to mess up its monopsomy powers.

Comments are closed.