America is having what President Obama called a “teachable moment” on single-payer health care, the goal toward which Obamacare is but the first step. Doctor Hal Scherz  has written an op-ed in the Wall Street Journal today in which he lays out the real problem with the VA single-payer health care system, and offers hair raising examples, naming names. This is a brave thing for a doctor to do. In his words:

The VA health-care system is run by a centrally controlled federal bureaucracy. Ultimately, that is the source of the poor care veterans receive.

Bureaucracies that don’t face real competitive discipline of the marketplace inevitably turn their efforts toward protecting their own members, leaving the ostensible goals of the organization in a subordinate position. Dr. Scherz provides examples of how this has worked out in the VA system. He notes that most physicians in the United States have experience with VA Hospitals because most of the 153 VA Hospitals are affiliated with the country’s 155 medical schools, so physicians in training work at them, gaining experience as interns and medical residents. This makes the “well aware” of the problems of the VA system. He writes: 

In my experience at VA hospitals in San Antonio and San Diego, patients were seen in clinics that were understaffed and overscheduled. Appointments for X-rays and other tests had to be scheduled months in advance, and longer for surgery. Hospital administrators limited operating time, making sure that work stopped by 3 p.m. Consequently, the physician in charge kept a list of patients who needed surgery and rationed the available slots to those with the most urgent problems.

Scott Barbour, an orthopedic surgeon and a friend, trained at the Miami VA hospital. In an attempt to get more patients onto the operating-room schedule, he enlisted fellow residents to clean the operating rooms between cases and transport patients from their rooms into the surgical suites. Instead of offering praise for their industriousness, the chief of surgery reprimanded the doctors and put a stop to their actions. From his perspective, they were not solving a problem but were making federal workers look bad, and creating more work for others, like nurses, who had to take care of more post-op patients.

At the VA hospital in St. Louis, urologist Michael Packer, a former partner of mine, had difficulty getting charts from the medical records department. He and another resident hunted them down themselves. It was easier for department workers to say that they couldn't find a chart than to go through the trouble of looking. Without these records, patients could not receive care, which was an unacceptable situation to these doctors. Not long after they began doing this, they were warned to stand down.

There are thousands of other stories just like these.

It is important that Americans understand the fundamental point about the incompatibility of monopolistic medical bureaucracies and high quality medical care. It is not a matter of incompetent management and employees (though such no doubt exist). The problem will not be solved by adding dedicated leaders and staff; they also no doubt exist in the VA health care system.

People who can’t be fired and who know that no matter what they do their organization will continue to exist inevitably become self-serving. This is the moral hazard of government funded bureaucracies.

The solution to the health care problems of veterans and all Americans lies in the competitive discipline of market forces. As Obamacare implodes, we must keep the example of the VA sstem in mind. And as we figure out how to get care to the veterans who have earned it, we must embrace market forces.

Hat tip: Cliff Thier