Dear readers:  This is a little longer than usual.  It contains excerpts from the responses to our suggestion that the Veterans Administration be examined as a part of the ongoing debate about a federal healthcare system.  We argued that the US already has one and that the Congress should look at it.  Responses are below.

Here is the single paragraph we added as a postscript to our August 18 market commentary:

“With all the healthcare debate cacophony, has anyone noticed that there is a fully functioning federal healthcare system with a nationwide electronic records system and millions of users?  It competes in the present environment.  It may be analyzed for systems use and it may be both praised and criticized for its good and bad points.  It is funded by the federal government.  I haven’t heard a single Congressman use it either as a positive argument or a negative one.  I wonder if it holds the key to a compromise, in that it has in place a national infrastructure so that a new wheel doesn’t have to be discovered.  It is called the Veterans’ Administration; the hospitals and clinics are ubiquitous in the United States.”

That closing paragraph unleashed an email barrage that caught us by surprise.  There is much and divided opinion about the VA.  And it comes with great intensity.  So we decided to excerpt from some of the email, keep the writers anonymous, and share these views with readers who may be interested.  We will also be forwarding this email to several of the Congressional offices who were involved in the first round of email.  We cannot remember a time when an afterthought closing paragraph in a market comment triggered so much discussion.  Here goes.

1.  JAS wrote, “Thank you giving credit to the VA's electronic health record. I have too wondered why it has not been included in the health care debate or at least in the electronic medical record discussion. I work for the VA and find it to be an amazing system.  I have my thoughts why it has not been included but that is just the cynic in me.”

2.  Jerry wrote, “The biggest advantage the VA has, in my opinion, is that they consider veterans that use their services to be lifetime customers.  The goal is to take a problem like high blood sugar and treat it so they don't treat the person for diabetes in twenty years.  Most health care in America focuses on treatment now instead of prevention later.  Of course many people don't get annual physicals for a variety of reasons. They don't even know that their blood sugar is a problem.

“Phil Longman, the author, lost his wife to breast cancer and personally went through the health care system at one of the better hospitals in America. He saw firsthand some of the problems with getting tests to physicians so information was available for the physician to make the best decisions available.  The book does a good job in my opinion to show the advantages of the Veterans Administration approach.  YOU are the first public person I have heard question why the Veterans Administration is not being given more serious consideration.”

3.  Roger wrote, “VA System is underrated, but is also justly criticized for obvious failures.  The attributes you mention go unnoticed as positives -- too bad for that because it is unlikely to get raised in the debate because of all of the recent negatives.  My Uncle died in 2005 because of a negligent nurse station at a VA hospital.  The list goes on.  (VA hospital salaries are set by Congress -- and VA hospital work ethics are set by a tough union -- an awful combination).”

4.  SL wrote, “Anyone who spoke in favor of the VA has never had serious medical care in a VA facility. I have had such experiences and they were horrible! I had an uncle (decorated WWI combat veteran) who died in his own waste and a son [military identity withheld by Kotok to preserve anonymity] who almost died from knee surgery and only survived because I was the [identity withheld by Kotok; writer held a high position in the Defense Dept.] at the time and he got the "best" they had to offer. How short people's memories are. Don't they remember the scandal just over a year ago about the treatment of our veterans at Walter Reed Hospital, the premier military/VA-type facility? Please!”

5.  Mickey wrote, “The VA is not a particularly good example for me.  I'm a vet, a disabled vet.  40 years ago I liked the VA, but today it feels like the department of motor vehicles.  Today I wait up to six months to see a bone doctor and then I see him for less than 15 minutes.  In the meantime, I'm served by PA's.  

“I called recently to make an appointment and they didn't know who I was.  I have to reapply.  

“My last operation, I chose to use my private insurance and my own money, rather than use the VA. I did this mostly because of the paperwork. I'd have to prove again why it was service-connected.  If my needs were more pressing perhaps I'd get a different result, but today I prefer the waiting room of my private doctor to the waiting line at the VA.”

6.  Rob wrote, “Congressman Tim Bishop of NY brought up the VA healthcare: http://www.youtube.com/watch?v=UOLs7Cybnqw.  Watch and listen to what one old guy said about 2:40/2:45 into the video.”

7.  JAM wrote, “Pursuant to your comment on the VA medical system … don’t forget the Indian HealthCare Service and the active-military hospital system serving both active soldiers and dependents.  Between the Indian Service, the active duty and VA hospital systems, and Medicare and Medicaid, the federal government is already providing tens of millions of American with health care – and you’re quite right, nobody seem to think it’s worthwhile comparing or contrasting this effort with what’s being proposed.

“As an aside, my brother is a career military doctor.  He left the military after his initial obligation to practice private medicine in civilian life but was so put off by the various hoops he had to jump through from state and federal governments and insurers that he returned to military practice.  The medicine he saw being practiced by civilian doctors was, in his opinion, inferior to and less efficient than that conducted by the military.  The focus in civilian practice was on lawsuit avoidance and cost control, while the military has a strict regimen of quality control strongly enforced.  Cost controls are there but are less emphasized than issues of quality.  Bluntly, he tells me that, in his opinion, the active military practices much better medicine than the civilian side.  Whether this would translate into better medical care all around under a nationalized system is of course debatable.  The military is seen as having special needs and priorities when it comes to medical care.”

8.  Dan wrote, “I agree with your comment regarding the veterans’ healthcare system one hundred percent.  Surely, with adjustments, the cost per patient could be extrapolated from decades of data with little problem.  The Veterans Administration is of course a socialist system set up for the defenders of capitalism.  It is interesting it has not been included in the argument.”

9.  Norm wrote, “I am a Viet Nam veteran and in the last couple of years started using the VA healthcare system (primarily because I got tired of the arrogance and incompetence of the regular health care system).  The VA system is amazingly good.  I can only speak for the Omaha, Nebraska facilities, because this is where I live.  Their computerized records system is truly impressive at all levels.  As far as the care, the buildings are old here, but the care is great.  USA would be wise to look to the VA system.”

10.  John wrote, “I wonder why someone doesn't propose for everyone the same plan that Congress has; not "similar,” the same one.”

11.  Doug wrote, “As a Vietnam War veteran, I use the VA System (2002 to present) as one of my healthcare providers.  I have also used Kaiser (1992-2000).  I view these two as roughly equivalent, though the patient population is quite different since most Vets are old -- real old -- and sickly, from what I have seen and know.  I have heard comments in the media about the VA as a model and especially their information system which, in my observation and that of VA MD's who have been elsewhere, is superb.  This information allows faster and more accurate diagnosis, more effective visits, and rapid response to patient needs.  Certainly it is better than Kaiser and virtually all private providers I have experienced.  All said, you raise a useful point.  I will make a point to talk with my Senators Merkley and Wyden.”

On August 18, Jim Towey wrote an opinion piece in the Wall St. Journal.  See  http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html  .

His lead three paragraphs follow:

“If President Obama wants to better understand why America's discomfort with end-of-life discussions threatens to derail his health-care reform, he might begin with his own Department of Veterans Affairs (VA). He will quickly discover how government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.

“Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, ‘Your Life, Your Choices.” ‘It was first published in 1997 and later promoted as the VA's preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated ‘Your Life, Your Choices.’

“Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.”

We will stop excerpting here.  We draw these inferences:

1.  Clearly there is much to be gained by examining the VA system as part of the national healthcare debate.  There is good and bad that can be learned.  There is an electronic records system that could be adapted and made immediately available to any American with a Social Security number.  It could be voluntary, so those who chose not to use it would not be forced to use it.  It could have a cost attached or use a subscription method.

2.  Congress has parsed out a separate and believed-to-be superior healthcare system for itself.  By doing so it is saying that Congress members are in a separate class that the rest of us.  We can hear no loud congressional discussion about making all members of Congress subject to exactly the same healthcare system they are willing to impose on the rest of us.

3.  For our veterans, it seems more attention is needed to the healthcare system that serves them.  I, for one, believe that our country owes this to those who defend it and who serve willingly in our present voluntary system and to those who served when we had a draft.  Caring for our servicemen and women is too hidden from the public view.

We thank readers for their responses and for their patience.  We thank those in Congress who read this and who care about the veterans and are willing to look at this option as part of the national healthcare debate.