Despite 49 Deaths on Waiting Lists, Progressives Still Defending the VA

Phillip Longman, the author of a book on the superiority of VA health care, returned to its defense Tuesday at his Washington Monthly blog. According to Longman, the problems aren’t systemic but only regional.

Longman starts out by saying he wants to correct some misleading impressionism of “how well the VA is performing as an institution.” And yet, his first piece makes no mention of the 49 (at least) wait list related deaths we know about.

He writes “let’s just start by scrutinizing the now almost universal
assumption that there is a ‘systemic’ problem at VA hospitals with
excessive wait times.” Are those intended to be scare quotes around the word systemic? More on that in a moment. But first, Longman argues the population of vets using the system is actually down around most of the country. He provides a link to this map showing where the decreases have happened and, roughly, by how much.

This is where Longman gets to his argument about VA problems being regional rather than systemic. He writes, “there is a comparatively small countertrend that results from large
migrations of aging veterans from the Rust Belt and California to
lower-cost retirement centers in the Sun Belt. And this flow, combined
with more liberal eligibility standards
that allow more Vietnam vets to receive VA treatment for such chronic
conditions as ischemic heart disease and Parkinson’s, means that in some
of these areas, such as, Phoenix, VA capacity is indeed under
significant strain.” In other words, veterans are flowing into Phoenix and overwhelming the system.

But the map he links to shows Arizona has had a 6-11% drop in the population of veterans between 2000 and 2014. It’s not clear how this substantial drop in the number of veterans in the state can be squared with Longman’s claim of a migration of veterans to overwhelm the Phoenix VA. Perhaps it can be but he points to no evidence other than the map to back up his claim.

Getting back to Longman’s scare quotes, the idea that wait time statistics are being systematically abused is no longer a matter of discussion. Phase one of the VA audit found evidence of improper scheduling taking place at 64% of 216 VA sites nationwide. That’s clearly not a regional problem. The audit also concluded that the 14-day appointment goal “was simply not attainable.” Note they are not suggesting, as Longman does, that it’s not attainable in a few states. The audit says it’s not attainable system wide and, because of this, should be dropped immediately.

But the real problem with Longman’s argument is that he ignores the deaths we know about and returns to surveys showing VA inpatients are 4% more satisfied than inpatients for private sector hospitals. He doesn’t mention that outpatients are 1% less satisfied with the VA than those in private hospitals. He also doesn’t mention that this difference is within the margin of error for the survey.

The sample size here is incredibly small, just 245 former VA inpatients. Their names were not selected at random but were provided to the survey company by the VA. And of course only people who received treatment and survived are able to respond to ASCI satisfaction surveys. That means this metric literally take no account of the people-at least 49 at present combining those in South Carolina, Georgia and Arizona–who died waiting to make an appointment.

Longman says he’ll be returning to the issue throughout the week, but so far he hasn’t incorporated those who died into his estimate of “how well the VA is performing as an institution.”