WHY WALTER REED WENT WRONG
By SALLY PIPES
NEW YORK POST
Opinion
March 23, 2007 -- THUS far, recriminations, finger-pointing and scalp-mongering are Washington's response to the substandard care at Walter Reed Army Medical Center. But in many respects, Walter Reed is a classic example of what's wrong with government-run health care.
Start with the bureaucratic morass.
In 2004, amid the war, the Army decided to award Walter Reed's maintenance and operations contract to itself. It soon emerged, however, that the Army had underestimated its costs and would not be able to perform the work as cheaply as previously imagined, so the contract re-entered procurement limbo for another year.
During this period, badly wounded veterans from Iraq and Afghanistan streamed into Walter Reed requiring extensive therapy for brain injuries, amputations, combat stress and more. Today, wounded veterans continue to arrive, often with several serious injuries.
A completely unrelated event deeply exacerbated matters when, in 2005, the Pentagon's independent Base Closure and Realignment Commission recommended Walter Reed's closure in 2011.
In all likelihood, this prompted many otherwise well-inclined healthcare professionals to reconsider working at Walter Reed and discouraged the Army from investing in the facility.
Fast forward to early 2006, when the Army finally announced that IAP Worldwide Services, a private contractor, had won the maintenance contract.
Because of bureaucratic delays, however, the contract wasn't actually awarded until November, and IAP was prevented from beginning work until Feb. 4 - just two weeks before the Washington Post reported on the rats, mold and substandard living conditions at the hospital.
At this point, one begins to understand why the conditions had deteriorated so dramatically. Indeed, it's a wonder that Walter Reed wasn't in even worse shape. The facility is a classic victim of too many government bureaucracies working at cross-purposes with one another.
The Department of Veterans Affairs - a separate agency that doesn't handle Walter Reed - is sometimes trotted out as evidence that, contra the Walter Reed fiasco, government-run health care can actually work. Even now, some in Congress are pushing to remodel Medicare Part D on the VA's drug benefit.
But thus far, the VA has proved inadequate for the many wounded veterans who have returned home from Iraq and Afghanistan. Better suited to the needs of much older veterans from World War II, Korea and Vietnam, the VA is simply too slow to react with the speed and efficacy needed to deal with the injuries of modern warfare.
In House testimony just last week, for instance, the Government Accountability Office (GAO) reported that the VA is near the breaking point.
A claim now takes between 127 and 177 days to process - well above the private industry average, which is 89.5. An appeal takes a staggering 657 days. Meanwhile, the VA faces a backlog of approximately 600,000 claims and expects another 400,000 Iraq-war claims by the end of 2009.
That's not even considering the surfeit of problems that arise when service members transition from the Defense Department to the VA, which have been well-documented in the news.
This rings all too familiar to me personally. I've long been urging Americans not to emulate my native Canada, where, thanks to government-run health care, delays are interminably long, diagnosis and therapies using the latest technology lag behind, and drug availability does too.
From 1999 to 2001, for example, of the 100 drugs that came on the market in the U.S., only 43 were approved by Health Canada. Who knows how many lives could have been saved with those 57 medications that Canadians simply couldn't buy?
Indeed, according to a new study from the Fraser Institute in Vancouver, Canadians wait about two to three years longer than Americans for new medicines. And it takes an average of almost 18 weeks from seeing a primary care doctor to getting treatment by a specialist. Despite the Canadian government's best efforts, the average wait time actually rose by 91 percent between 1993 and 2006.
But that's what happens under a system where the government foots the bill. All too often, state-run health systems have an overriding incentive to save money. In the private sector, cost-cutting incentives are balanced by the need to attract customers. But government providers do not have to compete for business - so issues of quality tend to be a secondary consideration.
The problems afoot at Walter Reed and elsewhere result from the lack of competition in government-run health systems. So why not unleash market forces to help fill evident needs?
Congress could begin by legislating healthcare vouchers for Iraq and Afghanistan veterans. At the very least, that would bring some immediate relief - including quality and choice - to America's returning heroes.
Sally C. Pipes is president and CEO of the Pacific Research Institute and author of "Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer."
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