In the United States, we’re in the midst of a giant scandal about just how bad the Veterans Administration hospital system is.
For those unfamiliar with it, the US maintains a mini-NHS just for former soldiers, and it appears that it has both been undergoing a systematic meltdown and systematically falsifying records that would have allowed outsiders to learn of the situation.
As it happens, Paul Krugman, everyone’s favorite economist, effusively praised the VA hospital network as a model for future American health care in 2006, claiming it demonstrated that state operation of the health system was to be wished for rather than feared. Quoting his New York Times Column:
I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system–it runs the hospitals and clinics.
No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.
The discovery of a column or speech by Professor Krugman that seems embarrassing in the light of later discoveries has become quite routine. (see, for example, his effusive praise for the quality of Thomas Piketty’s data and the inability of opponents to refute it at a point where “Capital in the 21st Century” had been in public hands for mere days. There are numerous other examples to be had.)
What is not routine, sadly, is for Professor Krugman to ever acknowledge such a mistake. I am unaware of an instance of his admitting to an error.
That Krugman could have praised the VA in 2006 simply indicates he didn’t know (or ask) any veterans about it.
I’m not sure anyone has ever actually liked the VA as a “customer”; the veterans I know have been pretty much uniformly negative about the VA as a health-care provider, for as long as I’ve known any and heard them talk about it – long before this latest set of scandals.
I agree with Sigivald. But with respect to Perry M’s principal point, Krugman’s hubris is such that it is inconceivable that he would ever admit to error. But that’s OK; anyone with a shred of intelligence knows that everything Krugman says is wrong. He’s the perfect contra-factual indicator.
My father routinely uses the VA and has nothing but praise for them and the healthcare he’s received there. As a matter of fact, a few years back he was hurt on the job and hospitalized at the local university hospital and requested that he be moved to the VA hospital because the level of care at the local university hospital was lacking. His physicians have been on top of every problem he’s had and the one time we had an issue with his care, the very next day the head administrator called us and then followed up with us a few days later to explain not only what the problem was but how they fixed it.
Laird:
I’m afraid he isn’t, and especially, much of his academic work was explaining the benefits of free trade. Even if you believed that he was right for the wrong reasons, you would still have to accept that, sadly, we cannot use Krugman as a perfect indicator of bad positions.
Steven: Regardless of your father’s opinion, the internal audits are horrifying.
For example, quoting from that article:
and also:
and also:
and this is just one article.
I’m not doubting that report, but administrative flaws does not necessarily equal patient care flaws. It’s hardly the fault of physicians if the patient never makes it to him.
Steven: I don’t think it matters much to a dead patient whether they died because they never got to a doctor or because the doctor failed them. The claim that about 40 patients died awaiting care is bad enough regardless of the detailed explanation.
It matters if you’re trying to fix a problem. Is it an organizational problem or a health care problem? There are an awful lot of moving parts in an organization as large as the VA and it’s not as simple as just blaming the VA as a whole. Physicians can’t fix administrative issues anymore than administrators can fix medical mistakes.
Perhaps the reason Mister Krugman likes to regard himself as having a scientific approach to economics and related social problems is that all his determinations are subject to refutation and so many of them have been refuted.
Steven, I don’t think that anyone is claiming that the issues with the VA are medical in nature. I think that for the most part it can go without saying that doctors in any system are just trying to do their job, which is provide their patients with the best possible care under the circumstances. In that, private American doctors are no different from their VA or NHS colleagues. It is the administrative and financial systems under which all these doctors are required to function that are under discussion, and indeed scrutiny.
The Department of Veterans Affairs is a very extensive bureaucracy, in which the healthcare operations are but one major and critical component.
That particular component was reformatted and designed for the “carryover” needs of the citizens military forces raised by conscription. It was not designed for the needs of a professional military, which is not periodically demobilized and returned to civilian life and to the Healthcare facilities of that civilian life.
And grafted upon the VA health services is the typical parasitic bureaucracy of the Federal Administrative State. It Is Comprised of 2 Substantial trade unions and a network of “managers” administrators and lawyers (something over 400) sinecured in a status quo.
Reorganization, on the basis of the present needs, which are principally those of continuation of the provisions available in military and naval services will probably provide the only solution.
That kind of reorganization because of disruption of bureaucratic structures will be extremely difficult and time-consuming. The “wait time” for that reorganization will be more like 1000 days, even if it gets scheduled.
Except that is part of the claim, that VA healthcare is sub standard and universally disliked. Look at what Sigivald wrote:
There was a time when the VA was perceived as nothing more than a place to warehouse veterans until they die, but even if that was true, the organization as a whole has fought to change that, in large part by giving the best care possible. My dad thinks his care under the VA is far better than it was in the service and even compared to his civilian private practice docs. He’s received exemplary care at the VA. Anecdote isn’t evidence, but from my dad’s perceptive as a patient and mine as his family, the VA medical side has done a great job with him and the other vets I’ve seen.
Steven, i have just got out of an NHS hospital. Many good people work of harmful institutions. I walked into A&E (Accident and Emergency) and received excellent care. Indeed by the time I left the hospital several days later, they had fixed the problem I walked in for, and then worked on a different problem in my shoulder and made that a great deal better. Does that mean I think the NHS is great? No. I think many of the people who *work* for the NHS are totally great however. They are great because they are great, in spite of rather that because of who they work for.
A&E was a marvel. Quite fast, very attentive, unfailingly polite and very very professional. They ended up arraigning for *more* than I had actually gone in for. Impressed.
I was then moved to a ward, which was a bit like moving from a First World Battlefield (on the winning side) to a Third World residential slum. Some of the nurses were great. And some were surly slow moving Nigerian women with 90 IQs who were not great. Need help? Press the button… If the awesome Filipino or Polish sisters were on, they clearly had the ability to be three places at once somehow and you did not have to wait long at all. They were even nice. If not and you get a surly Nigerian on duty just then… Press the button and wait 10 mins. Need help URGENTLY? Press the button, shout and wait ten minutes. Guy in next bed screaming for painkillers? Press the button and wait ten minutes.
Are you Nil By Mouth? Well guess what, some well meaning F-wit with a tea trolly will still come around and offer you something to drink… which is no biggie if you are compos mentis because you just say “no thank you, I am NBM”… but if you are out of your fucking skull on meds or some hapless geriatric who thinks they are the King of Denmark, well so much for your “Nil By Mouth” unless some one else in the next bed intervenes and says “Er, no, nice Mister Fred McAlzheimer is nil by mouth”. For some reason they do not have a sign saying NBM above your bed, it is just on a list at the front of the ward, which the Third World tea lady does not appear to read, or if she does, she seems to have forgotten by the time she reaches the bays.
Can’t move and need a crap *fast*? You might get a commode in time unless you get a Nigerian (not all of which are bad, only about 75% of them), in which case odds are you poop in bed. And if you do get a commode but find yourself in Legos-on-Thames, expect to sit on a pile of your own poop for the next forty minutes when you are done, within sight of your bed. Need to piss? Oh dear, we are out of disposable piss pots. Seriously??? Yes, seriously. Not impressed.
And then when I left the ward and went to get a procedure (called a Barbotage, which is a bit like getting raped in the shoulder by a crazed robot), I was back in the First World, with an awesome doctor doing the exquisitely painful stabbing with consummate skill. Eye wideningly painful, screamed like hell, but it was adroitly done (and his assistant was a bit of a babe). Very Impressed.
So… NHS. Mixed bag to be sure. Some *really* great people. And some people who really need to find another job. And I was in the NHS flagship hospital for the whole country by all accounts (thank gawd).
I love it when people try to defend State-run medical institutions after evidence of incompetence, neglect and negligence surface. They always say the same things ‘I/My relative had wonderful care!’ ‘They deal with thousands of patients perfectly well every day, the odd mistake is only to be expected’ ‘The people working there are dedicated professionals who work very hard for their patients in difficult conditions’
For some reason the same logic flies out the window in cases where a private sector organisation is guilty of killing someone they were supposed to be serving. Did anyone say ‘But I had a perfectly safe train ride’ on the day of the Hatfield rail crash? Or ‘Rail travel is far safer than road anyway, you can’t expect perfection!’ ‘Rail workers do great work in difficult circumstances’?
Thought not.
Indeed Jim, the double standards are stunning.
But you see, Nobel award winning economist Professor Krugman was working from “the data” provided by the VA, and “other” official “sources”.
I suppose he ALSO hears about stuff, from the paper.
He’s positively Presidential.
To paraphrase David Letterman: I call Paul Krugman “Professor”, and he calls me “Admiral”.
All Krugman’s good work was done in his earlier years — hence the Nobel — and pretty much all his work since has been an embarrassment. It used to be the case that his diagnoses were spot on, and his recommendations hit or miss. Now his diagnoses are faulty if not completely wrong, and his recommendations uniformly dreadful.
As for the VA: government control + highly unionized work force = the usual fuckup.
All of my veteran friends and family absolutely loathe the VA, and maintain private insurance in order to avoid it. There my anecdote cancels out yours. Now how about we stick to the facts?
“All Krugman’s good work was done in his earlier years — hence the Nobel.”
I’m really tired of people asserting that Krugman ever did “good work” at all. I’ve seen no evidence of that, and I’ve looked for it. Perhaps someone could kindly point me to an example? But don’t cite the Nobel: that was completely unmerited. I finally found* what I wrote about it here almost three years ago:
I stand by that assessment.
* The search function in this new SI format is really terrible.
Governments in the United States also run a similar system on the Indian reservations and in Federal prisons (State and local governments fund government health care in State and local prisons – and in inner cities via infamous government clinics).
This is the mess (of prisons and reservations – and the VA) that Paul Krugman wishes to see replace voluntary action (both charitable and commercial).
Paul Krugman , and those like him. are not well meaning people who happen to have a different point of view – they are EVIL (they seek to do HARM – because they LIKE doing harm).
And Laird is correct.
If there was an Nobel Prize for economics (Alfred Nobel set up no such prize) Paul Krugman (and George Stiglitz and …..) would deserve it about as much as Barack Obama, the European Union and U.N. administrators deserved the Nobel “Peace Prize”.
That the international elite choose to honour evil men such as Paul Krugman (and Barack Obama – and…..) shows all one needs to know about the international elite.
Is the purpose of VA medical care the saving of money?
(On the veterans’ pension bill?)
Steve, in Sigivald’s quote you provided there is no mention whatsoever of purely medical issues. I stand by my assertion that the root of the problems in organizations such as VA, NHS, and other services ran by governments are not related to professionalism or good will of their actual employees, but to the administrative and financial structures of these institutions. In other words and as Perry explained: when good people are caught up in a bad system, results will be at best inconsistent.
Sorry, that should have been Steven, not Steve.
Laird, Krugman’s seminal work sounds on a par with another groundbreaking study.
They’ve got Nigerian nurses in the NHS? Jesus wept! Who went to Lagos and decided they would be an asset to a service organisation?! I’m guessing they’re there because they’re cheap.
From what I’ve heard about the NHS, they are extremely good at saving your life – either from illness or injury – but pretty awful at the huge area of medicine which covers improving qualify of life of those suffering from a non-urgent condition. See dentistry, for example.
Heh, I did have the feeling that Tim would find that mildly amusing :-O
Its been a while since I studied economics at University, but I recall that much of the novelty of Krugman’s work came from the application of calculus to trade theory and the theory of international finance (in particular financial crises). We would scoff, obviously, but by the standards of modern economics it was a strong ‘contribution’ to the profession. I have one of his books in front of me now (for the purposes of drafting this post only I assure you) and if I were to refer to him as deeply intelligent I would have to consider myself to be disingenous.
I meant ‘deeply UN-intelligent’.
Indeed, Peter – I was just about to post this article that someone pointed out to me, and which, at least rudimentary, seems anything but unintelligent. That said, that article is not the one for which the prize was awarded.
@Laird: When I was in the supermarket business (for over 25 years: oy), the critical part of every merchandise set was the degree of choice which a.) gave the customer a reason to prefer our store over another and b.) enabled supermarket chains to make a profit — too much choice is a profit-killer, because some products just don’t move at all.
Surprisingly, the Krugman Forumula (yes, we called it that) was actually a very good matrix to help us make our item selections, when fed with the actual sales data. And this is a key point. (“Garbage in, garbage out is not just a clever aphorism.)
Where Krugman has come off the rails is that he believes that everything can be reduced to a formula — but worse than that, he’s careless about the data he feeds into his testing models. (Note that I’m being charitable: some have accused him of outright fraud when it comes to his data selection, but I’ll just call it careless.)
The real problem is not just Krugman, but economics itself. “Guesswork masquerading as science” is the kindest epithet for what’s also called “the dismal science”; most serious statisticans and mathematicians are completely dismissive of economics, simply because the models are so incredibly fragile.
Myself, if I were Emperor of the World: one of my first edicts would be that economists be forced to wear wizards’ hats in public (also psychologists, for the same reasons, but we can debate that another time).
Yeah, Krugman is not stupid, he is evil.
Krugman was once a notable economist. Now he’s a partisan hack. Since becoming a partisan hack he has done nothing of note in economics, almost certainly because the two disciplines (heh) are mutually incompatible.
“almost certainly because the two disciplines (heh) are mutually incompatible”
Not at all.
Economics is a very flexible “science”, and you will find economists supporting all ideologies or political parties.
In fact, it’s rare to find two economists agree on any proposition.
Every claim can find an economist to support it, especially if the price is good.
Ask five economists and you’ll get five different answers – six if one went to Harvard. – Edgar Fiedler
I grew up in a military family, so I was in the VA system until I graduated from college. The problem with a system like that isn’t that they can’t deliver good care – they do, sometimes. Usually, even.
The problem is they are all managed to statistical metrics, and there’s no bottom line to keep them honest. Some VA facilities are great. Some are terrible. They all look great on paper.
If you live by a private hospital with a bad reputation you can go somewhere else. If too many people do that the hospital loses money and administrators make whatever changes are necessary. Maybe the hospital closes. But if you’re in the VA system you’re pretty much stuck with what you get, and there’s no feedback to cull out the worst facilities.