Viewpoint

Fixing the VA, one patient at a time

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

Hey Larry, it’s Jack. What do you know about cataract surgery?”

Jack, a friend, called from Atlanta. I replied, “I know so little about so much, but cataracts? I’m your man.” Jack told me of Robert, a friend who was discharged from service in the Vietnam War. As a helicopter pilot, he took machine gun fire to his leg. While left with a limp, Robert had a long career as a counselor, lecturer and author. Due to the service-related injury, the VA covered his medical care. Well, it was supposed to be covered.

Robert noticed his vision gradually deteriorating to the point where he could no longer perform his work. He was told by the VA clinic that for him, cataract surgery was elective. He’d have to wait until his eyes worsened. I told Jack, “Technically yes, the surgery is elective. If you don’t have it right away you won’t die. But try to get him up to Tennessee; I’ll see what I can do.” The offer excited Robert — like Ralphie on Christmas morning. (Younger readers, Google it.)

Five days later, Robert was in my exam lane. His vision was 20/50 in each eye with best correction — in the dimly lit exam room. With medium glare testing, it plummeted to worse than 20/400. My examination revealed each eye had a dense central PSC, explaining why he couldn’t safely drive in sunlight, much less at night and with oncoming headlights. Plus, with accommodation the pupil constricts, making reading and writing next to impossible. The following day he had uncomplicated cataract surgery in his left eye. He underwent surgery in the right eye the following week.

For the past few months the VA health care system has been in the news, most of it negative, involving mismanagement, extremely long wait times, and even some malfeasance. Central planning often looks good initially, but eventually fails. Compare this to numerous examples where government work has been privatized, usually resulting in an outcome that is better, faster and cheaper. Simply giving the VA system more money is not the answer. It would be interesting to find out exactly how much, for example, cataract surgery costs in the VA vs. the private sector. We already know how much more eye surgery costs in a typical hospital vs. a surgery center, yet with no evidence of improved outcomes.

If our healthcare system is to survive and prosper, we will have to make these comparisons, and determine the setting in which care is delivered better, faster and cheaper. Our practice has been taking care of “overflow” VA patients for some time now. My administrator offered a solution for the VA problem: If they’re eligible for VA benefits, give them a Medicare card and let the private sector take care of them.

And Robert? He saw 20/20 uncorrected in each eye at the four-hour post-op visit. OM