The VA Scandal Shouldn't Be A Surprise And It Portends The Future With ObamaCare

For decades, liberal politicians have pushed for a complete government takeover of this nation's healthcare system.  However, the general population of Americans and their representative politicians wanted nothing to do with that.  They understood that a government run healthcare system would have all the typical problems -- waste, fraud, abuse, and heavy handedness -- relative to every government run system. But, despite the wishes of most Americans, the Democrats and Barack Obama went ahead and passed ObamaCare into law.  In 2010, they were punished for such action with a sweeping defeat that reversed their majority rule in the House of Representatives.  Now, in 2014, their control of the Senate is in jeopardy again, thanks to ObamaCare.  The botched rollout; the cancellations; and, the fact that people were losing their doctors and hospitals while paying higher prices for their insurance re-emphasized why most Americans dreaded any government involvement in their healthcare. 

While still trying to distance themselves from ObamaCare and all its problems, several in-jeopardy Senate Democrats find themselves with another reason for their voters to oust them in the Fall.  Again, because of healthcare.  This time it's the VA hospital wait-list scandal; proving once more how crass and incompetent a government-run system can be.  Our veterans have literally died in the process of waiting, but, this wait-time scandal should not be a surprise. It is a common problem wherever the government is controlling healthcare.

In Britain, they have a fully socialized system called the National Health Service (NHS). The Democrats love to point to the NHS as a perfect example because it is universal and because it has been able to control costs. It has the lowest cost-per-capita of any other industrialized country in the world.  But, the penalty for such cost control is long wait times and, in some cases, results in death.

The very charter of the NHS legally guarantees that a patient should be able to get advanced care (access to specialists, surgery, hospitalization, or advanced testing) in no less than 18 weeks (nearly 4-1/2 months) after being referred by a primary care physician; access to which is, in itself,  an average wait of about one week.  The usual wait time for surgery is 15 weeks or just over 3-1/2 months with over 500 patients at any given time waiting longer than a year.  If you're injured, the typical wait is 4 hours in the emergency room.  Of course, if you are dying and you just can't wait, the NHS says you can always pay out-of-pocket for private access to any healthcare provider.  Maybe these are the reasons that Britain trails the rest of the world in cancer survival rates.  Now, despite all these problems, the Brits seem to love their NHS.  I  don't think most Americans would be so forgiving.

Now, you don't actually have to go to Britain to see long wait times as a result of government control.  In this country we have the literal blueprint of ObamaCare in the state of Massachusetts. It is something that is informally called RomneyCare.  Thanks to that healthcare system, a city like Boston has the longest wait times in the country for both seeing a primary care physician or receiving advanced care:

In the very place that Americans railed against government intervention in their lives in what we know today as the Boston Tea Party, Bostonians now wait, on average, 45.4 days to see a primary care physician and another 66 days for advanced care.  Thus as a blueprint for ObamaCare, RomneyCare is also the blueprint for what is happening at the VA and in Britain.

The primary reason for long wait times is because the profit incentive is missing.   Healthcare service providers in the NHS are all being paid by the government at a set salary for their particular skill level, and they will always be paid the same; no matter how many patients they see or don't see.  The same is true in the VA hospital system.  Also, in both systems, physicians and hospitals are themselves shielded from malpractice lawsuits because the government is held responsible.  Thus, if someone dies as a result of care being delayed, the doctors and administrators have no liability.  Now, this is not to say that there aren't caring and dedicated people in both the NHS or the VA, but the healthcare in these government run facilities can't hold a candle to the average non-government system in this country.

References:

Your rights in the NHS: Guide to NHS waiting times: http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Pages/Guide%20to%20waiting%20times.aspx

NHS waiting lists are at highest for 6 years with 2.8m waiting for surgery or other hospital procedures: http://www.dailymail.co.uk/news/article-2607418/NHS-waiting-lists-highest-6-years-2-8m-waiting-surgery-hospital-procedures.html

Patients will wait at least a week to see GP in 2014, it is claimed: http://www.telegraph.co.uk/health/nhs/10537094/Patients-will-wait-at-least-a-week-to-see-GP-in-2014-it-is-claimed.html

NHS delays operations 'as it waits for patients to die or go private': http://www.telegraph.co.uk/health/healthnews/8668906/NHS-delays-operations-as-it-waits-for-patients-to-die-or-go-private.html

Britain trails in cancer survival rates: http://www.dailymail.co.uk/health/article-125860/Britain-trails-cancer-survival-rates.html
 
In cities, the average doctor wait-time is 18.5 days: http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/29/in-cities-the-average-doctor-wait-time-is-18-5-days/

Malpractice Payouts to U.S. Veterans Reach 12-Year High: http://www.bloomberg.com/news/2013-09-09/malpractice-payouts-to-u-s-veterans-reach-12-year-high.html

There's a Reason We Already Call Them Waiting Rooms!

To me, this whole health care plan of the Democrats overlooks a very critical and proven theorem of demand dynamics: Queuing Theory.

Right now there are about 46 million people or about 20% of the population in America who don't have health care insurance. Some can't afford it. Some have opted-out to save money or aren't buying it because they feel they are still young and healthy and they don't need it. Others can't get it because they have a pre-existing condition that has nullified their eligibility to obtain any insurance at a reasonable cost. Others are eligible for low cost or no-cost health care coverage like Medicaid but don't know how to apply for it. Many others are without insurance because they are between jobs. And, of course, about 10-15 million are illegal aliens who either can't get insurance or can't afford it. All these people receive high-cost and generally free care in our emergency rooms when they really do get sick.

Additionally, we are already in the midst of a shortage of certain health care professionals. Registered nurses have been a rare commodity for years. The number of both family and general practitioners has been declining rapidly; primarily as a result of doctors moving into specialty fields. Many small and rural communities have no nearby doctors. Additionally, because of increased malpractice suits and higher and higher costs for malpractice insurance, many OB/GYNs are leaving that specialty. All too often many new doctors are avoiding specializing as OB/GYNs for that very same cost reason. Lastly and increasingly, urban hospitals have decided to give up their "trauma center" status because they are being overwhelmed by the non-insured demands that are being placed on their emergency rooms and limited staff.

With these facts in mind, let's look at the Queuing Theory and how it applies to our health care system.

For those not familiar with Queuing Theory, it is a branch of statistics that deals with the probability of service availability and the probability of service being denied or of service being unavailable. Generally, speaking it looks at the dynamics of demand on any system of servers.

When I managed telecommunications, my staff would used formulas based on Queuing Theory, like Poisson and Erlang-B, to engineer the number of required phone lines, both incoming and outgoing, to achieve some level of desired service during peak times of the day. We would deal in levels of service as expressed in percentages. For customer support operations that need high levels of service, we looked at having a 98% throughput for incoming customer calls during any peak business hour. That, in turn, meant that some customers would experience peak hour blockages or busy signals; hopefully, only between 1 or 2 percent. We engineered to 98% level because to engineer to a level of 100% throughput would be cost prohibitive. That's because the extra 2 percent of increased service to a level of 100% might actually need 20 or 30% more phone lines to avoid any busy signals or call blockages. Additionally, when you have service level below 98%, the traffic load gets magnified by the amount of time that customers hang up and redial; over and over, again. At the 98% service level, the calls are usually minimized to only one failed attempt.

Traffic engineers use similar techniques to design and engineer new roads; the amount of exits; and how long traffic should wait at signals. It's also used in retail stores to estimate how many cash register/checkouts would be needed when designing a new store. So, it's application is endless in all walks of business where service is involved.

Anyone who is familiar with Queuing Theory knows the probability of service denial is not directly equal to the amount of servers being added or reduced. The best example I can give you of this is a 4-lane highway at rush hour. Hypothetically, it might normally take you 5 to 10 minutes to get from point A to point B on that highway. However, if one of those 4 lanes closes due to an accident, it might actually take an hour or more to get from A to B. The loss of one lane is only a 25 percent reduction in the total lanes of traffic. However, the delay time might be increased by a factor of 10 times or more than that. The inverse is also true. If you add 25 percent more traffic to the normal rush hour, you will, once again, experience delays that are disproportionally higher than the percentage of traffic that was added.

Now to health care.

The plan is to bring 46 million or 20% more people into the primary care system. While this will reduce the demand on hospital emergency rooms for unnecessary and uninsured clinical activity, it will swamp the already limited supply of primary care physicians and nurses. That's because the system will not only have to handle the previous emergency room traffic but it will also have to handle increased preventative care as being demanded by the Health Care Reform Bill. Based on my experience with Queuing Theory, the average wait times to see a doctor will increase exponentially and not just by a simple 20%. As a result, we could very well see weeks to schedule those things that had been previously done in the same day or within just a few days. Or, we could literally see months to schedule procedures that had been done previously with only a month or less notice. To lend some credence to this fact, please read this article about the United Kingdom's attempts to improve accident and emergency (A&E) wait times: (Click to See Full Story: "Professor Mayhew challenges Government A&E waiting times").

In business, it would be normal to increase capacity "before" you added 20% in new load to any existing system; especially one that is already overloaded. We have waiting rooms in our hospitals and in our doctor's offices because people are not being served immediately. They are there because patients are already waiting for service and things can only get worse with this nationalized health care reform. But our people in D.C. don't seem to understand this. I don't know if the system will be totally swamped; but, for sure, waiting times will increase and your doctor's availability will be reduced. This is the case in both Canada and the U.K. since they nationalized their own health care systems. And, it will be true in this country. It's just that simple when looking at the health care system from a Queuing Theory standpoint!