I was reading the latest Thoughts from the Frontline newsletter from John Mauldin and I was struck with the thought that if I substituted Veterans Administration(VA) for China in this passage I would be describing the current situation at the VA.
There is really no way to know what is happening in China today, much less what will happen tomorrow, based on widely available data. The primary data is flawed at best and manipulated at worst. Sometimes the most revealing insights lie in the disagreement between the official and unofficial reports… suggesting that official data is useful only to the extent that we think about it as state-sanctioned propaganda. In other words, it tells us what Chinese policymakers want the world to believe.
Over the last six years the VA has been held up as the model for the Affordable Care Act. I have no doubts that some of the stories about the VA successes such as using their purchasing power to drive down drug costs are true but I am increasingly suspicious of the rest of the data. When I try to balance the VA successes with the lack of transparency and accountability, I think they provide an ominous prediction for the fate of health care reform. Like we see in China, I think we are seeing that federal programs are more prone to state-sanctioned propaganda gambit than programs with a more distributed decision making and accountability process. In hindsight it probably took more work to make up the lie than to fix the problem but once they started telling the lie it looks like they failed to find sufficient motivation to change their ways until the scandal broke. Since the Administration knew about this problem six years ago and the problem remains unfixed, this is a good reminder why so few of the successful heath care systems are pure single payer systems. To err is human, to make a really big mess you need to get the federal government involved. So why do we expect to get smarter health care decisions in the future when our current system is stuck in the state-sanctioned propaganda mode?