Phillip Longman’s Book ‘Best Care Anywhere: Why VA Health Care is Better Than Yours’ is a narrative of the transformation of the Veterans Affairs hospital system from the worst in the nation to arguably the best in the world, becoming the ‘Toyota of Healthcare’. Longman attributes the VA’s success in large part to the VistA electronic health record system, application of quality metrics system wide made possible by VistA, and alignment of economic incentives. The author contrasts this with the private sector in which poor quality and disorganization are rewarded. He warns of the consequences of retaining the private sector status quo. He ends with a proposal for private sector change.
A journalist by profession, Longman begins with the story of encounters with the private health care system when his wife was diagnosed with cancer and ultimately died 10 months later. He then proceeds to note the vastly expensive and troubling problems with health care in the United States such as the lack of quality improvement despite large expenditures of money on health care. He chronicles the tumultuous and often dark history of the Veterans Affairs hospital system culminating in the beginnings of the transformation in the 1970s post-Vietnam era.
The book recounts epic bureaucratic struggles that threatened on many occasions to senselessly destroy what became the VistA software system. Much of the work had to be done with no central leadership, in secrecy and against VA policy. The origins of the Hard Hats, the rebellion against the IBM mainframe high-priests, and the establishment of the underground railroad are all there.
Longman reports that once the struggle for the VistA software system was won, it provided the foundation for the transformation of a large health care system on an unprecedented scale. For the first time, quality and performance measures could be far more easily acquired on a system-wide basis. The VA leadership, armed with such data proceeded with a nearly inevitable result: vast and verifiable improvement in quality at a much lower cost than the private sector.
The book continues by contrasting the VA’s performance with the expensive, disorganized, low quality squalor that is private sector health care. It provides several case studies of quality initiatives in the private sector that clearly improved the health of patients, only to be dismantled because it bankrupted the sponsoring entities. In short, there is a large disconnect between health care quality improvement and reimbursement which ruthlessly punishes attempts to practice real quality control.
The book concludes with a proposal to reform private sector care using the VA as a template for successful care. It also warns of the danger to the country as a whole of failure to reform as well as the dangers of nonsensically closing or reducing the use of the current cost-effective VA system. The book is a look at real success in the VA contrasted with real failure in the private sector. The book appears to be well-researched and references respected and important works in the scientific literature on health care reform. Its advocacy for change is not over-stated. At 136 pages, the book is an accessible, important summary of health care reform over the past 30 years.