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NNU has called ���participatory democracy���) that is essential to ���create higher standards of well being, fairness, and ecology���a greater commitment to morality���throughout our society.��� ���Charles Idelson Best Care Anywhere: Why VA Health Care is Better Than Yours By Phillip Longman; PoliPointPress, 2010 I n this important book, which was first published in 2007 and updated for 2010, journalist Phillip Longman not only shatters the myth that government cannot be trusted to be the administrator of healthcare services, but that government cannot be trusted to be the provider of top-notch healthcare. Longman���s primary exhibit: the Department of Veterans Affairs healthcare system, better known as ���the VA.��� By almost every measure, including quality, safety, effectiveness, cost, and patient satisfaction, the VA healthcare system consistently outperforms American private-sector healthcare and also Medicare. It works so well that other countries looking to establish their own systems have come to the United States to study the VA. Are you surprised? Because Longman was. He originally set out to write an article for Fortune magazine spotlighting which CEOs had the best solutions to today���s healthcare crisis. He said that his ���assumptions going in were typical of those held by many Americans, particularly those with conservative, pro-market views and instinctive distrust of government.��� As he diligently did his research and interviewed experts, however, about who was delivering the best healthcare in America, he ���kept hearing an answer [he] could not believe.��� Everyone kept pointing him to the VA, and they backed up their statements with many, many peer-reviewed studies published in prestigious journals. Longman found ���the hardcore data were overwhelming,��� and was shocked that so little discussion of the merits of the VA system factored into current healthcare debates. He is attempting to correct that problem with this book by explaining how and why the VA has been able to achieve these kinds of results while the rest of the healthcare industry flails. But first, Longman provides a little background and history into the VA system. Though states and communities have been taking care of veterans as long as they have been fighting wars, it wasn���t until World War I that Congress established a national system of benefits for veterans, including healthcare. Unfortunately, as Longman describes, the VA over its history has been plagued by a series of mismanagement scandals and subject to the whims of Congress and the public���s attitude toward veterans (positive after WWI, more negative after the Vietnam War). Over time, administrators just added layer upon layer of government bureaucracy to the system, which caused the VA to stagnate and ���ossify.��� The only things that saved it during the 20th century from being dismantled were a smart decision after World War II to partner with the country���s medical schools for training, and politicians��� fear of being labeled ���unpatriotic��� if they voted against the system. Still, Longman explains, the VA healthcare system has a few major advantages going for it. Foremost, the VA as an institution has a near-lifetime relationship with its patients. This allows it to not only collect and use decades of data and hold a vested interest in J U LY | A U G U S T 2 0 1 2 preventative health measures to ensure long-term health but, most importantly, to reap the rewards of any efforts they put into making the system more effective, more efficient, more accountable, and more affordable. As Longman points out, in the private-sector healthcare world, patients change insurers all the time, using different hospitals, doctors, and clinics. There is little to no business incentive in the forprofit, private-sector healthcare industry to invest in promoting health beyond making sure that customers pay their premiums but don���t use their insurance. To that end, it���s easier to just deny them coverage than to make everyone healthier. And while we���re on the subject of financial motives, unlike the vast majority of the healthcare industry, the VA system does not exist to make money. It exists to care for its veteran patients, and that also helps to attract the kind of idealistic and committed staff and administrators needed to run this kind of system. In Longman���s view, arguably the best thing the VA ever did was to adopt an electronic health records system, called VistA, early on in the 1970s and 1980s. Unlike the counterintuitive, commercially developed systems many RNs and doctors struggle to use today, VistA was created from the bottom up by a loose grouping of providers scattered across the country. Known as the ���Hard Hats,��� they labored in secret against the massive VA bureaucracy to write primitive, open-source software that would do things like gather all of a patient���s data into one complete chart, allow for online psychodiagnosis tests, or run a patient discharge system. In 1981, more forward-thinking VA officials decided to embrace these initiatives, grouping them into what would be known as VistA, and also gave the Hard Hats the green light to continue their innovation. Since then, VistA has evolved into the most sophisticated, inexpensive, and expansive electronic medical records system in the country, unrivaled by any private software company. According to Longman, VistA allows the VA to not only maintain higher safety standards, but to also boost quality standards by providing researchers a vast quantity of data with which to determine what medical interventions work, and which ones don���t. And because it runs off of open-source software, anyone can make inexpensive improvements or alterations to the system to optimize it further. Unfortunately, recent shifts toward privatization are forcing the VA to buy more commercially developed health IT software, even as public health systems in Finland, Germany, Mexico, Nigeria, India, Uganda adopt the VistA system. After taking the reader through how and why the VA system is superior to any healthcare the private sector is providing, Longman argues, very persuasively, that the VA needs to be opened up to all veterans, their families, and eventually any member of the American public that wishes to participate. Since World War II, the VA has suffered from excess capacity, particularly in areas far from the Southwest where its aging patient population has migrated. Instead of laying people off and shutting down facilities, we should use the W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 17