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Eye on the News

Clark Whelton
What V.A. Health Care Should Be
Lessons for Obama from the Cleveland Clinic
10 June 2014

After weeks of steadily increasing scandal at the Department of Veterans Affairs, culminating in the resignation of secretary Eric Shinseki, the Obama administration responded to the crisis—grudgingly, one suspects—by floating the name of Dr. Delos “Toby” Cosgrove as the next head of the troubled agency. Cosgrove, who withdrew this week as a candidate for the job, is currently president and CEO of the Cleveland Clinic, one of America’s most distinguished medical centers and a growing leader in international health care, with a clinic in Toronto and a hospital nearing completion in Abu Dhabi. Though it has nearly 4,500 beds system-wide, the Cleveland Clinic is less famous than the Mayo Clinic, its main rival for preeminence in American medicine. The Cleveland Clinic first came to the attention of many Americans during the initial debate of the 2012 presidential campaign, when Barack Obama and Mitt Romney both cited it as an outstanding example of what a health care provider should be.

I watched that debate with special interest because at the time I was recovering from surgery at the Cleveland Clinic. From my hospital bed, I listened to Obama emphasize that teamwork—clearly evident from the moment I’d arrived at the 165-acre campus near downtown Cleveland—was responsible for the medical center’s glowing reputation. Romney countered that the clinic owed its success to private-sector innovation and efficiency. No government agency or program, Romney said—not even a multi-billion dollar bureaucracy like Obamacare—can deliver medical services of comparable quality.

I agreed with Romney that government, no matter how capable or well intentioned, rarely meets private sector standards. In Cleveland, I saw for myself that very few medical facilities, private or public, could match the high, cost-efficient standards of the non-profit corporation that’s been running the clinic since 1921. In fact, I went to Cleveland for surgery because twice in the previous 15 years I had been admitted to major Manhattan hospitals for routine medical procedures. Twice these procedures had led to avoidable, life-threatening errors and weeks of additional treatment. In the end, it was not the errors so much as the sullen staff I encountered in those hospitals, along with an uneasy feeling that they didn’t really know what they were doing, that led me to avoid New York.

The Cleveland Clinic—which is made up of some 50 buildings, including an outpatient clinic, a children’s hospital, state-of the-art centers for cancer, eye, heart and urologic care—provided an entirely different experience. The pre-op tests went smoothly and on time. The staff, medical technicians, and doctors (who work on salary) were friendly and professional, with the right touch of compassion. After the operation I was surprised to learn that the Cleveland Clinic functions as a group practice. I would not see either my diagnosing physician or surgeon again. Their jobs were done.

My recovery was left almost entirely in the hands of the nurses who manage the wards, and every one of them was tops. They ran a tight ship, moving from room to room with mobile computer workstations, constantly updating patient data. Not for a moment did I think the job was too much for them. At first, the absence of frantic activity in the clinic’s corridors made me wonder if I had the floor all to myself. But during recuperative walks I noticed that every room was occupied, not only by patients but by family members, who are allowed to stay overnight to provide an extra measure of care.

By leaking Cosgrove’s name, the White House was clearly hoping to tamp down the growing V.A. scandal. But Cosgrove decided to withdraw from consideration, likely concerned that the V.A. bureaucracy would resist the culture of teamwork and efficiency that has made the Cleveland Clinic so well respected. Even if Cosgrove had, miraculously, been given the power to hire and fire at the V.A., those who see the true function of government as the provision of paychecks, bonuses, and benefits would not be easily led in new directions. They would not have actively opposed Cosgrove; they would have simply outwaited him. His goal is better health care. Theirs is retirement.

Cosgrove could still do a few things that might make a difference. He could persuade the president and leaders in Washington to accompany him back to Cleveland. He could ask them to wait with him by the entrance to one of the Cleveland Clinic’s hospitals and watch as the shuttle buses roll up to the door. There, they could observe the lame and the ill—many in wheelchairs or breathing with the help of oxygen tanks—as they are greeted by the clinic’s uniformed staff and helped inside.

Most importantly, Cosgrove could explain that when Obamacare kicked in, the Cleveland Clinic—though highly efficient—was forced to lay off 3,000 people. He could explain that it’s not too late to develop a better health care system. He could explain that the private sector isn’t the enemy, but instead the key to better health for everyone, and that when the supply of doctors, nurses, and health care facilities goes up, the price of care will come down. He could explain to administration officials how politicizing health care leads to V.A. hospitals where bureaucrats file phony performance reports and veterans die on waiting lists. He could explain that better health care should not begin with controls that originate in Congress and work their way outward to doctors and hospitals. Rather, reform should begin with a proven model of efficiency and success like the Cleveland Clinic and works its way back to Congress. The political content should fit the medical objectives, not the other way around, he could explain.

Finally, Cosgrove could remind our leaders from Washington to remember what health care is all about. He could point out the helicopters and ambulances that arrive at the Cleveland campus around the clock, carrying people from 133 countries and every state in the union. These are people for whom the Clinic means hope, he could explain, people for whom Cleveland is Lourdes, with lasers.

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