There is no such thing as an unqualified success in this life, and even our cover story, which examines the amazing turnaround at the Veterans Health Administration, concedes that this government system is not perfect. The problems that it has, however, remind me of the stories at the turn of this decade fretting over what to do about huge national budget surpluses.
We should have such problems now. At some point, we are going to have to tighten our belts, and the VHA offers a case study in getting the biggest bang for the buck. The need for belt-tightening goes not only for the federal budget; it applies all the way down the line. Admittedly, there are things that can be done in a nearly closed, hospital-based system for a clearly defined population that cannot be replicated by commercial health plans in the fractious open market. But one of the promises of managed care has been that it can control costs. For a few years in the early to mid '90s, it appeared to be doing just that. It does not appear to be doing so now, but maybe someone will explain to me that it is making a valiant effort against irresistible pressures.
The VHA turnaround happened to a great extent because of the man on our cover, Kenneth Kizer. There are probably many theories about what moves history along. There's the "great man" theory. Today's historians are more likely to say that history is shaped by societal pressures that move across space and time like an amoeba oozing under a microscope, with some help from physical phenomena like plagues and — just guessing here — global warming.
Both views of history, I suppose, have merit, and they are not necessarily exclusive, at least within microcosms (a century, a nation).
Not everyone thinks Ken Kizer was a totally positive force at the VHA, but man, did he get results.