Filed under: Health
It is disturbing to hear that a Veterans Health Administration hospital in Philadelphia had a “rogue” cancer unit that made serious mistakes in treatment and covered them up. But I don’t really understand Megan McArdle’s argument that this is “one of the things that can only happen at the VA”:
Not because hospitals are above covering up malpractice, or because doctors don’t protect other doctors, but because any private hospital would have been terrified of getting sued. The VA is very hard to sue because of sovereign immunity.
It’s true that because of the doctrine of sovereign immunity, the VA and other federal government branches can only be sued via the Federal Tort Claims Act, which makes it harder than suing private doctors. (Not impossible — just harder. Claims — like the one Megan cites — that it’s extremely difficult to sue the VHA mainly come from lawyers who specialize in suing the VHA, which…well, there you go.) But if sovereign immunity is the problem, then there’s an easy solution: spin the VHA off as an entity separate from the Federal government. That wouldn’t compromise any of the attributes that allow the VHA to outperform private healthcare in the US; it would just eliminate the wholly unrelated issue of sovereign immunity.
In fact, almost no other country in the world even has a US-style doctrine of sovereign immunity, yet the government-run parts of other countries’ health systems seem to get along just fine without it. The UK invented sovereign immunity, but like other monarchies, it has gradually restricted it such that it only applies to the person of the Queen; it’s perfectly legal to sue the NHS. Yes, one might argue, but it’s much harder to sue for malpractice in the UK and elsewhere in Europe for other legal reasons. Fine; but what exactly are we saying here? Are we trying to imply that France, Germany, Sweden, the Netherlands, and Japan are full of doctors merrily committing malpractice and getting away with it? Then how do we explain the fact that their health outcomes, like the VHA’s, are all just as good as the US’s overall health outcomes or better?
If Megan is just arguing that we should remove the VHA from the protection of sovereign immunity, that seems like a perfectly valid idea to me. But if she’s saying that the VHA is a kind of hothouse flower of medicine that can only deliver the best care in America because it’s under the federal government’s protection against malpractice suits, that claim makes no sense to me.
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