In 1994, the New Republic asked me to write an article about the Clinton administration’s “reinventing government” (REGO) initiative. REGO, you may recall, was the campaign spearheaded by Vice President Al Gore to improve the performance of federal agencies by encouraging innovation within the bureaucracy...

The department I decided to look at was Veterans Affairs...

That same year, Clinton appointed Dr. Kenneth Kizer, a physician, public health expert, and registered Republican, to run the entire VA hospital system. Kizer was given free reign to make sweeping changes, and he did so, cleverly. To build political support for shuttering un­derutilized hospitals, he cut a special deal with the Office of Management and Budget, whereby the VA could keep a portion of the proceeds from the downsizing. He then promised veterans’ groups that opposed closing hospitals that he’d spend part of the money on projects their members wanted, like new ambulatory care facilities. He plowed the rest of the money into an innovative information system that could electronically keep track of every aspect of a patient’s care and make those records available to any VA doctor or nurse anywhere in the country with the click of a mouse. He used that system to identify best practices, reduce medical errors, and generally reorganize the entire VA caregiving operation around better managing the chronic illnesses of the aging veterans who make up the bulk of the VA’s patients.

Kizer’s efforts are chronicled in a new book by Phillip Longman, Best Care Anywhere—a book that began as a cover story in the Washington Monthly (January/February 2005). Those efforts, Longman shows, so completely transformed the VA that it now outperforms every other sector of the American health care system. Elderly VA patients have longer life expectancies than Medicare patients who choose managed care. VA hospitals earn higher ratings from the National Committee for Quality Assurance than Massachusetts General Hospital and the Mayo Clinic. And the VA achieved all this while spending less per patient than the average American consumes in health care dollars per year, even though VA patients tend to be older and sicker.

Reading Longman’s book left me with four strong reactions. The first is irritation at myself for not having stuck with the VA story, and hence missing its turnaround...

For the complete article, please visit The Washington Monthly website.

To learn more about Phillip Longman's book, Best Care Anywhere, please click here.