Hooray for VA.

Your article ("The Best Care Anywhere" by Phillip Longman, January/February) should be required reading for a) every member of Congress and the administration who continue to underfund the best health-care system in the country, and b) your colleagues in the print and broadcast media who appear to be interested in the Veterans Health Administration only when we have a problem.

Patrick J. Doyle, Ph.D.

Associate Director for Research, Geriatric

Research, Education and Clinical Center

VA Pittsburgh Healthcare System

I am not a veteran, but I am employed as a nurse for the VHA in the outpatient prime medicine clinics. I cannot use the VHA for health care; therefore, I have a private sector physician. I cannot remember when, if ever, I have received the quality and detailed care that we are required to give the veterans with each and every visit.

When I converse with colleagues in the private sector, they are amazed at our per year in-patient and safety education requirements, as well as at the details we are required to handle within the clinic. As a result of this, our skills are sharpened every day as well as our thirst for the most updated knowledge in healthcare. In the private sector, it is the patient's responsibility to update their health-care providers about changes in their health. In the VHA, each visit to a specialty clinic, admission and consult are followed back to the patient's primary healthcare provider via electronic files. The primary healthcare provider is really the primary, unlike in the private sector.

Colleen Goessling

St. Louis, Mo.

I find it curious that Phillip Longman, who had so much to say regarding the quality of the care and the quality of the economics found in the Veterans Health Administration, would omit any mention of the fact that VHA physicians do not carry malpractice insurance and the VHA follows strict algorithms in its prescription of medications. The VHA is completely insulated from expensive medical lawsuits and considers carefully the cost of medications when approving prescriptions.

The VHA offers a powerful example of the efficiency and real health benefits of a strongly centralized and managed healthcare system. However, the V-HA, like Kaiser Permanente, also severely limits the choices of the physician and patient.

Damien Ellens

New Haven, Conn.