I am grateful to the many people who agreed to lend their time, expertise, and support as I set out to find a model for health-care delivery-system reform and absorb its paradoxical lessons. I am particularly indebted to Dr. Donald Berwick, formerly of the Institute for Health Care Improvement and Dr. Elliott S. Fisher of Dartmouth Medical School for teaching me new ways to look at health care. Dr. Kenneth Dickie, formerly of the VA, not only sat with me for an extensive interview but also provided me with invaluable access to his personal archive of material related to the VA’s early and tumultuous experiments with digitalized health care. Dr. Scott Shreeve, founder of Medsphere—a company committed to bringing the VA model of care to the private sector—was also very generous with his time, insights, and archives, as has been Dr. Ken Kizer, who is now Medsphere’s chair. I am also grateful to the many current and former VA employees who continue to share their insights, including Tom Munnecke, a pioneering VistA Hardhat who has now rejoined the cause of Health IT; Rick Marshall of the VistA Expertise Network; Dr. Ross Fletcher of the Washington VA Medical Center; and others who would prefer not to be mentioned.
My colleague Shannon Brownlee and I have deeply influenced each other’s thinking on health care over the years as we reported on—and tried to make sense of—the actual practice patterns of American medicine. For those interested in a deeper look at what’s wrong with American medicine outside the VA, I recommend her book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer (Bloomsbury 2007).
Thanks go as well to Paul Glastris, editor in chief of the Washington Monthly, for his help in formulating many of the ideas in this book and for having the courage to publish my 2005 cover story on the VA. Len Nichols and Sherle Schwenninger provided useful early comments and challenges. Brian Beutler provided invaluable research help, and Jeannette Warren provided essential editing of the early manuscripts. Deep thanks go to Bernard L. Schwartz, whose generous support of the foundation provided me with the time and intellectual freedom I needed to research and write this book. Finally, I am most grateful to my wife, Sandy, without whose thoughts, encouragement, and forbearance I could not have completed this book.