Fort Harrison here in Helena is the home of the best Veterans Affairs hospital in the country."Best," by VA standards, means best for patients. That's because the VA health care system, the largest HMO in the U.S., bases its assessment of patient care on evidence proven by medical research to get and keep people well. All those working in the VA system are held accountable to these highest standards. It didn't used to be true, which is why the story of the VA health care system is one we can all look to for hope.

Before 1994, the VA had what many considered some of the worst care in the country, but in 1994, Ken W. Kizer MD, trained in emergency medicine and public health, was appointed the system CEO. The VA is now lauded as "Best Care Anywhere" by the Washington Monthly (Jan/Feb 2005), and the New England Journal of Medicine, and Annals of Internal Medicine in 2003 and 2004 published studies proving it. Both respected, peer review journals published research comparing quality of care and patient outcomes between the VA and private sector patients.

The studies found, that the patient care and outcomes were superior in all areas for VA patients as compared to private sector patients. This is especially impressive because studies have shown VA patients to be on average sicker and poorer than their private sector counterparts.

What makes the VA so much better for patients? A few key differences stand out.

-- The VA is a health care system that puts patients and the practice of medicine ahead of profits.

-- The VA today is a health care system designed by a doctor CEO, trained in patient care.

-- The VA treats all equitably no matter what their income or rank.

-- VA care is the care your doctor has decided you need, not the care an insurance administrator has approved of, or that you've finally managed to get the cash to pay for.

-- If you are too poor to pay for medical care you still get what you need -- you get your medications, your preventive care and specialty care, and you see some of the best doctors in this community. Everything is done to restore health and avoid the need for emergency care.

-- Vets do not delay care for fear that they will get a bill they cannot afford to pay, or for fear they will be diagnosed with something that results in their premiums getting jacked through the roof in an attempt to "rid them from the system." a now common experience in the private sector that may be the greatest threat to public health.

-- Nationally the VA computer system, known as VISTA, developed with federal dollars and available even to the private sector, makes access to medical records quick, easy and reliable. There are several countries, including Germany, which have adopted VISTA; our local hospitals could too.

-- Drug costs are negotiated by the VA with drug companies. Because it is a large purchasing pool, it can bargain for the best prices for vets (and taxpayers). A recent study showed for example that the Medicare D drug plans costs are running 58.2 percent over what the VA has bargained for.

Affordable drugs help prevent complications, hospitalizations and enhance quality of life. We all deserve this.

Between 2000-2003, Montana used nearly $1 million in federal funds to study how to make health care available to all Montanans. Steve Seninger, Ph.D health economist, principal investigator, and director of economic analysis, published his findings for the "State Planning Grant" (as it was called), which included three themes:

1. "All respondents identified cost as the reason that people do not have health insurance or that businesses cannot offer it as a benefit;

2. "The current system(s) can not be fixed, and;

3. "Most respondents, who addressed long-term solutions, identified some type of universal single payer health system as a long-term solution." The "State Planning Grant" process has resumed once again, having met in

December. It is likely many well-intentioned politicians will say that there is NO solution to our health care crisis, but I'd hope we could be thinking more like Dr Kizer, in true American "CAN DO" spirit. He was empowered to do what needed to be done, and within four years he turned the worst health care, into "The Best Anywhere," regardless of rank. We must look at the VA and find a way to have VA quality at VA prices for all of us.

MARY CAFERRO represents House

District 80 in Helena.