The Best Care Anywhere?

I'm reading the second edition of Philip Longman's classic: "Best Care Anywhere". The book is a fascinating read into the story behind the VA's transformation from a case study in Government mismanagement to a model of modern medicine with manageable costs and outstanding outcomes.

The book offers some surprises, and I need to research them more.

• One story concerns Beth Israel New York and Duke Medical giving up promising studies into better patient outcomes because the programs were not profitable. This highlights the disconnect between incentives and goals that everyone talks about. I imagine other hospitals aren't any different and these two should be lauded for at least trying outcomes-based programs.
• The other bigger story for me was the apparent success of the VistA EMR system which is Open Source. There are emerging companies like WorldVistA, vxVista, and others following a "Red Hat strategy" of wrapping maintenance, enhancements, and support around VistA. Could this be an alternate world to the commercial EMR vendors?

See also the RAND Corporation's research brief on quality of care at the VA from 2005. Apparently, the VA's success isn't new.