Just like the rest of America, health care on Martha’s Vineyard is in trouble — too often fragmented, unsafe, variable, hard to access and far too costly. Poor system designs are the cause, designs sustained by a fee-for-service payment system that pays for volume (how much you do), not value (how well the patient does). Doctors, nurses, other clinicians, staff, and managers do their very best to help, but they are often fighting upstream against systems that make their work harder.

After more than two years without primary care on the Island, a group of Vineyard veterans blasted the Veterans Administration and Partners Healthcare yesterday for failing to restore medical services that had been available on the Island for years. The veterans met with a team of national representatives from the American Legion in the hope that they will bring their message back to Capitol Hill.

The Vineyard Nursing Association has announced a plan to expand its services to include hospice care, directly competing with Hospice of Martha’s Vineyard, a 28-year-old Island institution which operates solely on donations, unfettered by the constraints of insurance regulations.

Vineyard Nursing Association has applied to become a licensed hospice provider certified under Medicare.

In the summer, there is no such thing as a slow night for the Tisbury ambulance association.