Reminder: Until Very Recently, The Left Was Touting the VA as a Great Model for Government Run Health Care for All

This is from Kevin Drum in 2007:

As regular readers may know, Phil Longman thinks the VA model of healthcare is the best around. In the October issue of the Monthly, he takes his admiration to another level, suggesting that the best way to provide healthcare to the 45 million uninsured in America is via — what? I guess you'd call it a franchised version of the VA. Basically, the federal government would offer struggling municipal hospitals a trade: if you adopt the VA's management guidelines, the government will pay you to care for all those uninsured folks currently jamming up your emergency rooms and driving you bankrupt. Deal?

The supposed reason is that great panacea, electronic medical records, cited by the Left as the solution to all woes as often as the Right mentions the Laffer Curve.

"Since its technology-driven transformation in the 1990s...the VA has emerged as the world leader in electronic medical records — and thus in the development of the evidence-based medicine these records make possible." Hospitals that joined Longman's "Vista network" (his name for the VA-like franchise he proposes) would have to install the VA's electronic medical record software and would "also have to shed acute care beds and specialists and invest in more outpatient clinics." By doing this they'd provide better care than any current private network and do it at a lower cost.

Since that time, the Left has mostly stopped talking about the VA as a miracle solution, because it is becoming clear that the VA cuts costs the same way every state health care agency cuts costs -- by restricting capacity, leading to huge waiting times, and rationing care.  The scandal here in the AZ VA is just the latest

The chairman of the House Committee on Veterans Affairs said Wednesday that dozens of VA hospital patients in Phoenix may have died while awaiting medical care.

Rep. Jeff Miller, R-Fla., said staff investigators also have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits that patients must endure for ­doctor appointments and treatment.

"It appears as though there could be as many as 40 veterans whose deaths could be ­related to delays in care," ­Miller announced to a stunned audience during a committee hearing Wednesday.

Supporters of government health care like t o waive their arms about magic bullets, but the only strategy that has ever reduced costs in government health care systems is rationing and queuing (which is also a form of rationing).  Resources are always scarce, but the question is whether we want our health care rationed by government beauracrats or by ourselves.  The latter can only happen if we get away from first dollar and single payer medicine and find a way to get real, transparent price signals (which is the way every other service in this country is managed).

Update, Via Greg Mankiw:

"In Britain, even though they're already paying for the National Health Service, six million Brits—two-thirds of citizens earning more than $78,700—now buy private health insurance. Meanwhile, more than 50,000 travel out of the U.K. annually, spending more than $250 million, to receive treatment more readily than they can at home."

Which is the exact same way we run our education system -- everyone has to pay for a basic crappy level of the government monopoly product, and then if you can afford it you pay again to get a better private product.


  1. MingoV:

    All VA medical centers are not alike. Some are good; some suck. Some manage to grab more federal funds; some are massively underfunded. I worked at a reasonably good VA for a while. The physicians were very good. (I'm a pathologist who holds physicians to high standards, so they really were good.) However, the nursing care sucked despite having the lowest patient to nurse ratio in Memphis. The pharmacy was excellent, as were the clinical pharmacologists. Oncology sucked, because they needed three full-time staff oncologists and only had one plus two outside part-time contract oncologists. Most patients with cancer had to be sent to other hospitals. The same was true of psychiatry.

    The Vista electronic medical record system is reasonably good for clinical care. It can't do inventory or billing or scheduling. It's written in MUMPS, a programming language from the 1960s that nobody uses any more. Each VA hospital was allowed to customize its system. The VA has 150 versions of Vista, which is part of the reason why it cannot readily share data with military medical record systems.

  2. skhpcola:

    My VA facility is great. I can get an appointment in days, even if I call out of the blue and haven't been in for 6 months or more. I went last year because of persistent back pains and they sent me to the Navy Hospital ER at no cost to me (it certainly cost somebody something). My facility is clean, well-organized, and staffed by attentive, caring people...for the most part. I have had to switch doctors a couple of times, due to the doc dismissing my concerns about some service-related issues. All in all, I'm pretty happy with it, although I have to drive over an hour to get to the place. Plus, being in the VA system means that Ozerocare and its fines don't apply to me.

  3. sch:

    Medicare spends about $8500/recipient, the VA a bit north of $11,000 per recipient. Of course medicare does not have its own system of hospitals and clinics
    OTOH the VA relies on private facilities to provide ED/inpatient care if there is no convenient or accessible VA hospital. Not having interactive EMRs is a feature
    not a bug. This is rampant in the civilian world. Years ago when I was in training, if a vet managed to stay in the hospital for 3 weeks he would be defined as
    100% disabled for that month and a bump up in the disability pension. Dunnoh what the rules are now.

  4. joshv:

    "Which is the exact same way we run our education system -- everyone has to pay for a basic crappy level of the government monopoly product, and then if you can afford it you pay again to get a better private product."

    Well, if you are willing to pay more property taxes, you can get a better version of the private product.

  5. randian:

    Every time I see the phrase "evidence-based medicine" I cringe, since I assume it doesn't mean what the plain words say.

  6. irandom419:

    Actually, MUMPS is still used now, Google ANTRIM MUMPS. I've even heard it requires less programmers, but who wants to work with code that looks like line noise.

  7. Canvasback:


  8. obloodyhell:

    }}} (which is the way every other service in this country is managed).

    Not to dispute the general principle in any serious way, but... LOL?

    The governments -- state, federal, local -- have their FAT little fingers in LOTS of pies.

    An obvious example of this is college tuition. Even for private colleges, they distort the market via interference in the student loan pricing model.

  9. obloodyhell:

    I'm put in mind of how anytime you bring up statistical facts about the Canadian and UK health care systems, someone pops up with a denial saying they've just gotten spectacular treatment for absolutely free.

    How this all magically happens every time someone generates a negative statistic, and ONLY then (it clearly never actually affects the statistical process) is nothing short of amazing...

  10. obloodyhell:

    }}} but who wants to work with code that looks like line noise.


    REAL programmers, of course...

  11. skhpcola:

    Other than the reliable Canadian trolls, the Canadians that I've met acknowledge that their healthcare system isn't the spectacular paragon of efficiency that it is made out to be in the MSM. OTOH, the vast majority of Canadians live near the US border and can use our (used to be) best-of-class system as a failsafe. If we ever move to single-payer, as the inevitable failure of Obama(don't)Care was designed to achieve, they'll figure out quickly that misery loves company.

    As to the VA, the people getting the benefit have a contractual right to the care and have earned it through service to the nation (some more than others, but still). Not so much with the SSDI sponges. There are large networks of people in this country that teach others how to game welfare--disability, Medicaid, whatever. It's a tactic right out of Alinsky's playbook. At its base, the leftist desire for single-payer is a revelation of the ideological power-grab to destroy the medical system, as leftists have done in the educational, legal, and every other system that they've infiltrated. They're making a grab for our military, at the moment.

    Most of that had nothing to do with what you said in your comment, but it's a lazy Saturday afternoon on the beach and I've had more than a few pints of Guinness.

  12. jhertzli:

    The example of Britain shows that it's possible to recover from a "death spiral."

  13. W. C. Taqiyya:

    The VA facilities I have used in the past few years have done a pretty good job and the staff has impressed me. I would add that, like most things, you have to pay attention to your health service provider to get the most from them. If that means switching your primary, so be it. Further, it pays to ask for things that may not be on the menu and it pays to insist on the care that you need. Don't take no for an answer. As with any organization, if you complacently accept the first negative response, you won't get far. I suspect that some of those guys who died in Arizona were not very proactive. I don't blame them of course, but I also know that nobody in the VA or anywhere else is going to hold your hand. You have to get stuff done yourself. Once you take the bull by the horns, changing appointments, more frequent checkups and additional tests flow easily.

  14. skhpcola:

    Great points. Several years ago I got complacent and maintained the status quo of ordering my meds online or by phone and didn't call to set up an appointment. After a year and if you haven't had a face-to-face with your primary doc, you drop out of the system and it takes months to get back in. They don't discourage a vet from making appointments, but they sure as hell don't send you reminders or nag you about things, as civilian docs do.

  15. joshv:

    What are you not understanding?

  16. Canvasback:

    You mean we could get a better version of the public product?

  17. joshv:

    Read that several times, did not see the issue. Fixed.

  18. Benjamin Cole:

    Remember, though, in the right wing the story is now reversed.

    ACA, or socialized medicine is bad.

    The VA, or communistic medicine, is good! Paul Ryan says no cuts ever to the VA!

    The VA is a free health program housed in federal facilities, staffed by federal employees, for the benefit of former federal employees, all paid for by federal income and capital gains taxes.

    They might as well fly the hammer & sickle outside VA HQ. Maybe they do. I am sure they have a bust of Marx inside.