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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Today’s Policy Agenda: Should We Replace the VA with a Medicare Advantage-like System?



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The private market may be the best way to give veterans the care they deserve

Navigant Healthcare’s Casey Quinn and Paul Keckley lay out the arguments for a private alternative to the VA in Forbes. They imagine a new system in which veterans’ plans are run like Medicare Advantage plans – the VA would contract with local providers to coordinate and manage veterans’ care.

Conceptually, the VA could create the Veterans Advantage program: it would play an oversight role in financing and regulating Veterans Advantage contracting with clinically integrated, high performing networks to manage enrollee health. The issue in the private sector may not be inpatient capacity—private hospitals operate at 63% average occupancy today. The private sector is innovating in improving access to primary care—a sticking point in the VA and private market—through innovative uses of self-care technologies, expansion of primary care training programs, increased coverage of retail clinics and expanded roles for nurse practitioners and pharmacists.

Recently, the shortcomings of the VA system have been highly publicized, and for good reason. Data shows that the quality of care veterans receive varies widely and can be awful: Patients in a Phoenix VA system are 32 percent more likely to die within 30 days than patients in the best VA hospitals and more than 1,000 veterans have died unnecessarily due to poor care.

Lawmakers are considering ways to offer veterans more access to private care, but that would merely act as an outlet if they can’t get a timely appointment in the existing fully socialized system. Evidence indicates that Medicare Advantage has notable positive effects on patient outcomes, so it may be time for the government to put veterans’ care in the capable hands of the private market. 

Does it matter that Latinos think Obama is doing a bad job?

Washington Post’s Aaron Blake discusses the implications of Obama’s waning approval rate among Latinos. Over half of Latinos disapprove of the president’s handling of the current child migrant crisis, but Blake says that’s not enough to get them to vote Republican.

Latinos haven’t just voted for Obama in recent years; they’re also increasingly identifying with Democrats. In fact, even as polls have shown Obama’s numbers with Latinos plummeting again, those same polls shows Latinos sticking with the Democratic Party in the upcoming midterm.

At first glance, one might think Obama’s shrinking approval rate among this demographic would fare well for Republicans, but it actually highlights the fact that Latino voters more strongly identify with the Democratic party. Even though only 48 percent of Hispanics approve of Obama overall, 63 percent are still likely to vote for Democrats. In fact, Latinos prefer still prefer a generic Democrat to a generic Republican two to one, so it doesn’t look like the Republicans will be winning the Latino vote anytime soon.  

The Social Security cliff just got closer

Jed Graham of Investor’s Business Daily argues that Obamacare is playing a role in the fact that the Social Security trust fund is dwindling even more quickly than expected. The program’s funds (set aside as U.S. Treasury bonds) are expected to run out one year earlier than was projected last year:

The CBO’s most recent long-term budget outlook, which Andrew wrote about yesterday, cites lower payroll tax revenues and changing economic baselines as one driving factor for the updated prediction. Obamacare’s work disincentives are one reason for the decreasing payroll revenues. Baby boomers may decide to retire earlier because they no longer need their jobs to maintain health insurance, and the law’s health insurance premium structure may discourage full-time employment.

Overall, it’s clear people will be doing less work because of Obamacare: The CBO estimated in February that the law will cause a decline into 2.5 million full-time jobs in the U.S. by 2024 — that translates into a lot of lost payroll-tax revenue.



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