Don’t Nationalize the VA’s Failures

by Charles C. W. Cooke
They are endemic to government-run health care.

A health-care system run and funded by a national government has been caught covering up its waiting lists, leaving patients without care for so long that they have died before they were attended to and, worst of all, perhaps, fudging the numbers in order to make itself and its political masters look more competent. I’m from England, and I’ve seen this movie before.

Many American conservatives have responded to the news that the Department of Veterans Affairs is being run precisely as one would have reasonably suspected that the VA was being run by training their fire on the Affordable Care Act. These “scandals,” the editors of Investor’s Business Daily argued ominously, “foreshadow life under Obamacare.” Well, not quite, no. For all of its many faults, Obamacare remains predicated upon a system of private insurance, maintains the nation’s network of private hospitals, and redirects taxpayers’ money toward the subsidization of monthly premiums rather than to the reimbursement of carriers. What the VA foreshadows is what the Left would like American health care to become in the future. And that is infinitely worse.

“Don’t sweat it,” The New Republic’s Noam Scheiber wrote rather bluntly in January, for Obamacare’s “going to get us to a single-payer system before long.” Leading progressive lights Ezra Klein and Paul Krugman certainly hope so — the former having praised the VA as one of “the best health-care systems in the world,” the latter having not only endorsed the principle of a government takeover of the health sector but having advocated the nationalization of hospitals, too. The VA, Krugman claimed in 2011, is “an integrated system, which provides health care as well as paying for it.” As a result, he contended, “it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense.”

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On paper, this all sounds rather nice, I suppose. But, having lived for 26 years under such a system, I cannot say that I share Krugman’s enthusiasm. Explaining the nature of the new National Health Service in the late 1940s, the British socialist Aneurin Bevan told reporters that “if a bedpan dropped in a hospital corridor, the reverberations should echo in Whitehall.” (“Whitehall” is the part of London in which the national government is located.) Bevan got his way — and how. In England nowadays, when bad things happen to patients, we do not blame hospitals, doctors, and drug companies but politicians and their appointees. Those who follow Parliament are thus treated to the absurd spectacle of the prime minister being asked to comment on individual medical cases in far-flung corners of the nation. This he seems to have accepted as his role. Never does he say in response, “Why am I being asked about this?” Never does he ask whether it might be better if the state got out of the hospital business. Instead, in each and every instance, he takes responsibility and promises to look into it.

Does he do so? Rarely. Because mistakes in delivering health care are catastrophic for those seeking reelection or trying to push an agenda, politicians in Britain spend the vast majority of their time worrying about perceived rather than actual improvement. Government, by definition, has no competition, which means that those who staff it can lie and spin and cover up mistakes not just with impunity but with the full force of the state at their back. Thus do results become less important than statistics, reforms less important than spending, and patients less important than careers. Dishonesty is widespread. Per the Telegraph, the British National Audit Office discovered in 2013 that

one in four hospitals is recording false waiting list times, with patients waiting on average three weeks longer than NHS records show.

Patients groups have said the findings were “scandalous,” and that hospital managers had been able to routinely fiddle figures so they could claim to be hitting Government waiting time targets, when patients were enduring far longer waits for care.

Sound familiar?

In the process of declaring Obamacare a success, President Obama and his cheerleaders have of late taken to insisting that the “debate is over.” But in all likelihood, the exact opposite is the case. If there is anything I learned from my series of poor experiences with Britain’s system, it is that the more that government involves itself in the provision, management, and oversight of health care, the more securely it is guaranteed that health care is all we’ll ever talk about. At his press conference this morning, President Obama hoped aloud that “our veterans don’t become another political football.” Again, too late, I’m afraid. When the government is responsible for taking care of the citizenry, their care is already a political question.

All of which is to say that this is not only a question of what government does to health care but of what health care does to government. As Patrick Brennan noted yesterday, the sorts of problems that we are seeing at the VA — “gaming statistics, secret waiting lists, long wait times for serious procedures” — “seem to be endemic to single-payer health systems and especially fully socialized ones (as in ones where the government employs the doctors and runs the hospitals, too, like the VA, Britain’s, and Spain’s).” In short: Governments can’t run health-care systems efficiently, which irritates people, which leads to governments lying about health care. It’s a mess.

Conservatives tend to believe that the state’s embrace should extend only to a few groups: those who are genuinely incapable of looking after themselves, those who are temporarily embarrassed or debilitated, those whose current predicament is the product of the state’s behavior or orders, and those who have put themselves at risk in service of their country. In other words, the government should provide a safety net into which one might fall but not one that envelops all regardless of their station or their circumstance. Given that we have agreed that our veterans’ health care falls under such responsibilities, Veterans Affairs will always be home to some degree of corruption. Just as the core functions of government necessarily invite waste, so our indispensable programs will invariably run into trouble. In all likelihood, we cannot help this. What we can do, though, is to ensure that we do not nationalize the problem — extending it by choice to all and sundry, regardless of their situation. I’ve seen that future, and it isn’t pretty.

— Charles C. W. Cooke is a staff writer at National Review.