There are so many remarkable elements to the Veterans Health Administration scandal. But to me, the most striking is how much the stories coming out of the VA resemble those that come out of the British National Health Service: like the VA, a fully socialized system in which the government owns the hospitals, employs the doctors, and serves as the insurer.
This is an important point, one I discuss in a lengthy piece for Forbes today. Obamacare, for all its faults, is not technically socialized medicine. It’s part single-payer (Medicaid), and part subsidized/regulated/privatized (the exchanges). There is no health care system in America that is more government-driven, with all of the unaccountability and dishonesty therein, than the VA.
So if the VA is more socialized than even Obamacare is, why haven’t Republicans taken it on? In part because they’ve been afraid to. While many vets are dissatisfied with the care they get in the VA system, Republicans haven’t done the heavy lifting necessary to show that private-sector reforms could offer veterans better coverage and better care:
On Veteran’s Day in 2011, Mitt Romney met with a group of veterans in South Carolina. The vets shared with him their difficulty in getting treatment from VA hospitals. Observed Romney, “If you’re the government, they know there’s nowhere else you guys can go. You’re stuck. Sometimes you wonder if there would be some way to introduce some private-sector competition, somebody else that could come in and say, you know, that each soldier gets X thousand dollars attributed to them, and then they can choose whether they want to go in the government system or in a private system with the money that follows them.”
For this innocuous and appropriate suggestion, Romney was pilloried by the usual suspects on the left—but also, inexcusably, by the Veterans of Foreign Wars, whose spokesperson said, “The VFW doesn’t support privatization of veterans’ health care.” Romney, stung by the VFW’s rebuke, walked back his suggestion, and Republicans have stayed silent on it ever since.
But this may be starting to change:
Until now. On Wednesday, Sen. John McCain (R., Ariz.) told Roll Call that he was working with Sens. Tom Coburn (R., Okla.) and Richard Burr (R., N.C.) on a new reform plan. “Let’s let our veterans choose the health care that they need and want the most and not have to be bound to just going to the VA…Why wouldn’t a veteran who has served his country honorably . . . not be able to go to the health care provider of his or her choice?”
This is a promising development. Put simply, veterans will continue to suffer until they have the option to buy private coverage and seek private care. The premium support approach will allow the government to provide maximum subsidies to those who have suffered serious injuries in combat, and provide conventional subsidies to non-combat veterans who deserve traditional health coverage.
Much of the noise among Republicans in Congress is about making sure that “heads roll” in the VA scandal. But appointing a new Secretary of Veterans Affairs won’t do a dime’s bit of difference. Without fundamental changes, the VA’s flawed socialist model will remain intact. Reforming the VA will be one way for Republicans to show that they are serious about reforming the rest of the health-care system.