Briefly, I’ll note that I’m an admirer of Michael Cannon — particularly for his work on the Massachusetts health reform effort — and I appreciate that he’s acknowledged the successes of the Veterans Health Administration over the last decade. In the spring of 2006, Michael published a short piece critiquing the VHA model for NRO.

Fifteen years ago, the VHA consisted mainly of run-down, poorly managed hospitals. Doctors were inexperienced, layers of bureaucracy crippled the system, and patient satisfaction was low. After a major overhaul in the mid-1990s, much of that changed. The VHA as a whole was restructured to focus on outpatient care, rather than costly hospital stays. Nearly empty hospitals were shuttered, and smaller clinics were opened to focus on the chronic-care needs of aging veterans.
The reengineering seems to have worked. As Philip Longman detailed in the January 2005Washington Monthly, the VHA now minimizes medical errors, coordinates care, and maintains patient records with some of the most sophisticated technology available. Doctors and nurses no longer waste time chasing down patient charts and test results; computerized records help them deliver the right care to the right patient at the right time.

And since then, the VHA has consistently outperformed Medicare FFS. This certainly does not mean, pace Paul Krugman, that the VHA is an appropriate model for remaking the U.S. health system. As Michael suggests, it is more a reflection of how regulatory distortions have stymied business model innovation. But it’s worth keeping in mind.

I will say that I disagree slightly with the premise of a recent post Michael wrote for Cato, namely that problems plaguing the VHA offer a glimpse of the U.S. health system under PPACA. My sense is that PPACA will actually create a health system even worse than we’d see under a tightly-centralized model like that of the VHA, in which one can at least say that the incentives are aligned coherently.

While reading Miriam Jordan’s Wall Street Journal article on intermarriage, I was struck by the following passage:

“The massive influx of new immigrants from Latin America and Asia has not only fueled the opportunity to marry one’s co-ethnics, but also revitalized ancestral and cultural identity,” says Dr. Lichter.
The trend raises questions about whether assimilation among Hispanics and Asians in the U.S. is slowing as they reconnect to their ancestral culture through marriage.
Take Daisie Cristobal Sanchez, 31. The U.S.-born daughter of Cuban-Americans residing in Whittier, Calif., recently married a Nicaraguan immigrant. “I was a broad-spectrum dater,” she says. “But deep down inside I wanted to marry a Latino.” What’s more, she says, it’s “cool and back in style” to assert your roots. Most of her friends are fellow Hispanics, she says.

What’s noteworthy about Daisie Cristobal Sanchez is that she feels strong ties to a category with its roots in a 1970s era Census designation. When Dr. Lichter speaks of a “revitalized ancestral and cultural identity,” she is presumably not referring to the mythical culture that unites the very distinct traditions of Nicaragua and Cuba. As Hispanophone countries on the Caribbean rim with a Catholic tradition, there are of course common threads between the two countries. But a “Latino” identity is very much a “made-in-the-USA” identity. As Berkeley intellectual historian David Hollinger argued in Postethnic America, what we see here isn’t resistance to assimilation per se — rather, what we’re seeing is “quintuple assimilation,” in which distinctive Latin American traditions are fused into a syncretic, and one could ungenerously say synthetic, “Latino” tradition, while immigrants of Nigerian and Congolese and Haitian origin see their children assimilate into a broader African American identity, or choose to maintain distance from it.

In California, where Asian Americans represent over a tenth of the population, there has been a palpable shift towards a pan-ethnic Asian American identity. It is increasingly common for Vietnamese Americans, for example, to marry Korean Americans. And of course these couples are united by share used of the English language, not a shared ancestral identity.

Indeed, one can argue that a marriage between a Cuban American and a Nicaraguan American, or between a Vietnamese American and a Korean American, are as much “intermarriages” as a marriage between an African American and a Laotian American. But it is received and interpreted differently.