The Veterans Administration scandal is worse than you think. A report out this week from retiring Senator Tom Coburn (R-OK) found that approximately one thousand veterans have died in the last ten years while languishing on wait lists. Doctors, nurses, and administrators within the system say that they faced retaliation when they spoke out about unethical practices. One VA employee in Phoenix says that deceased veterans’ medical records were altered post mortem so that it would appear that they did not die on the VA’s watch.
The VA’s biggest problem, besides dishonesty of course, is timeliness. Delayed healthcare can mean the difference between life and death, as this scandal illustrates in vivid color.
The VA’s policy is for patients to be seen within fourteen days and it rewards administrators who make that deadline. Unethical administrators, and it appears that there are a number of them nationwide, cooked the books so that they could get bonuses for prompt service. Documents were destroyed and appointments were cancelled so that the wait lists would appear to be shorter than they were.
If you want to know what US Government-run healthcare looks like, the VA is a pretty good case study. I understand that some of those vets probably wouldn’t have any healthcare at all if it weren’t for this system but is that really a testament to their quality? What healthcare system would adopt as its motto, “Hey, it’s better than nothin’!”
There is an alternative to the wholly government-run model that is the VA. Vets could be given vouchers redeemable with private physicians. It might work better; it could hardly work worse.
Strangely, 31% of Americans polled this month said that they expected Obamacare to function better than the VA system. In other news, 31% of Americans are too stupid to vote.
Of course, Obamacare differs from the VA in that it is not a self-contained system wholly operated by the US government, or what we might call the single payer policy that liberals really wanted and may still get. They will therefore shrug off Obamacare’s faults by saying that it doesn’t go far enough. If only we allowed the government to take over healthcare completely we’d have a great system, like they do in Canada and France!
Well, no. What we’d have is a VA-style system for everybody.
While the VA scandal may be a tragedy, it is also a teachable moment. Now is a good time for conservatives to explain to the American people that we are not against universal healthcare. We are opposed to more government meddling in our medical system because our health is too important to entrust to a bunch of incompetent buffoons who destroy everything they touch.
As is the case with most issues, liberals and conservatives frame the issue in starkly different terms, which explains why we always seem to be talking past each other. The liberal position is simplistic. To them, it’s a question of universal coverage. Everyone should be able to get medical attention when they need it, they argue.
The media adopt the liberals’ terminology and consequently frame the debate the same way. Liberal journalists (a redundancy, I know) really think they’re being fair and balanced when they introduce a segment on healthcare by asking something like, “Should sick people be able to see a doctor? Up next—hear from both sides!” The conservative commentator is stuck defending the “con” side of that issue.
Conservatives aren’t against people seeing the doctor, we just think that the government sucks at almost everything, from education to mortgage-lending to energy production. Nothing in the last decade has persuaded me that our government is anything but incompetent and corrupt.
Liberals would disagree, I think, because they believe in the power of government to do good; or just in the power of government. Several leading pundits, including Paul Krugman and Nicholas Kristof actually argued that the VA is a model healthcare system!  Said columnist Paul Krugman in 2011: “[T]he VHA is an integrated system, which provides healthcare as well as paying for it. So 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.”
About those perverse incentives…
There is an argument to be made that the government can never deliver truly universal healthcare. Consider for a moment those veterans who fell through the cracks at the VA. Theoretically they had access to healthcare, but in reality they had access only to a wait list. Sometimes their names were struck from that list so that it would appear shorter. That’s not “universal” healthcare; it isn’t healthcare at all.
Other socialized medical systems sometimes fail to provide universal care for their patients. Look to England and its recently abolished Liverpool Care Pathway (LCP). Their idea of “caring” for elderly patients was essentially to kill them via dehydration, sometimes with their consent, sometimes without. Obtaining permission from next of kin was also optional. Just don’t call it a death panel.
The purpose of the LCP was to cut costs and open up valuable hospital beds by nudging old people off into hospices. England’s National Health Service calculated that each person who died at a hospital cost an additional one thousand pounds. Doctors were therefore given bonuses of fifty pounds for each wrinkled pensioner they could get onto the pathway.
That sounds an awful lot like our own disgraceful VA: People getting bonuses for making the system look good on paper even if the patients are actually dropping dead.
We all want healthcare for everyone. The question is how to best provide it. Should we provide for our own medical care, just as we buy our own groceries? Or should we look for the generous hand of government to give it to us for “free”, no matter how crappy it is? Conservatives don’t want to prevent poor people from receiving life-saving medications or getting a yearly checkup, we simply don’t want to be trapped in the shameful system that has already killed a thousand veterans.