For the left, the Department of Veterans Affairs is how health care is ideally supposed to work. No insurance companies, no private doctors, no competition — just the government and the patient.
New York Times columnist Paul Krugman has held up the VA as a model for the entire country. The Washington Monthly ran a famous article in 2005arguing that the VA was leading the way for U.S. health care. The socialist senator from Vermont, Bernie Sanders, is such a reflexive defender that in an instantly notorious interview on CNN he pooh-poohed the burgeoning scandal that may involve fatalities with the undeniable observation that “people die every day.”
The VA is an island of socialism in American health care. It generally provides adequate care — to a limited universe of people and for only certain conditions — but has long been plagued by scandal. It is perhaps theworst bureaucracy in the federal government. As with all such single-payer-type systems, the cost of the notionally free health care is in the rationing, in this case the wait times that have had desperately ill vets hung out to dry for months.
The usual ObamaCare excuses don’t apply here. The existence of the VA isn’t politically controversial. No one is trying to repeal it, or “sabotage” it. What we’re seeing is simply unaccountable bureaucracy in action.
When the bench mark was created for VA facilities to get vets appointments within 14 days, meeting the goal was easy: All it took was logging appointments dishonestly to hide the wait time. This is how poorly performing government bureaucracies have met goals from time immemorial; it’s why, on a much more vast and monstrous scale, Soviet five-year plans were always such runaway successes on paper.
The "scandal" is not that there is a waiting list for medical care and people are dying before getting treatment. That is a necessary and inherent part of the system. The real scandal is that anyone ever believed otherwise, or was allowed to pretend to believe otherwise. It is simply not possible to have a politically funded, politically managed system of health care that is NOT rationed This was absolutely obvious and inescapable to anyone with even a modest capacity for thinking critically.
ReplyDeleteThis is not an aberration or failure of the system. This is the intended result. This is the system working exactly as it was designed. The VA does not exist to provide the best possible care to veterans with no money being no object. The purpose of the VA is to create the *appearance* that veterans are being adequately cared for while in fact keeping expense to the barest minimum possible.
As with all other government bureaucracies, "the system" includes well-rehearsed and oft-used contingency plans which you've seen before: a lot of squawking and chest-puffing and tough-sounding talk about "accountability" and "full investigations", but these are intended to distract the naive away from the reality that no fundamental changes or corrections will be made (because that would require repudiating much of the philosophical foundation on which big government rests). Public scapegoating is the intent, not reform.
Shinseki's job, both at the VA, and previously in the military, has always been to protect those above him, not those below him. But he is not solely responsible for the existence of this waiting list and falsified records. That was going to happen no matter who was in charge. The configuration of constraints and incentives in this system would allow for no other outcome. The people who deserve the most of the blame for this are the politicians and the voters who didn't call BS on the politicians.
Defenders of government would have us believe that the problem is due to Shinseki (or possibly other VA staff too) and once the culprits are removed, the VA system will be great. Nothing could be further from the truth. Government management of health care is corrupt and rotten even *in theory*. It cannot be anything other than corrupt and rotten in practice.