Of course, the government entity now known as the Department of Veterans Affairs (VA) has always had a hard time getting veterans appropriate, high-quality treatment in a timely fashion.
The country has hardly ever done a great job of providing “wounded warriors” with the kind of care that the country has promised to provide.
It’s great to see political opponents of the Obama administration channeling their loathing into the admirable, useful activity of trying to help veterans get VA hospital appointments before they die — or at least to force VA hospital personnel to record the adverse outcomes correlated with failures to provide timely care in an honest, complete fashion.
The VA system is not the commercial health insurance system. The agents and brokers who read this website can’t sell VA care plans to consumers who walk in off the street.
But I think the VA system is something anyone who promotes government intervention in health care finance needs to think about.
The first health care programs the U.S. government paid for were health care programs for soldiers and disabled veterans. My understanding is that even most fervent Objectivists think that, if the country ever were in a necessary, truly defensive war, the defense force should somehow provide care for wounded fighters.
My wild guess would be that everyone involved in providing poor or delayed care for veterans sincerely wants veterans to get great care in a timely fashion.
But, even though just about everyone supports the VA health care system, and everyone involved wants it to work, it tends to work poorly.
One reason may just be that it’s big. Another reason may be that many veterans are elderly or poor and aren’t great at speaking up for their own interests.
But, to me, it seems as if some of the other reasons may have to do with the difficulties involved in having the government involved in running a big, complicated, time-sensitive organization that’s supposed to provide a great deal of person-to-person service day in and day out, in a humdrum, non-obviously emergency situation.
The government is pretty good at collecting taxes, because that’s largely a high-tech activity. The government can get computers to do much of the work, and have the taxpayer services help line advisors sit in an easily supervised call center.
The government is pretty good at fighting wars and dealing with catastrophes, because the people involved with those activities have adrenaline flowing through their blood.
But, in a situation in which the patients have a hard time choosing their providers, and interactions involve huge numbers of bored, hard-to-fire, low-paid workers helping those captive customers in facilities closed to the general public day in and day out, technology is not much help. Adrenaline is not much help. Brain fog creeps in.
Analysts in an office in Washington do studies and decide that the workers out in the VA facilities can do a certain amount of work per day. But, of course, even when the analyses are reasonable and the workers are feeling pretty good, everything takes longer and costs more than expected.
When wars increase the number of patients, and budget pressures lead to hiring freezes, stressful reorganizations and layoffs, that will throw off the numbers.
If the VA were a big box discount store, the customers could rebel. They could go to other stores, and post angry Web reviews.
VA customers respond by staying put, getting sicker than they ought to be, and dying.
On the one hand, once the government hears about the problems, it can order the people out in the field to shape up, and work smarter.
But, on the other hand, poorly funded government orders may not do much to change the basic economics of the situation that led to the problems in the first place. It’s a lot easier for the field workers and field managers to tell the bosses what the bosses want to hear than for the people in the field to work smarter and do more with less. If bad field managers do fire anyone, they may fire the troublemakers who have complained about the management problems, not the workers who just quietly hide in broom closets and play with their phones.
On the third hand, that’s just a problem with the VA, not with the commercial health insurance market in the age of the Patient Protection and Affordable Care Act (PPACA), because the VA is a government-run, single-payer system.
The commercial health insurance sold under PPACA is just a free-market commercial product (heavily regulated by political appointees at the U.S. Department of Health and Human Services who have huge incentives to get doctors and hospitals to report whatever it is that members of Congress want to hear).
So, PPACA World commercial health insurance plans have nothing to do with VA benefits. Right?