Liberals Were Wrong About The VA, But Conservatives Remain Wrong About Health Care Coverage

James Taranto of The Wall Street Journal, today demonstrating what they say about a broken watch, is right on one point. His column carries the subheading of “Not long ago, the left raved about the VA.”  While this is widely true about the left, there was at least one exception (myself). A few years back, many on the left were exclaiming about the quality of the VA system based upon quality evaluations. Evaluations of quality in health care currently has many limitations, and was downright primitive a few years back.  I pointed out several times, such as here, that the indications being looked at were not a valid means of determining quality health care.

Now we are learning that there is an even more serious problem beyond the fallacy of accepting computerized data as truly indicating quality health care. If the allegations we are now hearing are true, there is also the danger that information entered into computer systems might not even be accurate.

Suddenly, with the recent revelations about the VA, the line from the left has changed to (more accurately) saying that The Veterans Affairs Scandal Was Decades in the Making.

Of course this doesn’t mean that that the right is correct in their interpretation of this scandal. Many are using this to attack the idea behind the Affordable Care Act. We are comparing two entirely different ideas here. The VA is a rare case of government actually providing health care while the ACA involves using private insurance (or in some cases Medicaid) to pay for private medical care. The ACA became necessary in order to provide necessary regulations to curb the abuses of the insurance industry, along with providing support for those who could not afford health care coverage.

If government has problems in providing health care, as with the VA system, the problems in the private insurance industry have been far worse. In the past most areas had one or a very small number of insurance plans dominating a market. Thanks to the Affordable Care Act, we are having more insurance companies planning to enter many markets, which should lower prices. In the past, private insurance companies found it to be more profitable to deny coverage to many people with medical problems, including finding ways to terminate coverage should a policy holder develop a serious (and expensive) medical problem. Here is a report of just one example of an insurance company targeting women with breast cancer for recission of policies.

Obamacare provides needed reforms to encourage more market competition and eliminate this type of abuse from the insurance industry. It is an example of where government action is necessary and beneficial. We also have an example in providing coverage for medical care where government does a better job than the market. People on Medicare have a choice of the government program, which pays private physicians to provide medical care, or Medicare Advantage plans in which private companies handle the payment instead of the government. It costs from 13 to 19 percent less to over the same Medicare population under the government plan than with private insurance plans. The added money going to the private Medicare Advantage plans primarily goes towards increased profits for the insurance companies. Medicare might also be a better, and more cost effective, model to care for Veterans as opposed to the government attempting to maintain a parallel health system.

The lesson of the VA might be to question having the government actually provide health care, although Republicans certainly share the blame here considering their long history of opposing funding which Democrats have backed for the VA. Regardless of whether this is true, this has no bearing as to the benefits of the Affordable Care Act along with government programs such as Medicare which handle health care payments as opposed to directly providing health care.


  1. 1
    Ray says:

    Why is it that in Europe, Canada they have single payer healthcare and here we do not?
    Other then greed by those invested heavily in the numerous health care providers that is.

    I’am a veteran and the VA provided me with excellent care. They have also treated me with the utmost respect and professional courtesy. I want no part of privatization of the VA. I have had far to many bad experiences with the private health care providers.
    Just giving one veterans opinion based upon prior experience.

  2. 2
    Ron Chusid says:

    There are a wide range of systems being lumped together. The VA isn’t a single payer system as in Canada and many European countries. It is a totally government run system (as in the UK). When I refer to Medicare as a possibly better model, Medicare is a single payer model as used in Canada and much of Europe. The government run model is not commonly seen outside of the UK.

    Obviously different people are going to have widely different experiences both in the VA system and outside of it. My point was that problems in the VA are not a valid argument against other forms of government involvement in health care financing as it is a totally different model than used by Medicare or in plans under the Affordable Care Act.

  3. 3
    Randy says:

    Hi Ron,

    As you may recall I’m a solo FP doc. If I understand you right you’re arguing that combination of public administration and private docs (such as Medicare/Medicaid) is the optimal configuration as opposed to all public or all private. I don’t completely agree with that but see your point.

    You have to admit though that during the runup to passage of the ACA Democrats were generally critical of profit motives in medicine. The VA was held up as an ideal where all physicians received a salary and there was no profit motive (interestingly the profit motive in the VA seems to rest with administrators seeking bonuses). I remember Obama making speeches lauding Mayo and Cleveland Clinic on their completely salary-based systems. I felt, along with many I think, was that the ACA was intended to be a step towards completely socialized medicine, which is of course what the VA is.

    So what does the VA crisis mean? To me it shows that some of the tenets that the left used in arguing for the ACA were faulty. Socialized medicine is not the panacea it was made out to be.

    You also seem to part with many on the left in seeing competition as a positive. Many liberals are dismissive of competition, especially when it’s mentioned by conservatives.

    Regarding the VA I have many patients who both see me and use the VA, usually so they can get their meds cheaper. The care given at the VA is usually OK. They seem much more focused on the measurables – did everybody get their Pneumovax and colonoscopy – rather than handling illness or unexpected events. I don’t see how they can justify getting a CBC and CMP every time a patient walks in, it’s wasteful and is asking for a ton of false positives. My guess is some guy at a desk thought it was good idea and it’s job security for their lab people. While their EMR is often touted as the best, in my opinion it’s awful. There is way too much info that is not useful. The main positive is its connectivity across the system, otherwise the records I get from VA’s are terrible.

  4. 4
    Ron Chusid says:

    I’m not so much arguing that any one system is better than that the VA system is different in being a government run system. I greatly prefer single payer models such as Medicare, where the government pays private doctors, as opposed to the government actually running health care. Regardless of what is better, a government run system is not being advocated on a nation-wide basis and has nothing to do with what is being promoted by the Affordable Care Act.

    The VA was not held up as an ideal by Democrats in general, but there were a number of bloggers who did exaggerate the quality of the system. This largely came from a book which used the quality measures per their computer system as evidence. I’m sure you see the fallacy in this.

    The Mayo Clinic and Cleveland are not government run and are not a model comparable to the VA.

    The VA crisis says nothing about the tenants of the left as it is a totally different system than advocated by the left. I also disagree with your assessment of the left regarding competition. For the most part, the left supports a working market based system as opposed to the plutocracy and concentration of wealth promoted by the Republicans. If anything, it is the left which sees market competition as a positive and something to be encouraged.

    The ACA is certainly not a a step towards socialized medicine. It is the opposite, promoting private insurance. The ACA adds necessary reforms so that the private insurance system works, as opposed to having insurance companies find ways to deny coverage, and promotes greater competition by increasing the number of insurance plans in many markets.

    I also have a number of patients who go to the VA for meds. This seems wasteful and if there is a backlog of people who can’t get into VA doctors it would make more sense for the VA to provide the meds we prescribe as opposed to duplicating what we do. I have seen a number of examples of bad care from them, but the same is true of patients going to private physicians.

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