The United States has long had a patchwork system of delivering health care to its citizens. Unlike most modern, Western democracies, Americans don't enjoy a national health care system, per se, and only recently started trying to expand coverage to millions of uninsured.
For seniors, we have one system. For children, we have another. If you're a working adult, you probably get insurance through your employer, unless you're poor, in which case you might qualify for Medicaid -- but not in every state. It's as if the U.S. system -- some of which is socialized, some of which isn't -- has come to resemble a rather unattractive quilt.
But for veterans, there's an entirely different system, along the lines of the British NHS: it is, quite literally, government-run health care.
In light of the VA scandal, there's apparently some chatter about privatization. Charles Krauthammer argued on Fox News this week:
"If you would suggest that we go to a voucher system where everybody will get a voucher for treatment in any hospital he or she chooses, and I were a vet, I would choose that. I would rather go to Georgetown University hospital than to a VA."
Yesterday, Sen. John McCain (R-Ariz.), himself a decorated war hero, said he's currently working with Sens. Richard Burr (R-N.C.) and Sen. Tom Coburn (R-Okla.) on a Republican plan in line with Krauthammer's suggestion. Though McCain didn't specifically reference "vouchers," he told Roll Call, "[L]et's let our veterans choose the health care that they need and want the most and not have to be bound to just going to the VA."
If this sounds vaguely familiar, there's a good reason: McCain toyed with VA privatization in 2008. What's more, Mitt Romney floated a similar idea as a presidential candidate in 2011 -- on Veterans' Day, no less. (Veterans Of Foreign Wars soon after declared, "The VFW doesn't support privatization of veterans health care," and Romney quickly walked it back.)
Apparently, however, the idea is starting to make a comeback. That's not good news.
It's worth noting that there are some credible legislative ideas on the table for addressing chronic problems plaguing the VA. The House, for example, yesterday approved a bipartisan VA Management Accountability Act, which is intended to "make it easier for the secretary of veterans affairs to fire or demote career employees and managers who are found to be involved in cases of negligence or mismanagement."
That's not exactly a game-changer when it comes to the systemic problems that go back literally decades, but it's at least a congressional effort to do something constructive.
Which is more than we can say about privatizing the VA.
There may be some confusion about the difference between the quality of VA care and the quality of the VA system in delivering that care. For Krauthammer, for example, there's an apparent belief that veterans receive sub-standard treatment at VA facilities.
The evidence shows otherwise. The editorial board of the Washington Post noted today that the VA system "as a whole outperforms the rest of the health care system by just about every metric. Surveys also show that veterans give VA hospitals and clinics a higher customer satisfaction than patients give private-sector hospitals."
Those conclusions are bolstered by ample data. In 2012, RAND Corp. found in nearly every category, "VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up." There was also Philip Longman's 2005 report in the Washington Monthly, highlighting research from the New England Journal of Medicine, which found the quality of care in VA facilities was "significantly better" than private counterparts.
Jon Perr published a detailed Daily Kos piece on the subject yesterday, which is worth clipping and saving for future use: "Sending millions of older, sicker Americans -- many of them requiring specialized care for rare and complex health problems -- into the waiting arms of private insurers, private doctors and private pharmaceutical firms is a recipe for chaos and de facto rationing on a grand scale."
There's clearly reason for outrage about the ongoing VA scandal, but privatizing high-qualify care isn't a sensible solution.