Senate Veterans Affairs Chairman Bernard Sanders introduced the Democratic solution, to invest billions more and even open 27 new facilities, albeit allowing veterans to seek private care if they were delayed 30 days. But this counting of waiting periods is precisely what the VA careerists gamed, and 30 days is too long as it is. The system is beyond fixing and certainly can’t be fixed by those who created the problems in the first place, or adhere to the same discredited ideology. As recently as 2011, New York Times columnist Paul Krugman praised the VA as a model of “success,” as an American “socialized medicine” free of “the perverse incentives” of market capitalism, a mode of centralized administration that allowed the VA to make effective, objective medical decisions. If Obamacare was as socialized as VA, he argued, it would have been more successful.
The problem with the VA is not poor administrators, but just what Krugman found so attractive: the fact that it is socialized medicine. Government programs must be given a budget to spend as its experts think best. Yet, no matter how generous, there must always be more demand for free services than can be supplied. So managers must create waiting lists. Back in the 1980s, the Reagan administration tried to rationalize the VA, proposing to take the money supporting medical services and give vouchers directly to veterans to spend at any medical facility they chose, VA or not. The proposal, similar to the emergency chit the Obama administration offered to temporarily solve the current crisis, was defeated primarily by the veteran service organizations concerned that their special relationship at the VA and the government-supported services they offered at its facilities would be eliminated by such a program. When Senate Veterans Affairs Republican Richard Burr challenged them during the current crisis, he was immediately silenced by claims that criticism of the service organizations was an attack on all veterans. As a result, the top legislator was isolated, left to fend for himself, showing who really has the power to determine VA policy.
There is a need for an organization supporting veterans, but not one with hundreds of thousands of employees who know that their unions and managers will protect them from getting fired or disciplined. There is only one way to cut through Washington’s unaccountable bureaucrats, nests of special interests and self-promoters, and business as usual attitudes; and that is to get the programs out of government by issuing vouchers. An advocate leader and a few auditors and program analysts are all the government needs. At least initially, existing VA medical facilities could compete against private ones to see if they could survive. Obamacare was a program to reform one-sixth of the whole economy. Such an enormous program would naturally run into difficulties. But the almost century-old Veterans Affairs, with a much smaller population to cover and fat budgets year after year, is something else.
Unaccountable bureaucracy is the worst solution for humane health care, whether it’s for veterans or the public at large. Many who still support Obamacare seem truly upset at the enormity of the VA abuses. This is a teachable moment for them. The problem must not be allowed to be written off as both Democrats and Republicans would prefer, by firing one former war hero– perhaps above his head administratively but not primarily responsible for the problem–and shoveling in more money. That response only allows the politicians to ignore the real problem and escape the wrath of the powerful veteran service organizations that are wedded to the status quo.
The fact that the Obama administration even temporarily and partially adopted a semi-voucher process that would allow veterans forced to wait for VA care to use private medical services is enormously significant both intellectually and morally, and it must be used as a wedge to privatize every bit of it to resolve the fundamental problem once and for all. Then adopt the same solution for Obamacare, veterans, and everyone else too. Problem solved.