health care

The Veterans Health Administration Really Does Offer 'Lessons' in 'Socialized Medicine'

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Mollenborg / Foter

Just a couple of years ago, Paul Krugman pointed to the Veterans Health Administration (VHA) as a "huge policy success story, which offers important lessons for future health reform." He gloated, "yes, this is 'socialized medicine.'"

Similarly, a letter touted by Physicians for a National Health Program trumpeted "the success of 22 wealthy countries and our own Department of Veterans Affairs, which use single-payer systems to provide better care for more people at far less cost."

How could a bloated government bureaucracy achieve such low-cost success? As we found out recently, it's by quietly sticking veterans on a waiting list and putting off their treatment for months—sometimes until the patients are far too dead to need much in the way of expensive care. Which is to say, calling it a "success" is stretching the meaning of the word beyond recognition.

And, while the White House insists it learned from press reports about the secret waiting lists, Press Secretary Jay Carney acknowledges that the administration long knew about "the backlog and disability claims" that have accumulated in the VHA.

This should surprise nobody. Canada's government-run single-payer health system has long suffered waiting times for care. The country's Fraser Institute estimates "the national median waiting time from specialist appointment to treatment increased from 9.3 weeks in 2010 to 9.5 weeks in 2011."

Likewise, once famously social democratic Sweden has seen a rise in private health coverage in parallel to the state system because of long delays to receive care. "It's quicker to get a colleague back to work if you have an operation in two weeks' time rather than having to wait for a year," privately insured Anna Norlander told Sveriges Radio

An article in The Local noted that "visitors are sometimes surprised to learn about year-long waiting times for cancer patients."

Britain's single-payer National Health Service (NHS) is up front about wait times for care, with the organization's website promising, "you have the legal right to start your NHS consultant-led treatment within a maximum of 18 weeks from referral." Last year, the Daily Telegraph reported that "waiting lists, which have hovered around 2.5 million patients in recent years, reached 2.88 million in June, the highest level since May 2008."

Why the common delays across single-payer health systems?

Christopher S. Penn / Foter

It's like that sign you see in car repair shops owned by wiseasses: "Fast. Good. Cheap. Pick Any Two."

Advanced medical care costs a lot of money. Delivering it quickly costs more. To the increasingly limited extent that it's allowed, American private medicine recognizes the compromises that have to be made and offers a variety of coverage at different price points—that is, you have some choice in which two you get. The British NHS also recognizes the need to compromise—and there goes "fast." (The NHS is known for holding back on "good," too, when further cost controls are needed.)

The VHA has tried to pretend that compromises don't have to be made; that it can, somehow, deliver care to everybody without worrying about cost. But it faces the same lack of infinite resources as everybody else. If the VHA won't charge more for quick access to better care, fast will have to give. So we end up with secret waiting lists.

The VHA also often compromises on the good part, denying that illnesses exist, or that they're military-related and therefore its responsibility.

So the VA really is a good example of a single-payer, socialized health system. Just not in the way that fans of that approach mean.