VA scandal is no mark against big government

By Nicholas Wapshott
June 3, 2014

U.S. military veterans listen in the audience during a House Veterans' Affairs Committee hearing on the Phoenix VA Health Care System wait list, on Capitol Hill in Washington

For some, the veterans hospitals scandal is a human tragedy pure and simple. Those who loyally served their nation in uniform, putting their lives on the line, were shunned when they sought medical help.

For others, however, the troubles at the Department of Veterans Affairs have provided what one pundit called “A gift from God.”

For those commentators, the scandal confirmed their worst fears. The logic runs like this: The VA provides a government-run health service; the failures of the VA are a disgrace; ipso facto, all government-run health systems are a disgrace; proving that all government-run bodies are a disgrace. So all government should be sharply reduced — if not abandoned altogether.

Vietnam veteran Downs gives a thumbs up during a demonstration of modular prosthetic arm technology developed by the Defense Advanced Research Projects Agency at the Pentagon in WashingtonThe VA troubles, however, prove no such thing. The poor treatment of veterans has nothing to do with funding and everything to do with administrative incompetence combined with craven deceit.

Anyone who has been kept waiting inordinately by a doctor or hospital, or who has had their treatment or prescription drugs denied by their health insurance company, knows that. Anyone kept hanging on the line for an ill-named “customer service representative” and told by an automaton, “Your call is important to us,” knows that private companies treat customers with equal disdain.

The difference is that in the VA scandal, democratic accountability eventually — it took far too long, we know — kicked in. The top man resigned and top managers who presided over the incompetence and subterfuge were fired. It is a further scandal that it took President Barack Obama himself to push the wrongdoers into admitting responsibility. But at least the problem was ultimately addressed.

When can you remember a chief executive officer of an aberrant cable TV company or phone or utility company or even a health insurance company — fill in your favorite offender here — falling on their sword for keeping their customers waiting?

This is the full quote from the “Gift from God” analyst, former neurosurgeon Ben Carson: “What’s happening with the veterans is a gift from God to show us what happens when you take layers and layers of bureaucracy and place them between the patients and the healthcare provider.”

United States Veterans Affairs Secretary Eric Shinseki addresses The National Coalition for Homeless Veterans conference in WashingtonPerhaps, as a brain surgeon, Carson is given special treatment when he visits the doctor. But the rest of us endure “layers and layers of bureaucracy” whenever we try to access the healthcare we have so expensively bought.

One reason American healthcare is two-and-a-half times more expensive than in comparable countries is because of the “layers and layers” of insurance sales agents, ID checkers, referral faxers, hospital debt collectors from insurance companies and all the other expensive bureaucrats with no medical knowledge who are employed to administer and police the system. Add to that routine over-charging by doctors and Americans seeking healthcare are being ruthlessly abused and exploited by a commercial scheme that offers them little real choice.

Why do even the smartest free-market dogmatists, who like to paint the world in black and white, fail to see the flaws in commercial companies? Here is the dean of conservative commentators, Charles Krauthammer: “If there’s ever been evidence that a government-run system of healthcare is a disaster, it’s here,” he said. “It’s rationing, it’s waitlists, and corruption and laziness — as you get when people are salaried, rather than working in the free market.”

Cannot those employed on salaries by private companies, particularly employees of corporate behemoths who operate near-monopolies, also ration their customers and say they have been put them on waitlists that do not exist? Can employees of commercial firms not also be corrupt and lazy? Does the free market not employ salaried workers? This muddled thinking is simply partisanship posing as intellectual rigor.

The public-private divide is a red herring that used to distract the left from clear thinking. For a century or more, socialists and communists believed that the world’s problems would be solved if only the “commanding heights” of an economy and the “means of production” were brought into state ownership. Many otherwise smart people fell for an ideology that failed to fulfil its promise the second it was put into practice.

Undated handout of a pileup of claims at the Department of Veterans Affairs facility in Roanoke, VirginiaState socialism is now as extinct as the broad-faced potoroo and few except die-hard ideologues dare suggest the government should run everything. Yet the government, tempered by democracy, still has an important role to play when the private sector is found wanting.

It is not merely in treating veterans — whose profound mental and physical wounds can often be so expensive to treat that private insurance companies cannot offer an affordable rate. In many Western European countries taxpayer-funded health systems keep down the skyrocketing costs of treating their ageing populations, just as here in the United States the Social Security system provides an equitable, and relatively inexpensive, way of providing a decent standard of living for retirees.

Other essential services, too, are best administered by the state. Such as the armed services and the police. Schooling, too, is too important to the nation to be left solely to the private sector. State education too often fails, but it is not because taxpayers fund it — it is because the money is spent unwisely.

The question is not whether to have the government provide services the private sector cannot supply. It is a matter of where to draw the line between public and private.

Nicholas Wapshott is the author of Ronald Reagan and Margaret Thatcher: A Political Marriage, and Keynes Hayek: The Clash That Defined Modern Economics. Read extracts here.

 

PHOTO (TOP): U.S. military veterans listen in the audience during a House Veterans’ Affairs Committee hearing on the Phoenix VA Healthcare System wait list, on Capitol Hill in Washington May 28, 2014. REUTERS/Jonathan Ernst

PHOTO (INSERT 1): Vietnam veteran Fred Downs gives a thumbs up during a demonstration of modular prosthetic arm technology developed by the Defense Advanced Research Projects Agency at the Pentagon in Washington, April 22, 2014. REUTERS/Kevin Lamarque

PHOTO (INSERT 2): Veterans Affairs Secretary Eric Shinseki addresses The National Coalition for Homeless Veterans conference in Washington May 30, 2014. REUTERS/Gary Camero

PHOTO (INSERT 3): A pileup of claims at the Department of Veterans Affairs facility in Roanoke, Virginia, July 25. 2012. REUTERS/Government Handout

20 comments

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No, the question is why neither public nor private are, in the end, essentially unaccountable to those they purportedly serve?

There is no one in a “not for profit” or a “for profit” hospital that has the knowledge or authority to provide a COMPLETE price for a procedure in advance, even though that price, in many cases, will require financing as much or more than a new car and comes with no guarantee.

Posted by OneOfTheSheep | Report as abusive

While not all employees of the VA system are bad, those who are there just for a paycheck and hide behind employment rules and union protection should be fired.

A public union is a blight on the entire government and poor care because one or more employees are due a break before providing care to sick people is an example of big government gone wrong.

Posted by elsewhere | Report as abusive

Sigh, you *assume* that accountability has kicked in. I’m not political, but I don’t see a whole lot of administration interest in actually, you know, fixing the problem, instead of simply firing the visibly incompetent.

Posted by Curmudgeon | Report as abusive

The IG failed because they are not a justice organization, but rather a political organization. Anyone with any experience with them can tell you how they make false statements. They are more like FOX news than anything else really. Sure, the lawyers will tell you they don’t lie, at least in the legal definition of the term, but they make false statements and claims. Then when things like this happen, you wonder what they were doing. How could they be so blind? The answer is that they are not blind, they are dishonest.

Posted by brotherkenny4 | Report as abusive

The VA has been a mess for 50 years or more. Anyone in government who pretends to be surprised by the present revelations is guilty of the worst form of hypocrisy.

Posted by Bob9999 | Report as abusive

Having experienced HC in UK, France and the USA, i can attest that the USA is the most frustrating, expensive, and has average care…

Posted by GA_Chris | Report as abusive

“Big government” = beaurocrats = bad management = bad healthcare = VA scandel.

Posted by RCB53 | Report as abusive

Any job that comes with a permanent guarantee of employment only guarantees high levels of laziness and incompetence…

Posted by dcayman | Report as abusive

Wow…The mess at the VA that Obama addressed and said he was going to fix in 2007 is not a failure of the Obama administration or big government? Really? I would think it would have to be at least one of the above.

To say it is not a big deal because the cable company puts us on hold is a stretch that defies all logic.

Time to queue up the “Well it happened under Bush” excuse. I thought Obama was bringing hope and change to improve upon Bush’s record. What happened?

Posted by bobg123 | Report as abusive

“The poor treatment of veterans has nothing to do with funding and everything to do with administrative incompetence combined with craven deceit. ”

How is that NOT a mark against big government? It’s an example (although not the only one) of a government run and administered healthcare program. What recipient of the VA care, cares if it’s lack of funding, or incompetence, or deceit which yields the bad care? They only care that it’s bad care.

Posted by Yashmak | Report as abusive

The distinction here is first, that cable companies and the other private businesses Nicholas mentions are not taxpayer funded monopolies. The VA is. It’s employees and managers have no incentive to satisfy their patients because their bonus payments don’t come from those patients. Indeed, the top managers earned their bonus checks by falsifying service data on wait times. The government never checked. The managers got their checks.

A similar fact is that all the government rules and forty years of practice have not proved that Medicare has “bent the cost curve” or improved the quality of care. The availability of care might be better, but even there, low government reimbursement rates are driving doctors into practices which simply refuse to accept Medicare patients. The story of Medicaid is shorter and worse. Now the VA has emerged as a media headache for the Left. The VA has always been a 100% government run program.

Nicholas should be itemizing the ways in which the VA is light years better than the private sector alternatives. Instead, he merely brags that his government funded and operated model is no worse than the most horrible non-government operations he can name. If he argues that the Federal Government can do the job cheaper, where is his clear evidence of that? If he argues that the Federal government can provide “better” health care, he should have persuasive evidence of that.

Surely the skeptics can be excused for observing that the State Department doesn’t seem to do a very good job anticipating terrorist attacks on its own employees–let alone protecting them. The Internal Revenue Service has been abused for political gain since Richard Nixon with no obvious improvement in real world protections for taxpayers. The government’s “War on Drugs” has been so unsuccessful that the government is now encouraging banks to lend to Colorado’s legal dealers. Political management of our economic recovery since 2008 has left the United States with the lowest work force participation rates in generations. No politician even mentions long term unemployment as a problem anymore. The government created web sites to introduce America to cheap, easy, comprehensive health insurance didn’t work. Will the rest of Obamacare be easier than building a website?

I can understand that some people really believe that the only problem America has is that it doesn’t give its political class enough to do. The bureaucracy is just underfunded. The public is unfair, cynical and ungrateful. There really is “light at the and of the tunnel”, as Bob McNamara used to say. But mere belief, no matter how eloquent the talking points, does not make it so. Show us some proof.

Posted by lordbaltimore | Report as abusive

The distinction here is first, that cable companies and the other private businesses Nicholas mentions are not taxpayer funded monopolies. The VA is. It’s employees and managers have no incentive to satisfy their patients because their bonus payments don’t come from those patients. Indeed, the top managers earned their bonus checks by falsifying service data on wait times. The government never checked. The managers got their checks.

A similar fact is that all the government rules and forty years of practice have not proved that Medicare has “bent the cost curve” or improved the quality of care. The availability of care might be better, but even there, low government reimbursement rates are driving doctors into practices which simply refuse to accept Medicare patients. The story of Medicaid is shorter and worse. Now the VA has emerged as a media headache for the Left. The VA has always been a 100% government run program.

Nicholas should be itemizing the ways in which the VA is light years better than the private sector alternatives. Instead, he merely brags that his government funded and operated model is no worse than the most horrible non-government operations he can name. If he argues that the Federal Government can do the job cheaper, where is his clear evidence of that? If he argues that the Federal government can provide “better” health care, he should have persuasive evidence of that.

Surely the skeptics can be excused for observing that the State Department doesn’t seem to do a very good job anticipating terrorist attacks on its own employees–let alone protecting them. The Internal Revenue Service has been abused for political gain since Richard Nixon with no obvious improvement in real world protections for taxpayers. The government’s “War on Drugs” has been so unsuccessful that the government is now encouraging banks to lend to Colorado’s legal dealers. Political management of our economic recovery since 2008 has left the United States with the lowest work force participation rates in generations. No politician even mentions long term unemployment as a problem anymore. The government created web sites to introduce America to cheap, easy, comprehensive health insurance didn’t work. Will the rest of Obamacare be easier than building a website?

I can understand that some people really believe that the only problem America has is that it doesn’t give its political class enough to do. The bureaucracy is just underfunded. The public is unfair, cynical and ungrateful. There really is “light at the and of the tunnel”, as Bob McNamara used to say. But mere belief, no matter how eloquent the talking points, does not make it so. Show us some proof.

Posted by lordbaltimore | Report as abusive

scrap the VA..scrap obama care…turn some of the hospitals into rehab facilities…then, give all the vets the same care, we all get in the private sector..give all the congress the same…allow all insurances to compete in all states…put maximum awards that make sense and not feel good awards that sap all, for malpractice …do not allow insurance companies to be able to drop you, when u get sick…Most of all….put a business person from the health care industryin charge… so it can be run efficiently, without any political affiliations and interferences….

Posted by sabrefencer | Report as abusive

Not enough money = not enough doctors = long waits and poor care. Repeat until you grasp that concept. As it stands the average medical school graduate has so much debt that if he/she goes into primary care they will never be able to pay off their loans so the shortage of primary care doctors is exponentially worsening. What you see in the VA is what the general population is starting to experience and is going to get worse. Regardless of what the uninformed masses and media think the most financially efficient medical administrator is Medicare. It is time for a single payer system and government subsidized medical education. Its not socialism its financial reality.

Posted by bmsloc | Report as abusive

No Nicholas… NO… Most are NOT saying that ALL government is bad, or even that all government medical care is bad. However, the VA has been consistently BAD for decades…. Decades. It has nothing to do with ObamaCare or this current president… Under GW there were problems at Walter Reed. There have been problems under every president since Dwight Eisenhower. Look it up…. Get schooled, it’s educational.

Posted by edgyinchina | Report as abusive

All gov’t is not bad. It just seems that way in THIS administration.
When scandals and malfeasance are born weekly and not properly addressed you cast a long shadow over everything it touches.
Failures in State,, obamacare, energy,IRS, Justice, EPA, BLM,and the organizations charged with oversight plus the VA demonstrate the overall lack of competence.

Posted by gitmojo | Report as abusive

Every year, there are at least one million unnecessary appointments made by senior citizen veterans who are scamming the VA for multiple Viagra prescriptions. Every since the VA allowed Viagra to be prescribed and given, “good ol boys” have been getting their double doses from the VA so they can have them to sell to their friends. These senior citizen veterans are the murderers of the other veterans who cannot get care because of their own shallow actions. Stop the Viagra appointments and see the air clear.

Posted by SixthRomeo | Report as abusive

So beyond all the ridiculous theatrics…and for the record I would be dead were it not for the VA…but I have also had some of the worst mis-treatment…and non treatment…by them as well. (still nothing compares to all these drug doctors hobnobbing in the Caribbean and sticking it to the taxpayer…at least these doctors show up for work)
the VA system does in fact exist. It is truly massive AND impressive…where I live we have more than enough Doctor’s and others to handle the case load…this is the MOST solveable problem there is out there.

the only thing that is lacking is execution (meaning proper follow through on the care.) in other words “is the point to care for the patient” (in my experience with the private sector that is absolutely not the case…they just want the money…specialists excepted) and “is care provided.” (did the obese patient drop the 70 pounds? did the patient with the sleep problem get knocked out? did the patient with the anger management/rage issues get a positive outlet)..this is actual remediation.

I know of no one who has been fired other than General Shinseki. As far as I know “the liars” are still lying away. But we’ll see.

Again…this is the most fixable of problems…it’s just a question of focusing on the Mission Statement (how many vets are there even? Nothing like after Korea or World War II) and then once you have the (finite) number it’s simply a matter of checking the items off the list.

the systems and processes already exist. the need doctors who are hungry for patients…hungry for care…who after solving the problems with their veteran load want to step out into the community and start providing outreach.

Posted by lkofenglish | Report as abusive

The administrative incompetence and craven deceit of the VA employees is the problem, not the funding. Agreed. Now, how will government employees, protected by civil service AND a union ever be held to standards that prevent their craven deceit and incompetence from causing problems for others. Insurance companies and lawyers in the private healthcare sector have certainly increased wait times and costs. But at least you can vote with your feet and get a different policy or company. The costs of US healthcare paralleled the costs of healthcare in the socialized countries of Europe until 1984, when the costs of US care separated out and went ever skyward. 1984 was the year that “managed care” took hold in the US. Someone at the insurance company who has never laid eyes on you thinks they can do a better job than the doctor who is sitting in front of you, and save costs. The VA should have a few specialty centers for taking care of war related injuries, and the remaining vets should be given an card that guarantees they will be treated anywhere in the private sector.

Posted by zotdoc | Report as abusive

Note that Nicholas sees this 100% politically designed, bureaucratically administered system and all he can say is that it’s no worse than the worst non-government alternative he can imagine. Yet I thought his point was to win hearts and minds for government as the best alternative? He claims all the liars have been fired. From his mouth to God’s ear! He claims the dishonesty has been rooted out of the system.

His column is merely a set of claims that there is no longer a problem and we can all just move along. To question this set of talking points is mean spirited, I guess.

But skeptics will wonder why Medicare is broke and why physicians are increasingly refusing to accept Medicare patients. Skeptics will wonder why Medicaid isn’t giving free, high quality care to America’s poor. Skeptics will wonder if health services provided to Native Americans by the federal government are adequate.

Well, skeptics will wonder why the political class hasn’t fixed the IRS in the decades since Richard Nixon proved the political class would use the IRS as a political weapon. Haven’t they had enough time? Or have we not given them the money?

Skeptics may wonder why the government hasn’t put the economy back together after 2008. Look at labor force participation. Look at long term unemployment. And what have we got for our money and our votes but a new set of excuses every month when the government policies failed to create significant employment gains or growth. Each set of excuses is followed by a new set of promises of improvement next month, next quarter, next year, someday.

Tens of millions of Americans don’t believe politicians or their media. They know the VA is just one, heart breaking example of a failing, broken government which regards lies and obstruction as a tools of choice not a moral defect.

The America Nicholas describes may be the A,Erica he wants with all his heart. It just doesn’t exist.

Posted by lordbaltimore | Report as abusive