Vouchers for Veterans
By PAUL KRUGMAN
Published: November 13, 2011
“American health care is remarkably diverse. In terms of how care is paid for and delivered, many of us effectively live in Canada, some live in Switzerland, some live in Britain, and some live in the unregulated market of conservative dreams. One result of this diversity is that we have plenty of home-grown evidence about what works and what doesn’t.
“Naturally, then, politicians — Republicans in particular — are determined to scrap what works and promote what doesn’t. And that brings me to Mitt Romney’s latest really bad idea, unveiled on Veterans Day: to partially privatize the Veterans Health Administration (V.H.A.).
“What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform...”
“….Republicans have a thing about vouchers. Earlier this year Representative Paul Ryan famously introduced a plan to convert Medicare into a voucher system; Mr. Romney’s Medicare proposal follows similar lines. The claim, always, is the one Mr. Romney made last week, that “private sector competition” would lower costs.
“…But we have a lot of evidence about how private-sector competition in health insurance works, and it’s not favorable. The individual insurance market, which comes closest to the conservative ideal of free competition, has huge administrative costs and has no demonstrated ability to reduce other costs. Medicare Advantage, which allows Medicare beneficiaries to buy private insurance instead of having Medicare pay bills directly, has consistently had higher costs than the traditional program.
“And the international evidence accords with U.S. experience. The most efficient health care systems are integrated systems like the V.H.A.; next best are single-payer systems like Medicare; the more privatized the system, the worse it performs.”
Cassi Creek: I did part of my clinical rotations at a brand new, fully staffed, well-funded VA hospital. Seeing how miserable the patients were, how they were simply being warehoused by a government that had used them and now wanted little more of them than to die quickly so that they were no longer a burden was sufficient to crush any thoughts of allowing myself to become a VA patient. 30 + years, hearing loss, and chronic pain mixed with a combined medication bill of over $2000/month required me to reassess my position vis-à-vis VA health care.
Now the system is underfunded, under-staffed, and a primary target for the teavangelists who want to destroy government.
Here’s the problem: the VA system, despite the worst efforts of Congress, functions well enough to treat veterans as in and outpatients. When I walk into VA and see a physician, therapist, janitor, or interact with any employee, I come away knowing that the people tasked to care for veterans really do care for veterans. My medications are affordable because, unlike Medicare, VA can haggle, bargain, and finagle for the lowest drug prices available. I may have to wait 2-3 months for a non-emergency appointment. That’s about the same wait I’d expect from a non-profit or corporate for profit hospital/physician group practice. VA actually provides affordable care of high quality. That and the long-term nature of care provided for Veterans now are making it an attractive target for the corporate health care and health insurance industries.
If the corporate health care chains/health insurance companies. can glom onto the veterans in the system now, they stand to make a guaranteed bundle while the vets stand to be shuffled into voucher programs that will cost them an ever-increasing co-pay and provide them an ever-decreasing list of services.
The teavangelists will swear up and down on any object you care to offer that putting vets into a voucher for health care program will provide “Competition will lower the cost and improve the quality of health care!”
Bull Shit! In all the years I worked in civilian health care, I never saw competition improve the quality of care. Rather, it always brought about cutbacks in staffing and some idiot accountant or MBA demanding that we use cheaper products, which invariably led to lower quality care for the patients.
Competition = Quality? Seen cable television lately? The corporations promised us commercial-free television with increased service. That hasn’t materialized. We get more channels but they are mostly re-runs. We pay for programming that we have no interest in watching, and we have commercials every 5 minutes or even more frequently. Like the current state of cable TV? That, friends, is where the teavangelists want to take health care for veterans.
Once they drop the quality of care and restrict the access to what care remains, the problem of jobless vets will become a collateral benefit to the teavangelists. Those vets will most likely get sick and die quickly. It won’t make the insurance company CEOs very happy to lose the patient pool. But the increase in bonuses will help them get over their disappointment.
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