Health Care

No, the VA Is Not an Obamacare Preview

“Obamacare” is not a health care system. The VA is.

PHOENIX, AZ - MAY 08: Exterior view of the Veterans Affairs Medical Center on May 8, 2014 in Phoenix, Arizona. The Department of Veteran Affairs has come under fire after reports of the deaths of 40 patients forced to wait for medical care at the Phoenix VA hopsital.
National Journal
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Sam Baker
May 27, 2014, 4:51 a.m.

As if it wasn’t bad enough that dozens of vet­er­ans may have died be­cause of the VA sys­tem’s fail­ures, some con­ser­vat­ive pun­dits are turn­ing the fear factor up a notch: This is what awaits us all un­der Obama­care, they claim.

That’s non­sense.

The health care sys­tem that the Vet­er­ans Af­fairs De­part­ment ad­min­is­ters (or fails to ad­min­is­ter) has al­most noth­ing in com­mon with the Af­ford­able Care Act. No mat­ter what spe­cif­ic series of fail­ures led to the VA scan­dal, and even if Obama­care goes hor­ribly, it would take enorm­ous leaps of lo­gic to con­nect the two.

Not that need­ing enorm­ous leaps of lo­gic has ever stopped an anti-Obama­care talk­ing point be­fore.

“This is go­ing to be the VA on ster­oids “¦ much, much worse,” con­ser­vat­ive icon Ben Car­son — who is a doc­tor — said in an in­ter­view on Fox Busi­ness. “Without ques­tion,” people will die un­der Obama­care, just as vet­er­ans al­legedly died be­cause of the VA’s mis­man­age­ment, Car­son said.

“The real prob­lem is not man­age­ment,” the New York Post ed­it­or­i­al board wrote last week. “The real prob­lem is gov­ern­ment-provided health care.”¦ If the gov­ern­ment can’t even make such a sys­tem work for our vets, what makes any­one think it will work for the rest of us?”

If you want to ar­gue that the VA’s prob­lems are a sign of what hap­pens un­der true gov­ern­ment con­trol of a health care sys­tem, well, there’s an ar­gu­ment to be made there. Some of the prob­lems at the VA — namely, long waits to see cer­tain doc­tors — are sim­il­ar to the biggest com­plaints about oth­er so­cial­ized or quasi-so­cial­ized health care sys­tems, in­clud­ing the UK’s.

The VA is about as so­cial­ized as it gets: The gov­ern­ment owns the hos­pit­als, em­ploys the doc­tors, and fin­ances the cov­er­age.

And the VA is about as so­cial­ized as it gets: The fed­er­al gov­ern­ment owns the hos­pit­als, em­ploys the doc­tors who work in those hos­pit­als, and fin­ances the cov­er­age that vet­er­ans use to get care.

Obama­care, though, is not so­cial­ized medi­cine. It’s not a gov­ern­ment takeover of the health care sys­tem. Sure, people call it that, and in com­par­is­on with charges like “death pan­els,” those char­ac­ter­iz­a­tions don’t sound so off-the-re­ser­va­tion. But they’re still wrong.

Most people ac­cess­ing the health care sys­tem through Obama­care will do so by pur­chas­ing private in­sur­ance through the law’s ex­changes. The fed­er­al gov­ern­ment reg­u­lates those in­sur­ance policies and re­quires them to cov­er cer­tain ser­vices. The vast ma­jor­ity of ex­change cus­tom­ers also re­ceive sub­sidies, fun­ded by the gov­ern­ment in the form of tax cred­its, to help pay for their premi­ums. So it’s not like the gov­ern­ment isn’t in­volved at all.

But, un­like with the VA, no one on the ex­changes is buy­ing in­sur­ance from the gov­ern­ment; it’s all private cov­er­age. The gov­ern­ment doesn’t de­cide how much that cov­er­age costs. It doesn’t em­ploy doc­tors, or de­cide how much they’ll get paid, or re­quire them to ac­cept any of the in­sur­ance plans sold through the ex­changes. “Obama­care” is not a health care sys­tem. The VA is.

Obama­care also ex­pands eli­gib­il­ity for Medi­caid, which is a gov­ern­ment-run pro­gram. But it’s still not so­cial­ized medi­cine like the VA: You don’t use your Medi­caid card to go to the Medi­caid hos­pit­al for an ap­point­ment with the Medi­caid doc­tor, the way vet­er­ans do with their VA cov­er­age.

“If the GOP can’t find the cour­age to en­act fun­da­ment­al re­forms of the VA, it has no right to com­plain about Obama­care,” con­ser­vat­ive health care ex­pert Avik Roy wrote in a blog post that sug­gests mov­ing vet­er­ans in­to Obama­care’s ex­changes.

The struc­ture with­in the VA that al­lowed long back­logs to de­vel­op and, al­legedly, al­lowed work­ers to cre­ate secret, off-the-books wait­ing lists, is a struc­ture that has a lot to do with the spe­cif­ics of that sys­tem.

Private in­sur­ance doesn’t cre­ate back­wards in­cent­ives to trap pa­tients in an end­less ap­peals pro­cess, the way the VA ap­par­ently does. Plans sold through the ex­changes of­fer dif­fer­ent levels of be­ne­fits and dif­fer­ent net­works of doc­tors; the VA is the VA. The VA is a unique sys­tem with spe­cif­ic flaws. Its prob­lems don’t simply pho­to­copy them­selves onto the private in­sur­ance mar­ket just be­cause they’re both health care sys­tems.

And yet “¦

“You’re go­ing to see this is really what the rest of you all are go­ing to get: One big fat VA sys­tem in the form of Obama­care,” Fox News host Kim­berly Guil­foyle said last week.

Her co­host, Eric Bolling, went fur­ther and tried to ex­tra­pol­ate, based on the ac­cus­a­tions about the VA, pre­cisely how many people Obama­care would kill.

“If people are dy­ing, how many people are go­ing to die in Obama­care? Do the math. It will be about 500 people per year that are go­ing to die wait­ing — apples to apples — 500 people will die on Obama­care” Bolling said.



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