Some conservatives suggest that the burgeoning scandal about some VA hospitals allegedly cooking the books to make it appear that veterans were getting timely appointments—even as some died while waiting for months to see a VA doctor—is evidence of what the public should expect from the Affordable Care Act (ACA), “one big, fat VA system in the form of Obamacare” according to Fox News host Kimberley Guilfoyle.
There is no doubt that that the VA scandal, if proven upon further investigation, would demonstrate an unconscionable, dishonest, and possibly criminal disregard by some VA administrators for the well-being of the sick veterans. Yet we should be careful not to condemn the entire agency: I know of many honorable and dedicated VA physicians who do everything possible to ensure that their patients get the best possible care.
But is the VA scandal really a precursor to what to expect from Obamacare?
Ask Avik Roy, a former health policy advisor to Governor Romney’s presidential campaign and no friend of the ACA. He writes that the VA scandal is an indictment of "socialized medicine", not of the mixed private-public insurance structure used by the ACA to expand coverage:
The most important thing to understand about the Veterans Health Administration is that it truly is socialized medicine. We often throw the term ‘socialized medicine’ around to describe any government health care program, but the distinction is really important to understand.
Socialized medicine, properly understood, is a system in which the state owns and controls everything. The government owns the hospitals; it employs the physicians; it pays for the health insurance and the health care. That, in a nutshell, is the VA. It’s also, for the most part, the system in place under the British National Health Service. . .
Obamacare, he goes on to note, is not socialized medicine. “Obamacare expands coverage in two ways: first, by creating Swiss-style exchanges where people can buy subsidized, regulated private insurance plans; and second, by expanding Medicaid. For all of the exchanges’ flaws—especially their high premiums—the quality of coverage they will offer is decent, and we should expect that uninsured people will do reasonably well on them, so long as they can afford the premiums. Medicaid is a different story; the literature shows that Medicaid does not improve health outcomes relative to being uninsured.”
(There are studies to counter his latter statement--showing that Medicaid does improve health outcomes--but his point about how the VA and Obamacare provide coverage is essentially correct: the VA is socialized medicine, Obamacare is not. The VA scandal also doesn’t necessarily support Roy’s conclusion that socialized health care system equals poor access. A recent review of the United Kingdom’s National Health System found that “accessibility of healthcare in the UK is better than in any other country studied.”)
Yet both the VA scandal, and the foul ups with the ACA launch last fall, do have one thing in common: a dithering response by the administration to the “drip, drip, drip” of unfolding revelations of government incompetence.
But there also is a huge difference between what occurred at the VA and Obamacare’s troubled enrollment launch. The former is about denying government-run medical care to ill veterans who were promised it, and then lying about it, while the latter was about a broken government-run website making it harder for people to sign up for affordable (private) health insurance coverage regulated and subsidized by the government. We shouldn’t conflate the two.
Yet supporters of Obamacare, and I am one of them, should acknowledge that when the government screws things up, big time, and people get hurt as a result (think Hurricane Katrina, and now the VA scandal), it undermines public confidence in government. Even before the VA scandal, only three out of ten Americans trusted the government to do the right thing most of the time. And in that sense, the VA scandal likely will deliver another blow to Obamacare’s already shaky public standing.