A new report from the Government Accountability Office has confirmed that the Department of Veterans Affairs can’t take care of those it’s supposed to serve.
The GAO has placed the VA’s health system on the “high risk” list of federal programs that are vulnerable to “fraud, waste, abuse, and mismanagement.” The agency is still struggling to recover from an 8-month-old internal audit that revealed that returning soldiers had to wait more than 90 days for care. Some patients died while waiting.
The GAO’s findings apply far beyond the VA. The agency’s problems — which include long wait-times and out-of-control costs — demonstrate what happens in any government-run, single-payer health care system.
The VA’s failings ought to give pause to the liberal politicians and policy analysts who would love to introduce single-payer health care for all Americans. But they don’t seem to have heeded the GAO report. Within a week of its release, Rep. John Conyers, D-Mich., called for “Medicare for All.”
Champions of socialized medicine used to point to the VA as proof that single-payer worked. In 2011, economist Paul Krugman called it “a huge policy success story, which offers important lessons for future health reform.” In a 2009 debate with me, Princeton professor Uwe Reinhardt said that there’s an example of a single-payer system in the U.S. that works — the VA.
The VA offers lessons about health reform — just not the ones single-payer’s proponents have in mind.
Defenders of government-run health care claim that it will control costs by cutting out middlemen such as insurance companies. The evidence shows otherwise. According to the GAO, the VA budget more than doubled between 2002 and 2013 even as enrollment increased by less than a third.
Single-payer’s “guarantee” of access to high-quality care is a myth, too.
“Despite these substantial budget increases,” the GAO report says, “for more than a decade there have been numerous reports … of VA facilities failing to provide timely health care.”
Over the last decade, more than 63,000 veterans have been unable to get a doctor’s appointment. At least 40 veterans have died because of long waits.
Things aren’t likely to get better anytime soon. The VA has yet to act on more than 100 GAO recommendations for improving care.
Last summer, lawmakers allocated $10 billion to a program intended to reduce wait times by permitting veterans to see private doctors outside the VA system. So far, the agency has only authorized 31,000 vets to seek private care — out of a possible 8.5 million.
That has to change — 88% of veterans say that they want the ability to choose where they receive their care.
Fortunately, they have some allies in Congress. A bipartisan group of 41 senators led by Sen. John McCain, R-Ariz., is dialing up the pressure on VA Secretary Robert McDonald to fully implement the program. In late February, McDonald promised that he would do so during testimony before the Senate Veterans’ Affairs Committee.
The VA is not the only single-payer system to combine ballooning budgets and inadequate access to care. The United Kingdom’s National Health Service, for instance, is notorious for denying patients everything from certain cancer medications to hip replacements.
The program is also financially unsustainable. According to its own medical director, Bruce Keogh, “if the NHS continues to function as it does now, it’s going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future.”
In Canada’s single-payer system, the average wait time between referral from a general practitioner and the actual receipt of treatment by a specialist was more than four months in 2014. That’s nearly double the wait time of two decades ago.
Or look to Vermont, where Gov. Peter Shumlin has tried to install a single-payer system over the last several years. He finally admitted late last year, when he got the bill — more than $2.5 billion — that the program would not be viable. That’s equivalent to about 92% of Vermont’s annual tax take.
More than half of Americans say they would support a shift to a single-payer system. A look at the VA, or Vermont, or abroad, should cause them to change their minds. After all, access to a waiting list is not access to health care.