Hmmm, What’s the Difference Here?
Bruce McQuain confuses VA hospitals with Army hospitals, Ezra points this out, and Megan McArdle comes in to say this:
But here’s the thing: Army hospitals have all the advantages that single-payer advocates love about the VA. They’re unified. There’s no profit incentive–indeed, the doctors are on quite low salaries. They have great incentives for preventive care. They certainly don’t have any profit motive to provide bad care. So why did Walter Reed suck? And what guarantees that the VA is the system we’ll follow, rather than the multiple other dysfunctional government systems everyone hates?
Well, how about the fact that Walter Reed was dealing with a population that had been injured in war. Suffice to say, this isn’t the normal health care population. And while I’m sure the VA pool differs from the general pool, I’m also sure that the Army/Walter Reed patient pool is much, much different from any cross section of the general public. From an organizational standpoint, a lot of problems at Walter Reed had to do with problems unique to the Army bureaucracy, as well as to the fact that they were fighting two wars at the time. Also, it seems awfully pessimistic to assume that, in a world where we decide to create a VA like system, the government would emulate the bad example, as opposed to the good one.
Let’s see:
1. The veteran population is closer to the general population in terms of health needs.
2. The veteran population is/has the potential to be politically active and the portion needing medical services (i.e. essentially all) is large enough to have an effect, while serving military are restricted in their ability to be politically active and the portion in need of medical services is (comparatively) numerically small.
3. The patients of the Army system are also Army employees, whose status and career options depends on the people whom they might criticize, while veterans are not employed by the VA and employers of veterans rarely have a dog in any fight.
4. Veterans often have local family/friends who can represent their interests while serving military often are isolated from family and friends.
5. Veterans are older and more experienced compared to your average person serving in the military. (I mean more experienced in dealing with bureaucracies, dealing with politicians, etc.)
6. Veterans (as a result of being older) are more likely to have chronic diseases (heart conditions, diabetes, cancer etc.) which puts them into a long term relationship with the VA system, allowing them to have a long perspective on the system. Military personnel with debilitating chronic diseases are typically mustered out (and into the VA system) and so military personnel more typically have short contact with the military hospital system.
7. Veterans are more likely to live in one place for a long time and so veterans advocacy groups can have stable long term membership and if the VA system dislikes the actions of an advocacy group, there is not too much they can do. Advocacy groups for military personnel are more problematic, and if the Army dislikes a group, it can easily disperse the military personnel associated with it, thus effectively breaking the group up.
David Margolies
June 25, 2009 at 3:55 pm