Just a couple of years ago, Paul Krugman
pointed to the Veterans Health Administration (VHA) as a “huge
policy success story, which offers important lessons for future
health reform.” He gloated, “yes, this is ‘socialized
medicine.'”
Similarly, a letter touted by Physicians for a National Health
Program
trumpeted “the success of 22 wealthy countries and our own
Department of Veterans Affairs, which use single-payer systems to
provide better care for more people at far less cost.”
How could a bloated government bureaucracy achieve such low-cost
success? As we found out recently, it’s by
quietly sticking veterans on a waiting list and putting off their
treatment for months—sometimes until the patients are far too
dead to need much in the way of expensive care. Which is to say,
calling it a “success” is stretching the meaning of the word beyond
recognition.
And, while the White House insists it learned from press reports
about the secret waiting lists, Press Secretary Jay Carney
acknowledges that the administration long knew about “the
backlog and disability claims” that have accumulated in the
VHA.
This should surprise nobody. Canada’s government-run
single-payer health system has long suffered waiting times for
care. The country’s Fraser Institute
estimates “the national median waiting time from specialist
appointment to treatment increased from 9.3 weeks in 2010 to 9.5
weeks in 2011.”
Likewise, once famously social democratic Sweden has seen a
rise in private health coverage in parallel to the state system
because of long delays to receive care. “It’s quicker to get a
colleague back to work if you have an operation in two weeks’ time
rather than having to wait for a year,” privately insured Anna
Norlander told Sveriges Radio
An article in The Local
noted that “visitors are sometimes surprised to learn about
year-long waiting times for cancer patients.”
Britain’s single-payer National Health Service (NHS) is up front
about wait times for care, with the organization’s website
promising, “you have the legal right to start your NHS
consultant-led treatment within a maximum of 18 weeks from
referral.” Last year, the Daily Telegraph
reported that “waiting lists, which have hovered around 2.5
million patients in recent years, reached 2.88 million in June, the
highest level since May 2008.”
Why the common delays across single-payer health systems?
It’s like that sign you see in
car repair shops owned by wiseasses: “Fast. Good. Cheap. Pick Any
Two.”
Advanced medical care costs a lot of money. Delivering
it quickly costs more. To the increasingly limited extent that it’s
allowed, American private medicine recognizes the compromises that
have to be made and offers a variety of coverage at different price
points—that is, you have some choice in which two you get. The
British NHS also recognizes the need to compromise—and there goes
“fast.” (The NHS is
known for holding back on “good,” too, when further cost
controls are needed.)
The VHA has tried to pretend that compromises don’t have to be
made; that it can, somehow, deliver care to everybody without
worrying about cost. But it faces the same lack of infinite
resources as everybody else. If the VHA won’t charge more for quick
access to better care, fast will have to give. So we end up with
secret waiting lists.
The VHA also
often compromises on the good part, denying that
illnesses exist, or that they’re military-related and therefore its
responsibility.
So the VA
really is a good example of a single-payer, socialized
health system. Just not in the way that fans of that approach
mean.
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