Having government provide any product or service is a disaster.
either the service is poor or the costs are astronomical. In the case of the VA, both results obtain.
Not only does the Veterans Health Administration score better on quality measures than virtually any other area of the American health care system (
RAND,
CBO), it rates considerably higher in patient satisfaction than do other payers or providers. In 2010, the VHA had an American Consumer Satisfaction Index score of
85 for inpatients at VA medical centers and 82 for outpatients at VA clinics. Hospitals nationwide had a rating of
73 that year and health insurance also had a rating of
73 (the highest scoring individual big name insurer, Blue Cross and Blue Shield, scored a 70).
Regarding their costs, that CBO report cites research showing that
"if the federal government had tried to buy from providers in the private sector the same array of services and products delivered to veterans by the VHA in 1999, the cost to taxpayers would have been $3 billion more in that year. (That higher cost represents an increase of about 17 percent over VHA’s total budget of $18 billion for that year.)"
Indeed, the VHA's cost growth has been relatively tame compared to the rest of the health system:
"Adjusting for the changing mix of patients (using data on reliance and relative costs by priority group), CBO estimates that VHA’s budget authority per enrollee grew by 30 percent in nominal terms from 1999 to 2007. Although that estimate is not as low as the growth rate suggested by the unadjusted figures, it still indicates a substantial degree of cost control when compared with Medicare’s nominal rate of growth in costs per capita over that same period."
For comparison, private insurance premiums grew by an average of more than 9 percent
per year over that 8-year period (and national health expenditures grew by more than 7 percent per year).
Let me reiterate that: the VHA is associated with higher quality, higher customer satisfaction scores, and lower cost growth than the rest of the American health sector. They also remain ahead of the game on factors like care integration and use of electronic health records.
Perhaps the only practical solution is for the government to agree to pay a certain amount towards a veteran's premiums, like $7000/annum. Anything else is probably doomed to failure.
Again, practical solution
to what? To repeat what I asked in my last post, what's the point of this exercise--what exactly are you trying to achieve by ending the VHA?
You forgot to flush again.
