As an astute investor seeking reasonable profits, would you consider investing in an 88-year-old business with 380,000 employees in 1,831 facilities across the U.S., laboring under $255.6 trillion in accrued liabilities, with a projected income next year of $199 billion?
If you are an American who pays income taxes (44.3%, about 76 million, don’t pay any taxes), your taxes help to finance the largest health care system in America, the U.S. Department of Veterans Affairs (VA). President Donald Trump’s 2019 budget proposes $198.6 billion for the VA, an increase of $12.1 billion over 2018.
The VA provides a cautionary example. This is what happens when nervous Washington politicians keep funding government health care, trying to micromanage a medical system by constantly attempting to appease well-organized consumer constituent groups.
A Century of Frustration and Scandals
No one should, and I don’t, denigrate the vital contribution that American men and women have made in preserving our freedoms. But the considerable debt owed to those who served in the armed forces also compels a frank discussion of needed reforms of the health care programs that have failed America’s veterans.
At the moment, the scandal-ridden VA is without a secretary, the result of Trump’s game of cabinet musical chairs. VA Secretary David Shulkin, M.D., was fired by tweet on March 28. He lasted a year and 44 days.
In 1989, President Ronald Reagan proposed that the U.S. Veterans Bureau, created by law in 1930, be elevated to cabinet level. Since then, nine VA secretaries have come and gone, seven of them ultimately resigning due to scandal or from frustration.
A century of government veteran’s programs has been marked by scandal, a recurrent bureaucratic blemish that still festers today. The first head of the post-World War I VA, Charles Forbes, was sent to prison in 1926 for accepting bribes.
In 2014, yet another VA major political scandal surfaced.
The Entrenched Bureaucracy
Over 200 patients had died while waiting for care at the Phoenix VA hospital. Another 1,700 patients were never placed on official waiting lists for doctors’ appointments and never received care.
Investigations of over 100 other VA facilities discovered similar widespread VA staff falsifying of wait-time data.
With much fanfare, a shocked U.S. Congress pledged it would act decisively “to help the vets.”
There followed the Veterans Choice Act of 2014, allowing veterans who had to travel more than 40 miles or faced wait times of more than 30 days to get private care outside of the VA. The Veterans Choice Improvement Act of 2017 supposedly expanded those initiatives.
But after multiple investigations, two new major laws in place and lots of talk, very little has changed at the VA, where “reform” is a threatening dirty word among the entrenched bureaucracy.
I can personally attest that today’s VA, sadly, is very much like the VA where, from 1990 to 1993, I was an attorney in the office of the VA General Counsel, both in Washington, D.C., and in Florida.
A March 14, 2018, report by the Veterans Health Administration exposes staff as still trying to hide appointment delays, with 36% of patients seeking primary and mental health care forced to wait over a month for an appointment, and 18% of new patients waiting longer than 30 days, some as much as 53 days.
Before the ominous day of September 11, 2001, the total number of U.S. veterans was shrinking. Soon afterward, wars in Afghanistan and Iraq added four million additional veterans eligible for VA medical services.
There are now nearly 20 million veterans but, interestingly, 90% of eligible veterans choose private medical alternatives over VA health care.
The VA has 380,000 employees in Washington, 26 regional offices, 145 hospitals, 1,231 outpatient clinics, 128 nursing homes and 300 veterans’ centers, all trying not only to manage health care, but also disability compensation, life insurance and education benefits.
The VA, like the British health care system, is an example of the inherent failure of socialized, political medicine. Fundamental and zealous reform, including privatization, is the answer.
For more analysis and information, a 1994 Cato Institute report I authored is available here.
Yours for liberty,
Bob Bauman, JD
Legal Counsel, Banyan Hill Publishing
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