The Struggle Over the Veterans Health Administration

There are huge asymmetries between America’s two political parties. One of the most maddening is how quickly Americans forget when Republicans screw things up, which is all the time, and for the simplest of reasons. The one big idea that Republicans have is that they should hobble government, to turn its functions over to private enterprise, and to free business from oversight and regulation. When Republicans prevail, three things inevitably happen: businesses turn predatory, they take greater risks in pursuit of profit, and they dump their wastes and mistakes onto the public. Well, make that four: they concentrate wealth among the already rich, while making a mockery of our belief in justice.

But if that’s so obvious, why do we keep forgiving them? Why give them another chance, as happened in 1994 and 2010, when Republicans reclaimed the House only two years after being swept out of the Presidency? And after Trump’s mob made an even greater mess, why do pundits still expect a Republican resurgence in 2022? In other words, why when Republicans screw up, so many of us trust Democrats even less to fix the mistakes?

There are two ways to look at this question, and both are relevant. On the one hand, few people understand how things actually work, which leaves us vulnerable to half-truths and convenient homilies backed by special interest groups. On the other hand, Republicans have built a relentless propaganda machine that is constantly attacking Democrats, not just for real shortcomings but for all sorts of fantastical crimes that are only rooted in the fevered imaginations of right-wing pundits. Democrats have long been ineffective at countering either of these thrusts. Explaining how things work is too boring, and responding to madness in kind is too disrespectful, so again and again they stand blinded and take the beating. If only they had opponents who were sensible and sincere, but that’s exactly what Republicans aren’t.

If you want a concrete example, took at Suzanne Gordon and Jasper Craven: The VA Is Ripe for Right-Wing Attacks. Here’s How Biden Can Stop Them. In the 1990s under Clinton-appointee Kenneth Kizer, the VHA had become the highest-performing, most cost-effective organization in the sad-but-glitzy universe of American health care, but since 2001 Republicans have been picking it apart — while flooding the system with new casualties — making it easy to air complaints about slow service and other shortcomings. The key sentence here is this:

The right knows how to undermine veterans’ health care while simultaneously winning political points on the negative outcomes their own policies have wrought.

That is, in short, the magic Republican formula: mess things up and blame the Democrats. This overlooks the one great advantage VHA has: it is non-profit, the closest thing the US has to a NHS. It can, in short, dispense with profit measurements and solely pursue health outcomes, with strong confidence that a healthier system will save money in the long run. The problem I see is that VHA is limited to veterans for its patient pool, and the percentage of the American public that serves in its armed forces is small and dwindling. Right now, VHA is having trouble serving veterans in remote areas, because the patients are too few and far between. But the system could grow considerably if we let more people use it. It could, for instance, offer its services like an HMO, at attractive prices (at compared to private insurance). One could transition from its current patient limits by adding other public employees (who, very often, provide more useful services than does the military). Not that I like the idea of limiting it to a subset of the public — least of all to the military caste many Americans like to fetishize. An expanded National Health Service could provide a nice “public option” alternative to the private sector, whose profit-seeking approaches the predatory. An easy path here would be to make VHA an option for Medicaid.

Of course, before any such thing can happen, we have to get past the mental obstacle course Republicans have laid (and Democrats have way too often fallen for). In the 1990s, the VHA proved that capable and conscientious leadership, safe from political corruption, can deliver superior health care services. That is government at work for you, in sharp contrast to politicians who serve a private sector system that is based on market failures and run like an extortion racket. But Republicans will deny that, and blame their own failures on everyone else (like their efforts to crucify public servants like Anthony Fauci). And they seem credible, because who is cynical enough to imagine that Republican intentions are as malign as their results? An increasing number, but not yet enough to definitively reject Republican rhetoric, even among Democratic leader who should know better than anyone what they are facing.

By the way, the “Here’s how Biden can stop them” section is by far the weakest in the article. All they suggest appointing a “talented undersecretary.” That would help, but we need a more fundamental sea change in thinking about what, and whom, government is for.