Diary

VA Reform, Obamacare & 'Driving the Conversation'.

Ok. Obamacare sucks. We can all agree on this – and according to the polls, most Americans do too… However, those same polls show that the public may hate Obamacare, but they aren’t really sold on ‘what to do about it’… The Democrats, of course, are utterly opposed to any changes & have been using the line ‘the Republicans don’t have any solutions’ to try and keep it that way…

‘Repeal & Replace’ has been a good slogan, but the issue with that is that at present, there is no ‘demonstrable reason’ for the average American to trust the GOP over the Democrats on this subject beyond ‘The Dems screwed it up, let’s give the other team a try’…

Meanwhile, the VA – the only true ‘Socialized Medicine’ system that America has, being staffed 100% by government employees, in government-owned hospitals and clinics (as opposed to Medicare/Medicaid, under which the government only *pays for* care rather than providing it, and the active duty MHS/Tricare system, which is mostly government-run but has some ‘private’ features to it) – continues to provide our veterans with substandard healthcare. It’s so bad, it actually parallels the British NHS (arguably the worst healthcare system in the developed world) in terms of neglect, slow/inefficient care delivery, substandard care-quality & headline-grabbing failures… It is a walking, talking example of why ‘government healthcare’ sucks.

The scandals of a few months back have faded from the news – but back then the Dems still held the Senate & the massive reform that is needed could not happen. Now it can.

This presents Republicans with the opportunity to (A) improve care for veterans, (B) reduce the size/scope of government, and (C) prove to the American people that Republicans can be trusted to do broader ‘health reform’ right. We’d also be coming into it with the ‘built in’ trust advantage that the GOP holds on foreign policy/veteran’s issues – if we get this one right, we can use it as a beachhead to move further on the eventual removal/replacement of Obamacare.

What does ‘getting it right’ look like?

Well, for starters, it’s a bit different than what getting civilian health reform right should be. Whereas the government should not, generally, be providing health care to civilians, some level of ongoing help/coverage is a legitimate & earned benefit for military veterans. I’m sorry, but if you think we should not be providing continuing care for veterans out of some anarcho-libertarian impulse, we’re never going to agree…

With that said, there is NO REASON that the federal government needs to own, staff and operate hospitals and clinics. Especially when these hospitals are delivering sub-standard care compared to their private-sector civilian counterparts.

This is a massive waste of money AND a sick joke played upon our disabled veterans: ‘Thanks for serving, sorry you got hurt, here’s the worst health care we can legally give away for free’…. Beyond that, the government has to maintain staff and operate all of these medical facilities, all around the country, no matter how many veterans need service.

Meanwhile, the military provides still-serving reservists with the opportunity to buy coverage from a program called ‘Tricare Reserve Select’ (TRS), which although named after the active-duty medical system, is essentially employer-provided private health insurance (the govt being the employer) – administered by a major health-insurer in each region (out here on the west coast, it’s UnitedHealthcare). While it has it’s limits (low reimbursement rates lead to a somewhat-narrow provider network, and those who want ‘alternative’ treatments are SOL), the quality of care you get is the same as everyone else with private insurance going to the same private-sector doctor/hospital/clinic. All the government does, is pay most of the premiums, and (since they are the ones ‘buying’ the coverage) set the terms of what they want it to cover & how much they will reimburse…

With this in mind, VA reform should:

1) Eliminate the VA medical system, lay off the entire staff, and sell all the hospitals/clinics to the highest bidder.
The VA would become a disability-rating & benefit disbursement agency, operating in a similar manner to the Social Security Administration. It would no longer provide healthcare to anyone nor employ any veteran-facing providers, rather it would simply pay bills, cut checks & determine benefits eligibility. Proceeds from the sale of VA properties could be used to make the transition deficit-neutral.

2) Using TRS as a model, create a government-paid, privately-administered health insurance benefit for all veterans who would have been eligible for VA care under the current system. Deductables/copays would vary by disability level (just like they do now in the government-run system), but veterans would get their care from private-sector providers in their community – recieving the same quality of care as a civilian with employer-provided insurance.

The end result of this would be (a) better health care for our veterans, (b) a ‘win’ for the GOP on the subject of health care, and (c) the elimination of a redundant, expensive government agency.

Now, yes, there is likely to be Democrat pushback here – the most committed leftists see the VA as a model for what they’d like every American to be on. But this is an argument that Republicans can WIN, because (a) the VA system sucks, (b) we aren’t ‘taking away’ anything from anyone (beyond jobs from government employees, but that argument can be won with a Scott Walker-style argument: What’s more important: good health care for vets, or keeping the VA’s bloated staff on the public-employment gravy-train) , and (c) we can push the fact that the ‘classic’ VA sucks to discredit the Democrats on their plan to go ‘single-payer’ and give everyone crappy VA-style care.

From there, a ‘win’ on this is an easy start to a credible campaign to undo the mess Obama made of the private insurance market.