A Few Things to Keep In Mind About the V.A.

Even though there may be somewhat less demagoguery around the scandal at the Veterans Health Administration than around some other issues, there will no doubt be a certain amount on the way. So here are a few handy things to keep in mind:

  • This scandal isn't about the quality of care. While there are surely some veterans who have gotten poor care, just as there are plenty of patients at private hospitals who get poor care, the V.A. actually has an excellent record on this score. Surveys consistently show most veterans are extremely satisfied with the care they get at V.A. facilities, often more so than private insurance customers. And independent studies from places like the RAND Corporation have found that patients have outcomes as good or better at the V.A. as in private care. The problem around which this scandal revolves is how long vets have to wait to see a doctor, not what happens once they get there.

    This is an important distinction to make, because there are going to be conservatives saying, "See? Socialized medicine doesn't work!" And it's true that the V.A. is indeed socialized medicine, much like what you have in Britain—veterans are insured by the government and get care at government-run facilities with medical professionals who are government employees. But what we're talking about now, in terms of the scandal, isn't so much socialized medicine, or really medicine at all, it's the agency's difficulties in moving vets through the system.

  • The problems go back decades, but are particularly acute now. The Obama administration's task has been like trying to repair a leaky boat while simultaneously bailing out the water that keeps flooding in. They have made strides in updating an antiquated paper-based system for processing veterans' disability claims, but those claims keep pouring in at a rate of a million a year, driven by the large number of veterans of Afghanistan and Iraq, and by some policy changes the administration has made to make it possible for more vets to get benefits. So while backlogs and wait times have been reduced, they're still incredibly long.
  • The V.A.'s budget has gone up significantly. Using the White House budget's historical tables (How do I love thee, historical tables? Let me count the ways…), I charted the V.A.'s budget. As you can see, the department's spending went up dramatically in the last few years:

Spending this year is triple what it was in 2002, the year before the Iraq War started; it now tops $150 billion a year. But it's obviously still not enough.

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