VHA as State Healthcare Prototype

If I could find a souvenir
Just to prove the world was here
And here is a red balloon
I think of you and let it go
--Nena

Although the federal government generally exerts influence on the healthcare system rather than direct control, there are pockets where control does accurately describe the situation.

One such situation is the Veterans Health Administration (VHA). The VHA website promotes itself as "America's largest integrated health care system with over 1,700 sites of care, serving 8.76 million Veterans each year."

While US government-sponsored care for war veterans dates back to the early 1800s, sponsorship increased following the Civil War. Veteran healthcare has been a favorite program of most administrations since the Progressive Era.

Today, government-owned or sponsored VHA assets include hospitals, clinics, medical personnel, and associated information and bureaucratic infrastructure. In 2013, the federal government spent $139 billion on veterans benefits and services (Table 3.1). While not all of this was healthcare-related, some VHA-related costs surely spill over into other lines such as general health spending ($358 billion in 2013) and Medicare ($472 billion).

As such, the federal government does indeed control a sizeable chunk of overall healthcare resources via the VHA. Many people hope the federal government will take control of more of the market--perhaps even the entire healthcare system.

That is an unpleasant vision, as the VHA offers a prototype of what such a system would look like. Inefficient. Unreponsive. Low quality care. Few people who currently buy healthcare products and services through other channels dream of switching to the VHA channel.

The VHA is once again under congressional scrutiny--as if issues should be a surprise.

Sadly, the VHA system is certain to worsen as government influence in the overall healthcare system continues to increase.

Stated differently, the already unpleasant prototype of government-controlled healthcare is destined to become more unpleasant.