Abolish Veterans Affairs Healthcare?

In the United States, we have government-operated, single-payer healthcare for only a few selected segments of our population: the very poor, through Medicare; prisoners; the military; and veterans, through the VA healthcare system. The rest of the country must pay their own way, through a mosaic of private deals between employers and individuals on the one hand, and insurance companies of various kinds, but almost always "for profit", on the other. This system has always seemed to ridiculous, in that the argument against "socialized medicine" has been that it would taint our democracy and lead to communism; yet, we provide socialized medicine to millions of members of special groups throughout the land.

Up until now, I have been against this because it seemed unfair to the population at large that they could not share the benefits given to prisoners and military veterans. But today, I read about the study by CBS investigators concerning the suicide rate among veterans, especially young veterans of the "War on Terror". It seems that the rate is about four times higher for those individuals than it is for their age-mates in the general population, as many as 120 suicides per week among those veterans. This is obviously a failure of the VA healthcare system, yet, it is difficult to criticize them unduly. The VA must provide healthcare to veterans both during peacetime and during and after combat episodes. This means that there will be long periods of relatively low and stable utilization punctuated by surges of high utilization. Its is very difficult for the VA to respond adequately during these surge periods because their resources tend to be optimized to the long periods of inter-war stability.

But what if there was no separate VA healthcare system? What if all Americans could receive the healthcare they needed from government-operated facilities? Over time, the resources of the system would become optimized to cover the needs of all Americans, a much larger and more widely distributed group. This would benefit all Americans in obvious ways: no one would be without healthcare; costs would go down; there would be an increased focus on preventative care and so overall health would improve. The undoubted benefit to the general population of socialized medicine is something I've believed in for a long time. It clearly would also benefit veterans, because one of the complaints that veterans tend to have about the VA is that for many of them, it's a long trek to the regional VAMC where they can be treated. Under universal socialized medicine, there would be few if any VA-specific medical facilities, and veterans would largely be treated closer to where they lived, which would benefit them greatly. However, the CBS study suggests another benefit to veterans that would follow the abandonment of VA healthcare in favor of universal socialized medicine: it would help mitigate the wartime surges of healthcare demand -- for the kind of mental health treatment that could reduce the suicide rate among veterans, but also for other kinds of healthcare. All those veterans who must wait a year or more for treatment by the VA would be much more likely to get prompt attention if they could go to any facility in the nation.

So, rather than blame the VA for the suicide epidemic among young veterans, to me they are just another casualty of the greed-based American healthcare system in general. Maybe someday we will be able to move past our individualistic cowboy mentality and understand that there are certain things that simply work better when we operate collectively as a nation "united".

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