American Elephants


The VA Scandal Is Caused By the Perverse Incentives of Socialized Medicine. by The Elephant's Child

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Memorial Day just calls more attention to the scandal of the Veterans Administration hospital system. Democrats are in panic mode. This is a bad one. Nancy Pelosi is trying to blame it all on Bush, the usual fall-back position. She would have it that it is all the enormous influx of young veterans wounded in Bush’s wars. Nice try, but that’s not the case. It isn’t the young guys that are dying of inattention, despite their sometimes grievous wounds, they are younger and healthier. The problem is socialized medicine.

The reason Democrats are attracted to government-run health care is that the left is always focused on intent, not results. They believe in government by experts, the best and brightest, and ever more experts to get it right — in other words, in big government. Their intent is what matters. If the results aren’t right, they will fiddle and tweak until they get it fixed.  But they intend a bright and shining success.

When you guarantee beneficiaries free treatment which is open-ended in terms of cost, more patients are apt to seek treatment for less important reasons. They have no idea of the cost—they are guaranteed care. For the government, the patients are now their responsibility and the incentive is entirely to cut costs.

Doctors and nurses may well be wonderful, and choosing to work with veterans indicates a caring intent, when they could probably do as well or better in the private sector. But for the bureaucratic staff, the incentive is to force the medical staff to cover more patients in less time, to prescribe cheaper medicines, to do less costly procedures. Success at bringing down costs results in bigger bonuses and career advancement for the bureaucrats.Some are represented by unions. The incentives for unions are to gain bigger bonuses, better retirement, and better pay, not better care for vets.  Which results in long wait lists, hidden because they are embarrassing and certainly not resulting in career advancement— or exactly what we’ve got.

Democrats don’t really understand what all the fuss is about, because they are focused on their intent. The results can be tweaked to prevent such problems.

You can see  the intent of ObamaCare being tweaked daily by the president, as he issues executive orders and rewrites the law to overcome problems. But we have had added the United States Preventative Services Task Force (USPSTF) which issues decisions on what preventative services will and will not be covered and for whom they are indicated. Got that? You don’t get to decide, it will be decided for you by a new agency filled with unaccountable bureaucrats.

The Independent Payment Advisory Board (IPAB) is tasked with cutting Medicare costs either through a reduction of services or by cutting the payments to providers. They simply don’t understand that they cannot cut payments to providers below a certain point or there will be few or only poorly qualified providers.

Whether with Medicare, Veterans Care or Medicaid, Obama and his advisers were particularly concerned with the higher costs of health care for older people. Statistically, the biggest expenses for health care are in their final years. If you can cut back on those expenses, and old people have fewer worthwhile life years ahead of them, then you are more apt to meet your budget.

And again, whenever care is free at the point of service, the more care people will demand. I wrote this in an earlier post, but this is what Obama said:

Obama did say that people might be better off taking a pain pill than getting surgery. He also said “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there.” Excuse me, but isn’t that what health care is for?

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