Peter Suderman offers a useful corrective to Paul Krugman’s portrait of the Veterans Health Administration’s success:
When vets enroll in the program, they get assigned to these eight groups based on their disability status and calculations of their income and/or net worth. Veterans with disabilities calculated as 50 percent or more disabling are slotted into the first priority group; veterans with lesser disabilities or no disabilities at all and higher income or personal wealth get ranked in lower priority groups.
The reason is that the service was designed first and foremost to provide care for those veterans with serious disabilities. As the Congressional Budget Office noted in a 2007 report, “veterans with no service-connected disabilities and with income and/or net worth above established thresholds, who previously had very limited access to the department’s medical services” don’t fall into the VA’s “traditional target population.” The program’s administrators are clear enough about the reason for the grouping system: “Since funds are limited, VA set up Priority Groups to make sure that certain groups of veterans are able to be enrolled before others.”
The second important fact that Krugman fails to note is that on average most enrollees don’t actually get the majority of their care from the VA. In 2007, the Congressional Budget Office reported that none of the eight priority groups received more than 50 percent of its care from the program. In 2010, the VA reported that just two of the priority groups—the two groups that have the highest cost per enrollee—had barely crept above 50 percent usage.
So even the groups that rely on the VA the most end up turning to it for only about half of their care. For the rest of their health care, they rely on a combination of other public programs and private services, including Medicare, Medicaid, and private health insurance. This is not exactly a picture of a one-stop, fully comprehensive health system. [Emphasis added]
This seems worthy of note. The obvious rejoinder from champions of the VHA would be to say that we’d be much better off if the VHA were a one-stop, fully comprehensive health system, but of course that argument has to be made explicitly.