It seems that the phrase was first coined in 1945 by Clem Whitaker and Leone Baxter, the husband and wife duo behind Campaigns, Inc., and was in reference to the gubernatorial campaign of Earl Warren, who, in vying to be governor of California, proposed compulsory health insurance. The policy behind the slogan was that health insurance should be voluntary and involve individual choice, not be forced upon us by the government.
As the recent debates about the future of VA health care have become engulfed in partisan divide, this is an important phrase to remember. Political medicine is bad medicine for veterans too.
Although public interest in veterans's health care at large has waxed and waned since then, the systemic issues regarding access to care uncovered at the VA four years ago remain unresolved. Unfortunately, a permanent solution regarding access to VA care has not yet been found because, like most other things in Washington, the issue has become wrapped up in partisan politics.
The oversimplified version of political medicine at VA is that republicans favor privatizing the VA, whereas democrats favor greater investment in the current system. Ultimately, both sides want the same thing: better health care for veterans, but once again, politics corrupts the message.
No republicans are calling for wholesale privatization or dismantling of the VA, and no democrats are arguing to completely eliminate access to private care. (It is of note that VA has contracted out some care to private hospitals since World War II). Rather than argue which side is correct, let’s look at the history of other government health care programs to see that a practical, policy-driven solution is possible.
As anyone who’s followed the Affordable Care Act debates over the last decade knows, stripping politics from health care is easier said than done. Health care, for veterans and the general population, is vast and it is complicated. All too often, politicians limit themselves to making the occasional judicious-sounding statement about the need to invest in government health programs in order to halt waste and improve efficiency. The VA is no exception.
Here are a few recent examples:
On March 9, 2018, Senator Mark WarnerMark Robert WarnerThe Hill's 12:30 Report - Presented by Altria - Biden holds meetings to resurrect his spending plan Democrats feel high anxiety in Biden spending conflict Biden meets with Jayapal to kick off week of pivotal meetings MORE (D-Va.) stated that he was “deeply concerned” about an OIG report’s findings on the DC VA Medical Center, and that he “look[s] forward to pressing the VA and working with [his] colleagues in Congress to ensure that we are able to offer the best care for our veterans.”
On Feb.13, 2018, Sen. ohnny Isakson (R-Ga.), stated that “I look forward to working with the Department of Veterans Affairs in the year ahead as we continue to take steps to provide top-notch services to our veterans.”
And on Jan. 11, 2018, Senator Rob Wydman (D-Ore.) stated that “Our country’s commitment to the veterans who have served so proudly demands they receive the best possible health care when they return home.”
The examples cited above are merely meant to show the type of generic political statement often made in reference to the VA, and not to disparage any individual members’ political views on the future of VA health care.
However, it is also important to note that no amount of tinkering with a broken bureaucracy will fix the program’s deficiencies. One of VA’s chief challenges in moving forward is that it places many health care decisions in the hands of bureaucrats rather than consumers, i.e., the veteran themselves. Deferring to veterans directly is good policy, not just political theater.
An analysis of other government health-care programs shows that only the market allows consumers to make proper decisions about their healthcare decisions by having access to all information and an ability to weigh various alternatives.
For example, in 1997, Congress enacted the Medicare Advantage program, formerly known as Medicare+Choice, allowing Medicare recipients to choose private insurance plans for their coverage. At first, the program proved challenging to implement, as the benefits of competition can be relied on only in markets where the elements of competition exist.
This should serve as a valid warning to the Trump administration on VA health-care — choice is, overall, a good thing, but a choice program that is hastily implemented rather than well-thought may backfire in terms of political will.
Moving forward, a balance of traditional fee for service Medicare, which is more on par with the current VA system, has been implemented in conjunction with Medicare Advantage.
Like those eligible for Medicare, veterans’ health care needs do not fit into a one size fits all category. Whereas sicker beneficiaries tend to enroll in Fee-For-Service, healthier beneficiaries choose Medicare Advantage.
Similarly, whereas more disabled veterans with health care needs directly related to their service may benefit more from traditional VA health care, non-service connected veterans and others with health-care needs that mirror those of the general population, may benefit more from a choice program.
Aside from the political challenges of reforming the VA health-care system, Medicaid shows us that it is possible to offer both a traditional and choice of private insurance model.
Although a system that maintains two parallel tracks for VA health care comes with its own challenges, it would supply the necessary data as to what type of health-care veterans themselves choose, based on geography, age, and other factors, and not just what the politicians or the bureaucracy choose for them.
Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation’s veterans, and is also the owner of two rescued Dobermans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans’ Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs, and can be reached on Twitter @RileyTopping.