Making All Hospitals More Like the VA’s

Phillip Longman thinks he’s figured out how to solve the problems of the medically uninsured. Rather than realigning the entire system so that everyone, including the vast majority of Americans who are now satisfied with their options, is under one system, we should create separate hospital system for the poor modeled on the Veteran’s Administration.

When I first saw that notion at Kevin Drum‘s place, I chuckled. Apparently, though, I’m way behind the times. Longman:

There’s a funny thing about the VA. Among most Americans, it still has a reputation for mediocrity at best, and abysmal care at worst. Last spring, when the Washington Post reported on scandalous conditions at Walter Reed Army Medical Center, many observers mistakenly saw the news as another black eye for the VA—not realizing that Walter Reed is in fact run by the Defense Department, an entirely separate cabinet agency. As for the VA, since its technology-driven transformation in the 1990s, those who use it love it. The VA has the highest rate of patient satisfaction of any health care delivery system in the United States, by far—higher even than fee-for-service Medicare, with its limitless choice of doctors. As readers of this magazine are likely to know (see “Best Care Anywhere,” Washington Monthly, January/February 2005), the VA also comes out on top of virtually every study ranking the quality, safety, efficiency, and cost-effectiveness of U.S. health care providers.

He explains in some detail how this transformation happened but, at the core, the answer is pairing vast amounts of accurate information with powerful incentives.

Even Drum is skeptical and he’s both an easier sell on statist solutions and more studied on the health care crisis than I am. Still, the basic outlines of the plan are appealing. It would seem to go a long way to solving the most critical problem of the system without creating a lot of new ones. I’m less thrilled, though, than Drum about the prospect of this being “the camel’s nose” in socializing the entire system.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College. He's a former Army officer and Desert Storm veteran. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. greenpagan says:

    The United States used to have such a system, for US Merchant Seamen, American Indians, US Coast Guard, Public Employees, etc. The US Public Health Service hospitals. They were pretty good. Or at least better than nothing. But when the late ungreat Ronald Wilson Reagan came into office–having declared war on the poor and the workingclass in general–he abolished them.

  2. JKB says:


    I’m not sure how closing down a hospital system that served a population that was declining and moving those individuals to either the military system (USCG and USPHS) or to the same health plan for the rest of the employees of the USG (Civilian Mariners) is a war on the poor and working class. Wages for the civ mars are set according to the prevailing industry wages and paying for health insurance is part of the Union negotiations when setting pay in the industry. Entry level pay for someone with no ratings or experience is $30k with room and board while on the ship. Mates and engineers can make over $100k with room and board provided.

    Caveat: I don’t know if private sector mariners were covered by USPHS hospitals prior to 1980, in any case they get health benefits through their unions these days and aren’t limited to where they can receive care.

    Indian Health Service still runs clinics and provides services to their constituents.