"Still the Best"
I adhere to a lot of outré notions about the desirability of introducing massive socialism into our health care system and not satisfying ourselves with a lot of tinkering around the edges with subsidies and regulations and just having the government provide health care to people as a public service, just as we have roads and police departments and all the rest (and just as you can hire a security guard or build a driveway, people could also do whatever). There is, after all, tons of evidence in favor of such a system — from the awesome cost-efficiency of the UK’s National Health Service, to the massive amounts of ineffective spending, to, of course, the excellent quality of the VA system.
I remember reading Philip Longman’s Washington Monthly article that he later expanded into a book on the VA system and expecting the end to be something like “so, as you can see, even though it’s not politically practical at the moment what we really need to do is adopt massive socialism.” Instead, though he waxed all pragmatic. Which I guess is fine. But still, the ponit should be made that we really ought to adopt massive socialism.
In general, VA’s experience underscores the potential for improving performance in a large and relatively integrated system through a sustained and comprehensive effort that involves indicators of quality, financial incentives that are aligned with those objectives, and the use of health information technology. It is important to note, though, that the combination of these factors — a large, relatively integrated system; well-designed incentives; performance measurement; and health information technology — likely creates much more substantial opportunities for improvement than any of the pieces taken by themselves. The applicability of VA’s experience to other parts of the health system, which often have a much different structure than the VA system, is therefore unclear and will be explored in CBO’s final report (which will be published next year).
In short: massive socialism works, but the applicability of its success to other models is “unclear.” Thus, the case for massive socialism. But, yes, nobody wants to hear it.