The Best is Still the Best


Conservatives like to argue that “government-run health care” is doomed to failure, and thus any effort to reform the US health system is also doomed to failure since it’s destined to end in a government-run dystopia. One argument liberals make against this is to point out that it’s false. The World Health Organization’s ranking of health care systems around the world places a diverse group of systems ahead of the United States. That includes systems with Beveridge-style models (like the UK), systems with a single-payer insurance model (like Canada), and Bismark-style regulated-competition models (like Switzerland and the Netherlands)—all kinds of things work better than what we do. Another things liberals point out is that the Veterans’ Health Administration, which is an island of Beveridgism amidst America’s capitalist health fiasco, performs much better than the rest of the system.

That said, nothing is without its flaws, and this New York Times account of a rogue cancer unit at one VA hospital is certainly disturbing. Since the malfeasance has been discovered, I both hope and assume that the problems will be remedied. I also assume we’ll hear more of this kind of argument from Megan McArdle:

We often hear wonderful things about what the VA can do because it’s not a private sector system. I suspect this is also one of the things that can only happen at the VA.

This mode of argument seems beneath intelligent people. The case for the VA’s high quality is not constructed out of a handful of touching anecdotes. It’s a statistical comparison between the VA as a whole and alternative systems. As best I know, the information Phil Longman and others have presented regarding VHA quality remains valid. If it’s not—if some new studies have been done showing a dramatic erosion in VHA quality over the past couple of years—then that’s news worth reporting. If not, the exposure of problems at one sub-unit of one facility should be occasion to clean up the problem and maintain the VHA’s generally high standard of excellent, not an opportunity to randomly smear the hardworking people throughout the rest of the system.

That said, for the sake of readers’ understanding it should be noted that the whole debate over the VHA has very little to do with the health reform proposals facing congress. None of them entail creating anything resembling a VHA-style integrated system of government-run health providers. Some countries do operate on that model, but most countries with national health care systems don’t, and none of the bills in congress would have the United States move in that direction.