When Obamacare was under consideration in Congress, liberal bloggers like Ezra Klein, then at the Washington Post, called the VA health system "one of the most remarkable success stories in American public policy." It was an example of "when socialism works in America."
True, in some respects the VA system performs admirably. Its work on prosthetics has helped many severely wounded veterans live productive and satisfying lives.
And it's also true that some VA units perform better than others. Death rates and IV-line bloodstream infections are far better at the top-rated Boston VA than in Phoenix, for example.
But, as the Ethics and Public Policy Center's Yuval Levin points out, "centrally run, highly bureaucratic public health care systems that do not permit meaningful pricing and do not allow for competition among providers of care can really only respond to supply and demand pressures through waiting lines." Long queues are the price of free care.
It's easy to call for eliminating waste, fraud and abuse, and sometimes an administrative change can improve performance. Levin, who worked in the George W. Bush administration, credits the Clinton administration for some "very well executed" modernization efforts at the VA.
But policy failure and mismanagement, Schuck argues, are the result of "the deep structures of our policy system -- perverse incentives, collective irrationality, lack of credibility with necessary stakeholders, the superior speed, flexibility and incentives of private markets, obstacles to implementation, the inherent limits of law as a policy instrument and a mediocre and degraded bureaucracy."
It doesn't help when you have a president uninterested in the actual operations of government and a VA secretary unduly trusting of subordinates.
Barack Obama came to office determined to expand government and confident that Americans would like it. Instead, Obamacare, the sluggish economy and now the VA scandal have tended to discredit big government more than any abstract argument could.
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