Why the VA Scandal Doesn't Predict Anything About Obamacare

The VA's problems may be evidence of socialized medicine's shortcomings, but the Affordable Care Act works in entirely different ways than veterans' benefits.
Larry Downing/Reuters

As if it wasn't bad enough that dozens of veterans may have died because of the VA system's failures, some conservative pundits are turning the fear factor up a notch: This is what awaits us all under Obamacare, they claim.

That's nonsense. The healthcare system that the Veterans Affairs Department administers (or fails to administer) has almost nothing in common with the Affordable Care Act. No matter what specific series of failures led to the VA scandal, and even if Obamacare goes horribly, it would take enormous leaps of logic to connect the two.

Not that needing enormous leaps of logic has ever stopped an anti-Obamacare talking point before.

"This is going to be the VA on steroids … much, much worse," conservative icon Ben Carson—who is a doctor—said in an interview on Fox Business. "Without question," people will die under Obamacare, just as veterans allegedly died because of the VA's mismanagement, Carson said.

"The real problem is not management," the New York Post editorial board wrote last week. "The real problem is government-provided health care .… If the government can't even make such a system work for our vets, what makes anyone think it will work for the rest of us?"

If you want to argue that the VA's problems are a sign of what happens under true government control of a healthcare system, well, there's an argument to be made there. Some of the problems at the VA—namely, long waits to see certain doctors—are similar to the biggest complaints about other socialized or quasi-socialized healthcare systems, including the UK's.

And the VA is about as socialized as it gets: The federal government owns the hospitals, employs the doctors who work in those hospitals, and finances the coverage that veterans use to get care.

Obamacare, though, is not socialized medicine. It's not a government takeover of the healthcare system. Sure, people call it that, and in comparison with charges like "death panels," those characterizations don't sound so off-the-reservation. But they're still wrong.

Most people accessing the healthcare system through Obamacare will do so by purchasing private insurance through the law's exchanges. The federal government regulates those insurance policies and requires them to cover certain services. The vast majority of exchange customers also receive subsidies, funded by the government in the form of tax credits, to help pay for their premiums. So it's not like the government isn't involved at all.

But, unlike with the VA, no one on the exchanges is buying insurance from the government; it's all private coverage. The government doesn't decide how much that coverage costs. It doesn't employ doctors, or decide how much they'll get paid, or require them to accept any of the insurance plans sold through the exchanges. "Obamacare" is not a healthcare system. The VA is.

Obamacare also expands eligibility for Medicaid, which is a government-run program. But it's still not socialized medicine like the VA: You don't use your Medicaid card to go to the Medicaid hospital for an appointment with the Medicaid doctor, the way veterans do with their VA coverage.

"If the GOP can't find the courage to enact fundamental reforms of the VA, it has no right to complain about Obamacare," conservative healthcare expert Avik Roy wrote in a post that suggests moving veterans into Obamacare's exchanges.

The structure within the VA that allowed long backlogs to develop and, allegedly, allowed workers to create secret, off-the-books waiting lists, is a structure that has a lot to do with the specifics of that system.

Private insurance doesn't create backwards incentives to trap patients in an endless appeals process, the way the VA apparently does. Plans sold through the exchanges offer different levels of benefits and different networks of doctors; the VA is the VA. The VA is a unique system with specific flaws. Its problems don't simply photocopy themselves onto the private insurance market just because they're both healthcare systems.

And yet …

"You're going to see this is really what the rest of you all are going to get: One big fat VA system in the form of Obamacare," Fox News host Kimberly Guilfoyle said last week.

Her cohost, Eric Bolling, went further and tried to extrapolate, based on the accusations about the VA, precisely how many people Obamacare would kill.

"If people are dying, how many people are going to die in Obamacare? Do the math. It will be about 500 people per year that are going to die waiting—apples to apples—500 people will die on Obamacare" Bolling said. Nope.

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Sam Baker is a healthcare correspondent at National Journal.

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