Why VA health care is not comparable to Obamacare or single-payer systems
I often see opponents of the Affordable Care Act and single-payer health care systems point to the VA system. “See!”, they cry, “the government is terrible at providing health care!”. But there is a big misunderstanding involved in the comparison. While VA insurance for veterans could be considered single-payer (one source funding health care coverage for everyone in a particular group), I would further clarify that it is single-supplier health coverage. Most veterans must go to VA facilities to receive services (with some exceptions).
Conversely, Obamacare involves the government helping to ensure Americans have the ability to buy health coverage (oftentimes via subsidizing the coverage), and then Americans can go wherever the hell they want to receive services. Those who are on Obamacare plans have commercial insurance; they are only bound by the insurer networks. In West Virginia, Blue Cross Blue Shield is the largest exchange insurer, and they are in network with 9 out of 10 doctors and hospitals across the country. Obamacare enrollees are not getting their health care from government facilities. This is an important clarification, because it shows that the VA comparison is a faulty one.
Likewise Medicare patients can go anywhere they want for medical services within the bounds of their networks. 3 out of 4 physicians accept new patients with Medicare. That means that “government-run health care” has nothing to do with where Americans receive their medical services on the supply side.
Within the Obamacare exchange system, the government is simply: 1. regulating what insurers must offer to ensure that everyone can buy insurance that covers essential services like maternity care, emergency care, hospitalization; and 2. providing subsidies to ensure that low and middle-income Americans can afford to purchase said coverage; 3. providing an “exchange” in each state where people who need insurance can find comprehensive coverage. Even if we introduced a public option or moved into a single-payer system, that is simply referring to the “insurance” that funds/ provides the coverage, NOT the supply side where Americans are actually receiving health care. Again, in the VA example, the government is both the insurer AND the supplier of medical services.
