In an earlier column I acknowledged that I had been too optimistic about the medical care offered by the Department of Veterans Affairs. Having cited its popularity as a refutation of the argument that government inevitably messes up when it provides medical care, I felt it was important for me to acknowledge that there were serious problems.

I am pleased now to report that the consensus answer to those problems was, not a cutback of the role of the federal government in providing medical care, but an expansion of it.

There was one small corrective action – an expansion of the ability of VA officials to discipline people who misbehave, particularly if that misbehavior led to delay in care being extended.

Balancing the rights of public employees with the need to promote efficiency and penalize bad behavior is a constant problem in the public sector. In the past, I believed that some representatives of public employees resist too strongly the need for appropriate discipline; in recent years the far graver problem has been the insistence on right-wing Republicans in wiping out any rights for employees. But in a rare demonstration of complete bipartisanship, Congress responded to the central issue by providing more money to the Veterans Administration so that the agency could provide more care to the veterans who need it.

If the resolution to this crisis had been guided by the “government is always the problem” rhetoric of today’s extreme conservatives, the response would have been to cut back on the VA and to replace it with a system of privately funded medical care. The response would not have been to increase the capacity of VA hospitals, hire more VA doctors and nurses and in general expand its capacity, but to begin the process of replacing it with a purely private set of providers.

This privatization approach was not explicitly rejected because no one even proposed it. That is precisely the point. The fact is that the consumer satisfaction on the part of those veterans who have been served by the VA is so strong, and so deeply rooted, that not even the most conservative members of Congress proposed the orthodox conservative response to this: Replace an inefficient government bureaucracy with the private sector.


It is true that because it is not instantly possible to expand the capacity to provide the service that increased demand requires, a small part of the increased funding was so that veterans unable to be served by the VA could receive private care. But that was clearly meant to be the exception, aimed at helping those veterans who live in areas where VA facilities are not available. And it is also a measure that is taking effect while the VA’s capacity to provide direct services is expanded.

Equally relevant is that of the $16 billion appropriated to expand the capacity of a government agency to provide direct services, $12 billion was simply added to the deficit. In congressional jargon, $4 billion is the “offset” i.e., there were reductions elsewhere in the budget to balance it. (The $4 billion reductions will happen over time, and those who doubt that they will materialize when future Congresses vote on future VA budgets are right to be skeptical.)

But even if $4 billion in cuts does materialize, not enough attention is given to the fact even the most conservative congressional Republicans agreed to increase the deficit by $12 billion so that the federal government could expand its capacity to provide direct medical services to veterans in need of medical care. For those who are asking where was the tea party insisting that we “scale back the government and reduce the deficit,” the answer is that most of them were listening to their voters. That is, they were responding to what they heard from the veterans who have been the recipients of this form of socialized medicine – which is the only valid description of medical care provided by government doctors, in government hospitals, aided by government nurses and using government-purchased drugs.

Veterans are convinced by their experience that they are better served by the direct medical care provided by the Veterans Administration than they would be by any alternative form, and that is what they will continue to get.

Barney Frank is a retired congressman and the author of landmark legislation. He divides his time between Maine and Massachusetts.

Twitter: @BarneyFrank

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