For families that fit comfortably within our parameters for the “deserving poor,” we have established a food-stamp system that basically hands them a voucher, wishes them God-speed, and sends them on their way. The program isn’t perfect. One of the more popular scams of late is to buy a giant container of water, return the container for its hefty deposit, and then buy cigarettes – a much frowned-upon sin within the food stamp code.
But the food-stamp effort works better than most social-service stuff.
In large part, it is market-based; government is not providing the food, but providing the means by which poor folks can be their own consumers in the private market that competes for their business – much as it does for soccer moms shopping in Simsbury.
And then, of course, we have the medical program for our military veterans, in a nation that arguably has the best medical infrastructure in the world. Do we hand our veterans a voucher for lifetime care, wish them God-speed, and send them on their way? No, we have chosen instead to build a large, elaborate, often-duplicative medical system specifically for veterans, if they choose to take advantage of the national thank-you from a grateful nation.
The hideous conditions uncovered of late at the premier Walter Reed Army Medical Center may have been labeled a “scandal” by the frisky news media, but it was no particular surprise to a cadre of heath economists who have questioned for years the need or justification for a separate medical system.
The core argument for the veterans medical system, in its early days, was its research component — the niche research on matters of battlefield wounds and the like that would not be adequately addressed by the civilian system. But like so much of government, the system has become overblown, shabby, and to a large extent, unnecessary.
Lead To Better Care
An aggressive, smart Veterans Affairs program to hand out medical vouchers and direct veterans in need to appropriate civilian facilities would work as well, if not better, for most of the military in need of help. For those seeking routine care, and for many needing special care, there is little reason to require or even encourage utilization of VA services, unless that government system is competitive with civilian care.
Even at the state level, the proliferation of “veterans’ homes” are an expensive and worrisome oversight burden, in support of military clients who could be provided for in civilian programs and facilities. In some states, such as Texas, the veterans’ retirement and nursing home needs have been privatized — a first step toward recognizing that there is no special “Texas” or “Kentucky” way of caring for ex-soldiers.
Needless to say, Connecticut is not fertile ground for privatization of any kind — certainly not, for instance, the veterans home in Rocky Hill. After a bit of embarrassment a few years back for shabby maintenance of the facility, the state dumped a bunch of money into making things all better. But in the meantime, tens of thousands of civilian elderly, alcoholic and otherwise in need are serviced by virtually identical, if not superior, programs.
The embarrassment at Walter Reed has prompted uncomfortable and disappointing scrutiny of many veterans programs and facilities. In Arizona, the director of the Department of Veterans’ Services resigned last month, amid charges of patient neglect and nepotism. A new Veterans Affairs review of 1,400 hospitals and clinics found unappetizing flaws — leaks, mold, exposed pipes, bats. The two federal facilities in Connecticut didn’t make the list of maintenance nightmares.
Of course, the “answer” to all this will be more money — but that will fail to address the more basic issue of why veterans must be shuffled off to a government monopoly.
Health economist John Phelan of Guilford, former staffer in the U.S. Department of Health and Human Services, had it right in a recent letter in the Hartford Courant, when he asked if the “average American [would] like to be told he has no choice but to go to a particular hospital or physician.” His answer: Let the money follow the veteran.
We do it with food stamps. We did it with the G.I. Bill; veterans were free to select the colleges of their choice. And we can do it for veterans’ health care.
Laurence D. Cohen is a freelance writer.
