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PaperclipPerfector  16d ago (text post)   33736 thread views

Culture War Roundup for the week of February 24, 2025

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What is a VA?

The VA is a government run hospital system which provides free treatment to veterans, at very low standards. Veterans certainly use it, but it’s most popular among those who are either desperate or who have issues that won’t kill you if someone f’s them up.

If you are asking this question you are likely not from the U.S., so some details:

The VA is the U.S.'s primary "socialized" medicine - health care for veterans.

It's been criticized for having amazingly poor care (what's the difference between a VA nurse and a bullet? A bullet can only kill one person), being more of a job program than a health system, at the same time some people love it (everyone involved understands the veteran experience).

It's a huge system with a ton of rot that is essentially a preview of what would happen with single payor in the U.S.

It's a huge system with a ton of rot that is essentially a preview of what would happen with single payor in the U.S.

The VA isn't just a single-payer system - it's a "fully socialised" - i.e. single-payer, single-provider system. Among 1st-world countries, only the UK, Denmark and (for the publicly-subsidised part of their system) Singapore do this. Medicare is a single-payer, multiple-provider system as are the national healthcare systems (also called Medicare) in Canada and Australia. Canada goes further and bans most self-paid top-up care, something very few countries do (and in particular the UK and Australia don't).

All serious proposals I have seen for single-payer healthcare in the US are basically Medicare for all. We know what that looks like (Canada or Australia) - it offers a much better patient experience, at a much higher cost to the taxpayer, than the UK NHS.

I'm a member of a VFW and the VA is popular enough that we have people who assist veterans in applying for VA benefits. I don't doubt that media reports of incompetence are accurate, but the impression I get is that this is largely dependent on the hospital and the doctor. I'd certainly prefer the VA over any of the smaller rural hospitals and over most of the suburban regional hospitals.

It's popular because the financial benefits are great: for many (maybe even most) veterans the care they get through the VA system is either free or close to it. And the VA Community Care Network program means that for outpatient stuff you can actually get seen by a non-VA doctor and the VA wills still pay the whole bill (there are hoops you have to jump through, but a lot of people are motivated to jump if it means they don't have to pay a cent of their healthcare bills).

Context

Commented somewhere else but there are things to like about the VA, I suspect that part of the issue is that the part where it is weakest (inpatient care) is the part most patients know the least and where its hardest to tell when your care is ass.

It's been criticized for having amazingly poor care (what's the difference between a VA nurse and a bullet? A bullet can only kill one person), being more of a job program than a health system, at the same time some people love it (everyone involved understands the veteran experience).

One important thing to consider with the VA is that its level of care is pretty consistent over the entire country. It is "amazingly poor care" relative to many comparable institutions in some urban areas with high quality clinics and hospitals, but amazingly good care relative to what is available privately in many rural communities.

Much as I hate defending the VA I should say that the care can actually be very good at times. Inpatient medical care? Almost always awful. Outpatient care? Some of the clinics are actually excellent. PTSD treatment? Some of those programs are clearly best in the world in class.

Much of this had to do with the specific specialties and staff. Many people at the VA work at a slow pace because they want to be lazy and can get away with it, but some use that slow pace to do things like spending more time with patients which means satisfaction and care can sometimes be better.

Most of us train at the VA at some point though and the VA training experience is comically poor.

My grandmother used to work as an Occupational Therapist at the VA. They were way ahead of most of the rest of the country with a lot of the things she was doing. And, say what you will about the quality of care, the free van trip to the VA for those who needed it was a literal lifesaver.

Department of Veterans' Affairs

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