[DoreenMichele]

and spending a fortune on bootstrapping a public health system that undermines insurance and private health.

I think we could start by expanding military medical benefits. For example, give lifetime benefits to all honorably discharged service members, not just those who made it to retirement. We already have a government funded and run system. It has some excellent assets, such as Walter Reed, a research facility. We could just start quietly expanding that in a way that people could get on board with.

(Changed "honorably discharged veterans" to "honorably discharged service members" for clarity.)

[sailfast]

We already have a system for that called the VA. Their track record over the last ten years in providing care is pretty abysmal. I am not confident your suggestion would result in a different outcome but I’m open to ideas.

[r00fus]

That’s mostly because we started two wars without costing in the trillions it would cost to care for battle vets.

Then we continued to underfund the VA.

It’s only logical that it’s where it is.

Some of us foretold this from before the wars.

[TheBeardKing]

And the VA is run by government employees, which are just not cost efficient. Source: I am one and work with thousands of them.

[sailfast]

To be a bit snarky: why haven't you quit to give the job to somebody more cost efficient? Do you think that if you were given your job as a private citizen you would do better / be more efficient?

I agree that certain jobs do not have to be done by the government and in that way, doing them via government gives rise to all sorts of bad incentives and inefficiencies, but I would not want to paint anything run by government employees as cost inefficient (especially if it's a core government competency) compared to the private sector alternative without some clear evidence.

[TheBeardKing]

In my experience, the benefits and job security guaranteed to government workers provides no added benefit for the taxpayer. No market incentives translates to no worker incentives, and everyone is just riding the gravy train to retirement. The bureaucracratic red tape imposed by Congress builds up endlessly, and special interest groups and crony capitalists magnify the inefficiency. Most government pay systems provide raises based 90% on time served instead of performance, though the ship is slowly turning towards performance-based systems. My agency tried pay-for-performance years ago, the union shut it down, went back to GS, now they're trying performance again.

The comment was directed at the VA, there's no reason it needs to be run by government personnel for the most part. A few could be on hand to handle classified matters if necessary. People hired by the government are not necessarily the best subject matter experts, as the rigid pay structure doesn't allow offering to pay what they're worth - and more often, to pay less, as many job classifications are simply salaried too high. Maybe strictly in matters of government policy could an expert find their niche, and I'd agree be a core government competency. Most other government agencies I can think of would be better off contracted out to enact the laws set by the President and Congress, with the flexibilty of private employment pracitices.

[dsfyu404ed]

One politican's inefficiency is another politician's jobs program.

[verall]

I think this is just media spin. If you interact with VA much I think you find its staffed by a lot of vets and they try hard to do their best. There are problems of funding and staffing and more, esp in poorer areas, and I have heard some bad stories, but it hasn't been my experience.

If you're speaking from personal experience I'm interested what happened.

[sailfast]

Mostly speaking based on my hearing first-hand from those working there to some of the technology horror stories / treatment backlog issues. There are also some fairly comprehensive issues with specific hospitals that I recall from the news, but maybe that's media spin.

My point is not that interacting with folks at the VA is bad (generally folks try to do their best) but that at a certain point if a single organization runs a specific function incentives get turned around to the point where you lose the ball somehow, and there's no pressure to improve. This seems to have happened to a certain extent at the VA and I see the pattern happen a lot across large institutions, generally. ESPECIALLY if they are not in a competitive environment.

[koolba]

I’d rather go the other direction and expand Medicaid by allowing anyone to “buy in” to it regardless of income level.