[caseysoftware]

In both cases, private entities provide the bulk of the services, therefore you pay them.

And since you pay a fraction of the actual costs of the service for the public plans, the government subsidizes the rest.

The government is rarely the service provider for most of what they "provide" - roads are built by construction firms, medical care is mostly private doctors (the VA and HHS has some), the TSA is replaced by private firms in some places, and even nuclear missiles are manufactured by companies.

[lapcat]

> The government is rarely the service provider for most of what they "provide" - roads are built by construction firms, medical care is mostly private doctors (the VA and HHS has some), the TSA is replaced by private firms in some places, and even nuclear missiles are manufactured by companies.

That's a deliberate policy choice. It doesn't have to be that way, but our politicians tend to be corrupted by campaign contributions and lucrative post-political jobs or (inclusive or) free-market ideologues who demand contractor bidding for any government services.

[caseysoftware]

> That's a deliberate policy choice. It doesn't have to be that way, but our politicians tend to be corrupted by campaign contributions and lucrative post-political jobs or (inclusive or) free-market ideologues who demand contractor bidding for any government services.

That's a theory.

But as a former Fed, let me propose a different hypothesis: The people who want to do good work, want to grow, and want to push to the next level (whatever that is), don't go into government. Or if they do, they don't stay.

But don't believe me: if you know any US veterans, ask them about their experiences with the VA. Ask them if they've ever gone when it wasn't the only option.

[FumblingBear]

I'm a veteran and my experiences with the VA have been great! I fully recognize that many others don't necessarily have the same experience, but I am consistently impressed by the quality of care that I receive.

The other veterans in my area (that I know and talk to) also seem to have good experiences with our VA healthcare. Just chipping in to say that while there is a lot to criticize about the VA, there are things to praise too.

[caseysoftware]

Are you near/talking about Norfolk? That's the only exception I've ever heard.

[FumblingBear]

Funnily enough, yes! Though my care in Anchorage, AK was also great. I didn't realize it was unique enough for you to name the location on a guess though.

[sokoloff]

I have a family member who regularly gets care at the Raleigh (maybe Durham) VA and gives positive reviews. He also has a comprehensive pension-provided private health insurance and (I assume) access to Medicare, yet gets some of his overall care at the VA, which is a 3-ish hour drive away. So, it’s far from his only option.

[silverquiet]

Why is the VA their only option? I'm not aware of anything stopping them from seeing a private doctor, except for the obvious issue of cost.

[lapcat]

Any disparity between the VA and other hospitals is again the result of a deliberate policy choice to undermine government entities. With single payer health care, there wouldn't be such a disparity. And this isn't just a theory. The US is unique with our mostly privatized health care system, yet our health care costs per person are much greater than any other country, our health outcomes are worse than any other country, we have a ton of people who can't get health care, and we have many people bankrupted by medical debt, which is practically nonexistent elsewhere. Empirically, our largely privatized health care system has been a disaster.

In general, we give a lot of lip service to "supporting the troops", but mostly society doesn't give a crap about them after they come home. The only time this was different was during the World Wars period, where a large % of the male population was drafted. Veterans had political power then. Now that our military itself has been largely privatized and made up of volunteers, often themselves looking for financial opportunities, veterans are largely forgotten, except to make oneself feel good by "thanking them for their service". But if they're, say, permanently disabled from wounds? Welp, tough luck.

[silverquiet]

I work for a private employer who pays a private insurer who then contracts with private doctors - where am I getting any sort of public subsidy?