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How to not fix America's debt problem

I don't favor privatizing veterans' health care. Neither does prime-time MSNBC host Rachel Maddow, as she spent several minutes of her program Thursday night making clear. So I was hoping Maddow would defend the VA with some reasoned argument -- stressing, maybe, that this government program is actually relatively innovative on care delivery and cost control. Instead she spent a lot of time snarkily suggesting that we ask the beneficiaries of government aid whether they'd like less aid:

No, veterans care is not perfect. But tell this nation's veterans that you want to get rid of VA and see what they tell you....Like Social Security, like Medicare, you want find out whether or not VA care works, go and tell the nation's veterans that you want to take the VA away. Go talk to veterans' organizations. See what they think of privatizing veterans' care and ending the VA.

So one can measure the success of a government program merely by consulting those who benefit from it? Sure, beneficiaries of some government welfare programs might complain about the benefits they get -- but they're not going to say that they want the government to spend less on them, even if it should. And when recipients of government aid like the largess, that might show some very basic competence in distributing benefits, but not much more than the fact that spending money on people often makes them happy. Neither response on its own demonstrates that the program is a good deal for taxpayers.

By Maddow's slippery "logic," countless wasteful government benefits enacted all over the world would be "successful." Including, say, America's bloated and indefensible farm subsidy system, which robs average taxpayers to pay large agribusinesses. That's a great deal -- for the agribusinesses. Maddow also mentioned that independent groups had highly rated the VA's service. But, again, these ratings reflect the quality of the benefits, not the efficiency of the program.

Why does this matter, if I basically agree with Maddow on the policy, anyway? First, because throwaway arguments undermine the cause. But also, and more importantly, because of how dangerous Maddow's logic is when applied elsewhere.

Those who favor a robust social safety net must honestly examine how much federal programs cost, determine where they can be more efficient and make tough choices about what the government can sustain in the long-term. Otherwise we will have to dismantle the safety net when the government can no longer meet its obligations, resulting in more damaging cuts than would have been necessary otherwise. Judging welfare programs merely by the satisfaction of those who have an interest in sustaining them deeply undermines this process.

But Maddow seemed all too happy to use this reasoning to deflect criticism of every large federal entitlement, lumping Social Security and Medicare -- both of which require some reform if America's safety net is to reflect its capacity to pay for it -- in with the VA, all programs, apparently, that can't be touched because beneficiaries like them. "Tell an audience of people who are on Medicare, you would like to take their Medicare away from them. See how they react. See what happens. I highly suggest you bring a riot shield with you." And what if rapidly escalating health expenses eventually require more cost control? Surely Medicare recipients wouldn't like that. So is that out of bounds, too?

Maddow has made a point of avoiding this logic at times in the past. I wish she had been more careful Thursday night.

By Stephen Stromberg  | September 24, 2010; 11:30 AM ET
Categories:  Stromberg  | Tags:  Stephen Stromberg  
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Comments

Good points Mr. Stromberg. VA hospitals do excellent work but they are hardly a model in efficiency. I went to visit my father at the local VA hospital and saw many veterans waiting to be seen. Some of the VA hospitals work could be outsourced to local clinics without missing a beat (not every town has a VA hospital). I don't think that is necessarily privatizing veteran's healthcare.

Posted by: gmfletcher12 | September 24, 2010 12:19 PM | Report abuse

gmfletcher12,

While not perfect, from a purely economic standpoint, the VA is one of the most efficient healthcare delivery systems in the country. Sure, lines are long, and maybe some outsourcing to clinics for low level care might be warranted. But the point still stands: the VA is one of the most efficient, and innovative, systems around. Electronic health care records to increase speed while reducing mistakes? Pioneered and first put into widespread use by the VA. Team approach health care management to reduce redundancy? Also pioneered by the VA.

The problem with the VA is that it was unprepared for the great influx of eligible veterans returning from Iraq and Afghanistan and was underfunded to deal with the problem for the first years of those wars (by the way, not an attack on Bush -- both Republicans and Democrats in Congress, as well as the Bush administration, share the blame for that). In addition, the transition from DoD to the VA for discharged veterans was ridiculously difficult and inefficient, and included lots of unnecessary redundancy.

So yeah, lots of problem with the VA but none of those problems are relevant to the efficiency of the health care delivery system. I am in agreement with the author: Maddow should have used the VA as a model for how efficient government can be.

Posted by: DM_Inf | September 24, 2010 1:16 PM | Report abuse

At least Maddow is "man enough" to step up and question the idea, "slippery" logic and all, instead of just believing something to be true because some old, and/or cloistered republican says something is good for other people. I also don't consider asking people who have direct experience with a system, to share their opinion, as a bad thing...any idiot knows it isn't a scientific study including Maddow. As a matter of fact, the only thing I see going on right now, is a bunch of fat cat, old/old thinking politicians (republicans and scared-y-cat dems) who have their own lovely government health care/benefits, claiming that they know what is best for EVERYONE ELSE (even when what they think is best, isn't and won't budge because of this partisan BS). I assume that they would happily opt out of their own government provided health care programs (which give them access to better health care than the average, middle class citizen)? Or, are we going to hear how our government officials somehow deserve better health than I do? You may think that Maddow's logic is inferior to yours (one tactic men use to difuse the voice of a woman with an opinion) but I applaud her for not accepting the dullness of a government that is STILL a predominately white, upper class group of old dudes (some of whom are puppets for other men with even more money/access), who, when they do allow women in to their circle, use them to channel their own agendas (Jan Brewer is a perfect example)! At least Maddow isn't a "man-puppet", and she's damn funny! In other countries, she'd be stoned, literally, for the way she speaks out. In this country, fat cat men, throw hissy fits and challange her "slippery logic". Rock on, Maddow!

Posted by: jane1960 | September 24, 2010 4:46 PM | Report abuse

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