I generally agree that a little reform is better than none (subsidize care, reform regulations, etc). Ditto on hiding the costs of care by tying them to employment. There's definitely a lot of stuff to change besides socializing the whole thing, but where we have totally socialized health care it's worked better than where we haven't. It's certainly not a good choice for Bill Kristol to pick on… it was 20 years ago, but it's not today.

So if VA gets people who are unhealthier than the general population, I'd like to know how that happens. Maybe only the poorest veterans with the fewest options are going to them, fine, but that's hardly a ringing endorsement of the VA.

My point was that your comparison is weak and I'm still not convinced that it holds. One more fundamental mistake I think you're making is in believing that there's some special sauce that the VA has that makes them somehow better managed than private insurance. You're in good company: look at any job site and you'll see hundreds of consultants claiming that they've got some magical secret to running a business. If we just modeled a huge government system after the VA and gave them all this special sauce, we'd solve health care!

There is no sauce. Most businesses don't know how they work. A big corporation might carefully analyze how they run their core business (McDonalds, for example, does know how to make a burger), but that means that they understand maybe one out of thousands of departments. So the businesses around aren't the best, they're just good enough not to go out of business. The ones that are truly terrible are regulated, in effect by the market.

The trouble with government is that the only thing to regulate the government is the political process. Sure, certain small units within the government, e.g. police and military, have people who are routinely risking life and limb and they're highly motivated. And I'm sure that doctors and nurses under a government program, who actually have to see people in pain, are similarly motivated. But when you get one level removed you find the typical apathy and mediocrity.

And when you have laws like the WWII era vestiges of wage controls that tie health benefits to employment, you can insulate certain businesses from market forces. Insurance companies provide bad service because the huge cost of switching jobs protects them from the consequences.

We could achieve most of what people want by removing the tax break for health benefits and providing a subsidy for non-emergency care. And if the Dems genuinely wanted reform, they'd start with obvious reforms like that and build on it.

This is from a 1997 article in the Annals of Emergency Medicine – The “New VA”: Delivering Health Care Value Through Integrated Service Networks

Also, “Unlike the Medicare and Medicaid programs, VA health care is not an entitlement; it is funded by a discretionary appropriation, which currently exceeds $17 billion. Access to care is limited by the amount of appropriated funding and is guided by a . Accordingly, of the 25.9 million American veterans alive today, only about 9 million are actually eligible to use the system.”

VHA patients would be more expensive, on average, to treat than the average private health care patient. Previous life in the military involves a lot of what ends up being preventative care, but also leads to a lot of chronic problems.

When you go into MEPS (Military Entrance Processing Station or something like that) you go through medical screening. Any prior medical problems? Fat? Uncorrectable eyesight? Hearing? Psychological issues? Drugs? Goodbye, and don't let the door hit your ass on the way out.

And, yes, they really will shitcan you for a boil on the ass.

While you're in the service, you're forced to get all your shots, do calisthenics / running every morning, etc. (I'm immune to smallpox, hurrah!) You have to maintain a high level of strength and physical endurance and are taped to make sure you stay within body fat levels. You get free drugs to quit smoking.

Yes, a tiny minority of soldiers see action and are injured quite badly. But, all in all, the VA gets to work with a segment of the population that is far healthier than the norm.

“Expanding the VA to be the United States’ National Health Service…”

… would be impossible without ruling out 90% of the population the way the military can. You're 100% wrong on this, bub.