Ocasio-Cortez on the VA: If it ain't broke, don't fix it

If you don’t have time to watch the clip, no worries. It’ll be reprised a thousand times from many different pols over the course of your life once we finally realize the dream of Medicare for All. The system is working. The only threat is privatization.

Few, though, will be as bold as Ocasio-Cortez in citing one of the most chronically troubled agencies in the federal government as a case study in “if it ain’t broke, don’t fix it.” Ask the average American to name a “broken” department and the VA would doubtless be a strong finisher, maybe even top two. (The Department of Ed is a perennial favorite.) VA scandals famously bedeviled the last Democratic president. It’s true that the agency has improved since the dark days of 2014 with shorter wait times on average for primary care and some specialties than in the private sector, although regions like the south with a higher concentration of vets continue to see longer waits. But to cite Veterans Affairs, of all entities, as some model of government performance is amazing.

A recent USA Today survey of VA hospitals revealed that, believe it or not, they continue to underperform the private sector in some important ways.

At roughly 70 percent of VA hospitals, the median time between arrival in the emergency room and admission was longer than at other hospitals, in some cases by hours, according to a USA TODAY analysis of the department’s data…

On patient satisfaction surveys, veterans overall were less likely than non-VA patients to say medical workers treated them with respect or listened to and respected what they had to say, the USA TODAY analysis found.

They were less likely to recommend VA hospitals to others and rated their medical care providers lower.

The VA scorecards analyzed by USA TODAY feature questions for inpatients and outpatients about their health care experiences. Nearly every VA facility – 141 out of 146 – scored below other facilities on a majority of questions surveyed.

Last year saw rare bipartisan consensus in Congress in streamlining how the VA pays for private care for veterans, which could end up quadrupling the number of vets who go outside the system for treatment. Rep. Dan Crenshaw, who has personal experience here, is a fan:

Crenshaw said he has received care at four different VA facilities since his return from the war, but that too often care is inconsistent from location to location. Expanding options for veterans who face longer waits or insufficient expertise is not only a sensible step ahead, he argued, but a duty for the country.

“I need the VA to be flexible enough to send me outside for care,” he said. “This is a step in the right direction.”

As with so many other things, AOC’s messaging strategy is actually quite Trumpian. Imagine Trump pushing a big broad policy goal of his with some nuanced argument about making progress amid occasional setbacks. He doesn’t chatter at you about how easing illegal immigration requires a multifaceted approach that’ll involve technology, more border hires, aid to Central America, and ambitious enforcement measures like E-Verify. He’ll tell you to BUILD THE WALL. And not only that, he’ll tell you contra available evidence that THE WALL IS BEING BUILT AND IT’S WORKING. Ocasio-Cortez understands that the battle for hearts and minds over a change as momentous as nationwide socialized medicine isn’t going to be won with points like, “Well, the VA has sucked at times but it’s certainly gotten better recently!” You win with bold points that make people’s confidence surge: IT’S WORKING LIKE A DREAM. BUILD THE MEDICARE FOR ALL.