VA

As the almost daily reports of problems with the Veterans Administration health care system are reported, please recall that during the run up to Obamacare the press often portrayed the VA as a good example of how well government health care works. This was just one more bit of misinformation that surrounded this program. The number of uninsured decreased from 17.5% to 11.5% which means that 18 million who were previously uninsured are now insured. About 6 million of these people were eligible for free insurance under Medicaid and another 6 million lost their private insurance through their employer and another 6 million are people who had no insurance and signed up and most of these are getting some subsidy. The Medicaid sign ups were people who were eligible before Obamacare but chose not to sign up because there was a small fee and pre-existing conditions were covered. Thus they would just wait until they needed the service and then they would sign up. At this time we still have 35 million uninsured and they are the people whose income is high enough that they don’t qualify for subsidies. As the tax penalties for being uninsured increase more of these people will sign up. Most of these people are deterred by the high deductibles. They feel if they have to pay the first $5,000 each year that this is not really insurance. In fact it is the best kind of insurance to buy since the high deductible keeps the cost down while protecting a person from a catastrophic illness or injury. The people on Medicaid pay zero deductible and those with subsidies pay partial deductibles so the problem is for those whose incomes are high enough that they get no subsidy. Many of these people are now buying a new kind of insurance plan that helps cover the deductible. The others just use medical care when absolutely necessary. There is a belief that prevention promotes better health and while this may be the case on an individual basis it is prohibitively costly on a general basis. For example a test for TB cost about $20 and there are about 2,000 cases annually in the US. If we tested 320 million people to find those 2,000 the cost would be 3.2 million dollars for each case discovered. While prevention is good it is not cost effective.