The Socialized Medicine We Already Have — It  Works

There's a remarkable healthcare system operating right here in the United States. The government owns the hospitals. Doctors and nurses are government employees. There are no premiums, no co-pays, no deductibles, and no insurance companies taking a cut. It's funded entirely by taxes. Sound radical? Sound like socialism?

It's the VA. The United States Veterans' Health Administration.

The VA is, in fact, closer to true socialized medicine than almost anything else being debated in American politics today. It resembles Britain's National Health Service more than it resembles Medicare. And yet it exists, it functions, and for millions of Americans, it works.

A physician colleague of mine — a senior professor of medicine at the University of California — had full private health insurance through his employer. He could have gotten his care anywhere. He chose the VA. Why? Because the coordination between providers was better and he didn't have to waste time fighting insurance denials.

Think about that for a moment. A doctor — someone who knows exactly how the system works — preferred the government-run option.

The research backs him up. Studies have repeatedly found VA clinical care competitive with or better than private sector care for conditions like diabetes, heart disease, and hypertension. A RAND Corporation study found the VA outperformed both Medicare and private insurance on several key quality metrics. For mental health and care for PTSD, the VA’s specialized programs are among the most evidence-based in the world.

And then there are medical records. While private hospitals were still drowning in paper charts, VA engineers and clinicians built VistA — a comprehensive electronic medical system in which a patient's history followed them from facility to facility, coast to coast. Doctors could see medications, allergies, and prior diagnoses — instantly. The VA invented the model that the rest of American medicine and the world would spend the next thirty years trying to replicate.

Is the VA perfect? No. Wait times are often too long, and quality varies by location.

These are not small problems.

But here's the distinction worth making: the VA's clinical quality tends to be good to excellent. It's their systems and logistics — the access, the bureaucracy, the wait — that let people down. Those are real and fixable management problems. They are not evidence that government-delivered medicine can't work. The VA is living proof that it can.

We treat systems of socialized medicine as dangerous foreign experiments — yet we've been running one for decades, for the people we claim to honor most. By many measures, it outperforms what the rest of us have. So why can’t we call it what it is: a single-payer, single-delivery system?

Maybe the question isn't whether government-run healthcare can work in America.

Maybe the question is: Why do we only offer it to veterans?

— Dr. Michael Wilkes with a Second Opinion

Further Reading:

• A 2016 study, published in the Journal of General Internal Medicine: RAND analyzed a decade of research on the VA and found it generally delivered care that was better or equal in quality to other health care systems.
• A 2018 study, also in the Journal of General Internal Medicine: VA outpatient services outperformed commercial HMOs, Medicaid HMOs, and Medicare HMOs on all 16 measures of effectiveness of outpatient care examined. 
• Using Research to Transform Electronic Health Record Modernization, 2023, Journal of General Internal Medicine, PMC10593706.

The latest on Question Everything with Brian Reed: A 13-Year-Old’s First Words After Attempting Suicide: “I Need To Check Instagram.”