A blogger over on Washington Monthly flagged this article on what's been happening to the Veterans Hospitals in recent years. This was something I had not known about at all, and it's worth looking at. Apparently, some new blood in the middle 1990s came into the VHA and kicked some serious ass.

Now, of course I was expecting the usual waxing lyrical over how swell it would be if the government ran all the health care now, but instead the author presented a fascinating idea for "care-for-service" discussed near the article's end, which evokes Heinlein's "public service for franchise" concept. It's original enough to be worth looking at, and most importantly, it's presented as a choice, not a mandate. Could something like this work? Some people would complain that only the poor or disadvantaged would be "forced" into this option, but it seems the case the author is making is that this care system is actually superior to many private ones.

I still have a few problems with his analysis. His ideas on reducing choice to improve operations don't sit right (efficiency is not the only goal of an economy), and his reasoning on why improving health care reduces the bottom line for health providers leaves the customer completely out of the equation. It's like assuming that cutting prices at a store will wreck the store because of course, they'll make less money. The behavior of customers in response to the lower prices is not considered.