Smacking Down PragerU 3

In this post, I’m going to be smacking down PragerU’s “Single-Payer Healthcare: America Already Has It” video that features Pete Hegseth, former Executive Director of Vets for Freedom.

0:02-0:10

“Would a government-run, Canadian style healthcare system work in the United States? A nation with 320 million people? Well, we already know the answer.”

  1. Acknowledging that Canada has single-payer is a good start. Although you could’ve also mentioned basically every other rich country.
  2. I find the placement of “320 million people” tactical. For a single-payer healthcare system, why would it matter that there’s more people in the United States than Canada? Obviously, a bigger population would mean more tax revenue, which means funding for healthcare (and therefore quality) is able to keep up with the population.
  3. Does a private healthcare system work in the United States? Well, we already know the answer.
  4. Btw, lol @ the title
  5. Single-payer =/= government-run healthcare. Single-payer is a healthcare system in which healthcare costs are covered for all residents regardless of income, occupation or health status. Government-run healthcare, like the Military Health System, or Veterans Affairs, does not meet these requirements. You can say that the VA or MHS is similar to single-payer, but there are some crucial differences. I will talk about it more later on in the post.

0:11-0:36

“Just ask America’s veterans. They’ve had government-run healthcare for decades. The U.S. Dept. of Veterans Affairs, known as the VA, runs the largest hospital and healthcare system in America. The VA employs nearly 340,000 people. Twice the size of the Marine Corps. And it has a $180 billion annual budget, making it the 2nd largest department in the federal gov’t.”

  1. Yes, why don’t we ask the vets?
  2.  We should really ask them.
  3. I double-checked the numbers here, they’re all good. +1 for PragerU (up from -1000000)

0:42-1:05

“The VA is a true single-payer healthcare system. It runs over 150 hospitals, and 1400 community based clinics across all 50 states. The doctors, nurses, administrators – everyone who works for the VA is a government employee. The system actively serves some 7 million patients. 1/3 of the 21 million veterans alive in the US.”

  1. I’m impressed! 1 minute in and a PragerU video hasn’t made sweeping generalizations, straw man arguments and ad-hominem.
  2. But, Pete Hegseth is wrong. The VA is inherently limited precisely because it’s NOT a true single-payer healthcare system. Allow me to explain. In a single-payer healthcare system, everyone qualifies for health services. Be it rich, poor, white, black – all citizens. Although the VA definitely has the gist of single-payer, it is anything but a national health program. Most of the wait time associated with the VA (which Pete will get into  here in a little bit) is the government determining whether someone is even eligible for VA services. That is not single-payer. Furthermore, he cites the fact that there’s 21 million vets alive (I’ve also seen 22 million) but fails to mention that millions of vets do not qualify for the VA. That is not single-payer. Lastly, the VA has to deal with private health insurance providers such as Health Net, so it is intertwined with our fragmented healthcare system – which limits it from operating as a true single-payer system like Canada’s. That is not…oy vey, you get the drift.

1:08-1:29

“Sounds impressive, right? But for the past few decades, and especially for veterans in the war of Vietnam, as well as the wars in Iraq and Afghanistan where I served, the VA has been an abysmal failure. Inefficient, bureaucratic and sometimes, deadly. Among veterans, horror stories about the VA abound.”

  1. RIP PragerU’s whole minute of honesty :'(
  2. “Abysmal failure” -> wrong.
  3. “Inefficient” -> also wrong.
  4. “Bureaucratic” -> wrong and wrong.
  5. The “bureaucratic” argument is what always astonishes me the most. In any form of single-payer, administrative overhead (AKA bureaucracy) is drastically reduced because you eliminate the thousands of insurance plans, each with different enrollment, paperwork, rules, regulations, marketing etc. Example. Right now in the U.S., for every dollar spent on healthcare, about 31% of it is going to administrative bureaucracy. Contrast that to 1 or 2% in Canada. If we adopted Canadian levels of overhead, which we very well could do by switching to single-payer, we would save $375 billion annually. Those savings are more than enough to cover all Americans and upgrade healthcare for those who are under-insured. That makes single-payer systems inherently more efficient than bureaucratic, private healthcare.

1:30-1:49

“These stories were tragically brought to light in 2014, when whistleblowers in Phoenix reported that 1700 veterans there had waited an average of 115 days just to receive an initial appointment. According to the VA’s official policy: that should of been no more than 14 days.”

  1. The 2014 VA scandal was something that both sides agree was a failure and should have never happened. However, the problem was an organizational issue. Basically, lying became normalized behavior across various VA locations and as a result, some veterans suffered. But normalized deviance is an organizational issue that happens in public and private instances (see Washington Mutual). The difference is that in government-based failures, you’re going to hear about it because they’re publicly accountable and you know who to blame. In private failures, it’s harder to pinpoint private individuals who aren’t publicly accountable, so you don’t hear about it as much.
  2. Secondly, as Pete pointed out, recent wars in the Middle East and in Vietnam created a lot more vets. From 2007 to 2013, demand for VA services increased 200%, while funding during the same period only increased by 16%. In other words, proper funding did not exist to efficiently deal with the massive increase in demand.

1:59-2:07

“Phoenix turned out to be the norm, not the exception. The VA’s inspector general found systemic problems across the country.”

  1. It wasn’t the norm. It happened in several locations, that is true, but use the big picture here. Remember 500 hospitals and 1400 clinics? Only 5 clinics/hospitals were found to have had systemic problems.
  2. About 1,000 veterans are estimated to have died as a result of long wait times, which is truly despicable, but the VA adequately treats millions of veterans every year. Furthermore, 1,000 deaths pales in comparison to the tens of thousands of deaths that result in the U.S. every year due to a lack of health insurance. 250,000 deaths also occur every year as a result of medical error, with “fragmented health insurance networks” playing a role in those deaths. I’d say those are some pretty serious systemic problems.
  3. A private investigation of the VA conducted by the RAND corporation was released just last year, and government-run healthcare alarmists will be disappointed by the results.

2:47-2:56

“the Obama Administration’s own deputy chief of staff, Rob Nabors revealed that VA healthcare has a “corrosive culture”, with “significant, and systemic” failures.

  1. Rob Nabors made those statements as a testament to the fact that the VA at the time had systemic problems, not that the concept itself is bad, which is what Pete seems to be suggesting. Rob Nabor also urged Obama that the VA needed additional staff, and that the VA needed transparency and more accountability.

2:56-3:16

“What was politicians’ response to this debacle? Spend more money – a lot more money. The VA’s budget has almost doubled since 2009. They’ve hired 100,000 new people within the past decade. Wait times have actually gone up. Yet not one administrator was fired for the waitlist scandal.”

  1. Spending money is clearly what was needed in this case, along with drastically increased transparency and accountability.
  2. Specifically, Congress passed the Veterans’ Access to Care through Choice, Accountability and Transparency Act of 2014 which included with it a new ‘Veterans Choice’ program. The Veterans Choice program allows veterans who don’t live within 40 miles of a VA facility to go to a non-VA facility on the dime of the VA. It also allows veterans to seek non-VA services if wait times at the VA are too long. The idea is to improve veteran’s choice (nooo really?) and reduce wait times at VA facilities. But as Pete claims, wait times have gone up. Keep this in mind, I’ll get to back to it in a minute.
  3. Administrators were fired. The Directors of the Pittsburgh , Dublin, Georgia, and central Alabama VA system, and Phoenix VA systems were all fired. Now, I completely agree that they should’ve been forced to pay back any administrative leave they were given by the VA and should’ve lost their jobs much sooner. Also, the Secretary of Veterans Affairs resigned due to the scandal.
  4. Oh, and the VA has set up a new system of feedback and transparency that has no counterpart in the private sector.
  5. Also, what should’ve happened right after the scandal:
  6. no really though.

3:24-3:49

“The real solution to the problem is not more government, more money and more bureaucracy, it’s more competition, accountability and transparency. Let the money follow the veteran. If veterans were given vouchers that they could use at any healthcare provider, private or government, they would control their own care. This, in turn, would force the VA to compete for their business, encouraging staff to treat patients as customers, not just as names on a waiting list.”

  1. Veterans Groups oppose Pete’s idea because it would take billions away from the VA and cause a total collapse of the system.
  2. A form of Pete’s idea already exists, and it’s called the Veteran’s Choice (VC) program, which I previously mentioned. If Pete’s idea worked, then he wouldn’t be pointing out that wait times seem to be going up. The reason why wait times are going up, even with the VC program, is due to the nature of private healthcare. Now that the VA will pay for services for non-VA facilities, there is a new middleman in the equation: private health insurance providers. Specifically, Health Net. Health Net has to receive authorization from the VA before veterans have the greenlight to use private services. Then once it is approved, Health Net pays for the service with VA money. The problem is that the transaction of money and information gets slowed down by the sludge of the bureaucratic nature of private health insurance providers. If we were to expand VC, then wait times would continually worsen.
  3. Also, wait times in our private system are much longer than in Britain’s national health program. Like names on a list.
  4. Then again, why do we even need healthcare??

3:53-4:04

“Veterans will remain at the mercy of politicians and bureaucrats, who continue to insist that the government can deliver quality and timely healthcare, despite overwhelming evidence to the contrary.”

  1. The irony is almost beautiful, because conservatives continue to insist that the market can provide quality and timely healthcare, despite overwhelming evidence to the contrary.

4:10-4:23

“14,000,000 people [veterans] don’t use the VA at all. And those that do use the VA still get 75% of the healthcare they use outside of the VA system, even though they have to pay more for it.”

  1. In 2014, about 6.6 million people used the VA. With the number of patients increasing every year, it’s probably closer to 7 million right now. There are 21 million veterans. 21-7 is 14, which is probably where Pete gets his ‘14,000,000’ figure. Pete’s claim that 14,000,000 veterans don’t use the VA at all is highly misleading, because [again] he fails to mention many of those veterans may simply NOT BE eligible for VA care. There are no estimates that state how many veterans don’t use the VA because they aren’t eligible. But it is probably a lot. For a while, the VA had an income cap, meaning that if you made more than X amount of money you would not be eligible. That’s just one example of a potential limitation. There is also confusion among veterans whether the VA is only for veterans with service-related disabilities or not.  That could also prevent veterans from even checking with the VA to see if they’re eligible. The whole government-run healthcare alarmist rhetoric might have an effect too.
  2. I couldn’t find the source for the ‘75%’ claim, but here’s what I did find. 80% of people enrolled in the VA are eligible for other public insurance coverage, like Medicare or Medicaid. These people tend to ‘diversify’, by getting their healthcare across multiple providers. It is hardly a damnation to the VA, as much as it is using your resources.
  3. The VA has an 8-step priority system, P1 vets receive free prioritized, high quality care before everyone else. Needless to say, P1 vets are those most likely to be 100% reliant on the VA, which makes perfect sense, why would you go anywhere else? However, this is a prime reason why the VA is not really single-payer. Vets with lower priority are incentivized to get outside care because they are more likely to have to wait longer. But the fact that people who are P1 are most satisfied with the VA speaks volumes about the validity of single-payer healthcare, because, in a true single-payer system, everyone would be like the P1 vet. Everyone would receive high quality, efficient care as a right.

4:35-4:46

“So, could government-run Canadian style healthcare work in the United States? Given America’s experience with the government-run single-payer VA, why would we even want to try?”

  1. More like: “given my twisting and turning of reality, I’ve probably convinced you to be scared enough of government-run healthcare to prevent you from even considering the idea!”
  2. We would be wise to try it, considering most Americans agree our healthcare system sucks, and there is overwhelming evidence that countries with single-payer have better healthcare than us. Damn communists.

In closing, this was a huge topic to talk about, and I’m glad that PragerU recently made a video on it to give everyone the opportunity to see how much right wing lies about single-payer holds us back from achieving a better healthcare system. Even though generally speaking, the entire argument against single-payer is total BS, I want to give Pete credit for not being a complete dickhead like Greg Gutfeld. He refrained from the usual logical fallacies, and instead focused on making a strong argument with plenty of examples to support his case – a plus in my book. In short, Pete is a worthy opponent in the ring and he earns respect. With that being said, this video gets a new rating: not-so-stinky BS. 

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