An interesting tidbit off of VA Watchdog.org the other day:
Ignoring the long litany of charges about the defects in the VA system and statutes and abuses of veterans, the government argues that all claims by anyone about the treatment of our veterans must be “channeled” through that same system, however flawed. Defendants belittle the Complaint as merely raising “frustrations with political processes,” and urge that the problems described therein can only be addressed to “representative branches of government.”
...
Ironically, the government’s motion to dismiss addresses the veterans’ complaint that the laws and procedures applied by the VA are constitutionally inadequate by suggesting that veterans have no rights at all, no forum to raise their complaints, and no access to our district courts. Relying on the archaic principle that “the King can do no wrong,” the government argues that all claims by veterans against the government are barred by sovereign immunity.
The actual motion to dismiss and the arguments described above are available here: Motion to Dismiss
It's an interesting part of the equation of government run programs that is often ignored: sovereign immunity. It's a legal concept that carried over from our English roots that basically means you cannot sue the king in the king's court. In our king-less system it generally applies to our government. The exceptions are the exceptions that the government itself makes that allow you to sue them.
It's a legal concept that doesn't apply to insurance companies. If they violate your contract, you can sue. If they cause you harm by not fulfilling their legal contractual obligations, you can sue. If they have a systemic legal problem an entire class of litigants can sue for damages or force them into a settlement that either corrects or compensates for their behavior.
Some people point to the dirty tactics employed by private insurance companies to deny rightful benefits to their clients as proof that we need the government to fulfill their role. The problem with that argument is that the government and private insurance companies have this trait in common. The almighty dollar still comes into strong play, often at the expense of the needs of those who qualify for benefits but are denied. In the private insurance world the drive is to ensure the company is profitable. With the government the problem lies more with limited budgets and agencies competing for that tax revenue.
At the heart of the cold and uncaring bureaucratic image both seem to obtain is the fact that the people at the top making the rules are looking at the numbers and the budgets and making the rules accordingly. The workers who have to implement those rules and actually have to deal with the customers/citizens are not empowered to bend those rules, no matter how strange or unfair they seem when actually applied. If they did they probably wouldn't be employed much longer.
So what's your recourse if you're getting hosed?
If it's the terms of your insurance being changed prior to an illness then with private insurance the option is to take your business elsewhere. With the government you'd have to hope that your fellow citizens agree and are willing to make votes reflective of that view in consequent elections. If they agree but other issues take priority for them you'll still be hosed. The bet rests on whether enough support can be built specifically on the issue to influence current or future legislators. If it's a rule that affects few you'll have your work cut out for you. Whereas with private insurance, the only person it has to affect is you for a change to be instigated. You can take your business elsewhere.
If you are being denied coverage for something you are entitled to during an illness you can spend months or years dealing with the internal government claims processes before the government will allow you, within a narrow scope, to question the denial in an actual court. With insurance companies you can hold them fully accountable to their contractual obligations and for any resulting damages in a court of law. Neither situation is ideal to say the least. But one obviously gives an injured party far more leverage. With private insurance though such incidents can be taken into consideration when shopping for insurance so it can even play a role beyond the individual plaintiff.
The Safety Net
These arguments fall on deaf ears to someone who can't afford private insurance or their current medical costs. What good is all that choice and the ability to hold insurance companies accountable if you can't afford to be their customer in the first place? The answer: no good at all.
The above arguments are the most applicable to those who can afford private insurance but believe that the government can offer a better system for everyone. They are only setting themselves up for disappointment if they believe that government coverage would be better for them.
For those that don't have the option they need a safety net. Some libertarians argue that the government need not be involved in this safety net. They argue that private charities could fulfill this need if it wasn't for the extreme tax burden faced by potential donors. Democrats tend to lean more towards a wide government safety net that includes preventative care as well. Republicans tend to hold positions in between.
My federalist views on State authority and accountability and my belief that healthcare is a legitimate need of the people, even those that can't afford it, leads me to support a more broad safety net for those who have limited income/assets, disabilities, etc. I don't believe the federal government can be held appropriately accountable to ensure these programs are run to the satisfaction of the citizenry. It would necessitate a significant shift in the national tax burden to the individual States but I consider this long overdue.
What Else?
The other big issue for me is the rising costs of healthcare that are pushing more and more people into the group that simply cannot afford to pay for it or insurance rates for it. The libertarians may not be totally off base with wanting a more free-market solution to the problem. I'm not sure if I buy into the idea that charities alone could fulfill the need out there even if the tax burden was drastically reduced, but perhaps there is more that could be done to coordinate charities and other non-profit groups to fill the void in both covering the costs and providing healthcare.
I'm also greatly annoyed at the "cut-off" style rules governments often employ for healthcare programs. A more progressive subsidizing system after a certain income level would make more sense so that the government isn't inadvertently discouraging people from advancing. If getting a promotion and raise means your kid gets cut off from needed healthcare you still can't otherwise afford, would you still take the promotion?
I'd also like to see employers and employees demand that any group insurance coverage they sign on to covers them for at least some reasonable time after someone loses their job for whatever reason. A buffer period between jobs seems a pretty reasonable request, especially since the job loss may have to do with family medical issues.
And of course I'd also like to ensure that cases of fraud, overbilling, etc by heathcare providers and coverage groups are prosecuted as that only makes it more expensive for everyone. Speaking of which. When government programs do not pay the full amounts for healthcare, that seems to only push the burden on those who pay directly or through or other private coverage groups. Any ideas to help reduce costs and make healthcare more affordable I'm willing to listen to. I'm not going to support empowering the government to do anything and everything to do it though. When you empower the government you have to assume the people you disagree with will abuse that power when the get into office, not just look at what the people you agree with will do with it.
Imagine the Democratic Party's outrage if HillaryCare turned into HalliburtonCare down the road. Sure it might be great to see the look on their faces, but it wouldn't be worth it.
Oh maybe it'd be worth it for a minute or two.
Okay just for a minute.
