"Let's talk about big government run [healthcare] plans," Vermont Senator Bernie Sanders needled fellow Veterans' Affairs Committee member John McCain. "I don't want to shock anybody here and have people dashing out of the room, but the VA (Veterans' Administration) is a socialized healthcare system, right Mr. McCain?"

Socialized medicine. Yes, it is.

As Senator Sanders pointed out, in the socialized system of the VA, the staff is "not out there busy raising money; charging them [customers] money." We hear similar arguments in favor of implementing a government-run, single payer healthcare system here in Vermont. Get the profit motive out of our healthcare system, get private sector people who are motivated by greed out of the healthcare system, and everyone will get all the care they need when they need it.

The recent scandal at the VA involving bureaucratic fraud, care denied to patients, cover-ups, and the deaths of some forty veterans in Phoenix, Arizona, while they waited months and in some cases over a year for an appointment should raise some red flags for Vermonters. We are just a few years away from entering our own VA-like system: single payer Green Mountain Care. As such, it's in our best interests to ask some hard questions about the root causes of how a government-run healthcare system allowed these things to happen.

First, a brief review of what happened in Phoenix.


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The managers of the Veterans' hospital there were caught covering up that fact that 1,400 to 1,600 patients were denied care while being placed on waiting lists for up to 14 months to see a doctor despite the VA's stated policy to provide all care in a "timely manner," which is supposed to mean within 14 days (Green Mountain Care's promise is more vague: Care "at the appropriate time in the appropriate setting.")

In order to cover up the truth, hospital staff kept two sets of books, an official but fake set showing patients receiving the timely care politicians had promised, and a second "secret" set that reflected the grim reality."

The Phoenix story is not an isolated incident. Since Phoenix, similar accounts have emerged in over 25 states. Neither is this a new issue. Quality questions have dogged the VA for years. During the Bush Administration the Walter Reed facility in Maryland was the focus of some scandalous quality issues in which, according to the Washington Post, "troops who lost limbs and suffered traumatic brain injuries or post-traumatic stress were quartered for months in moldy and rodent-infested rooms with inadequate follow-up care." It doesn't matter who's running the system. It's the system. So, how does this happen and why does it never get fixed in a government-run, socialized system where the profit motive has been removed? Let's be honest, people in government have the same personal profit motives and are just as prone to greed as anybody else. It's not because of an absence of greed that six of the top ten richest counties in the country today are suburbs of Washington DC, and 13 of the top 30 form a circle around the capital. The power of government is a tempting tool for those wishing to enrich themselves and their cronies.

At the Phoenix VA, Forbes reports: Staff salaries were as high as $357,528 for doctor executives and $147,724 for nurse staff. The average Arizona doctor makes just over half of what the top-paid Phoenix VA doctors make, according to federal stats.

From 2011 to 2013, over $843,000 in bonuses were awarded to the staff.

The hospital's 2013 gardening budget was more than $180,000.

The hospital's interior design bills surpassed $211,000 for the past three years.

The problem with any government run system is that the bureaucrats running that system are not accountable to the people being served by that system.

Bureaucrats are ultimately accountable to the politicians who control their funding, and that's who they aim to please. Politicians aren't accountable to patients, they're accountable to voters, and that's who they aim to please. What do politicians seeking re-election hate more than anything else? Bad headlines. What do voters hate more than anything? Politicians who raise taxes. Problems don't get fixed because in order to fix them, you have to draw attention to the fact that there is problem in first place, and that's bad headlines. Fixing a problem once admitted to will likely require more resources and higher taxes and angry voters. If you get caught in a mess, better to just call the situation a "big nothing-burger" and promise big fixes after the next election, and wait for the people to forget. If this weren't the case, the VA would have been fixed long ago.

Rob Roper is president of the Ethan Allen Institute (www.ethanallen.org). He lives in Stowe.