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POLICY: Will infrastructure issues scuttle the VA idea?

Dave Moskowitz’s idea of using the VA as a public provision system to cover the uninsured has got a little bit of feedback. While some of you wonks might be thinking as I do that the VA would be overwhelmed as employers opted out of providing insurance if the VA (or would it now be the UA?) did a half decent job of providing care for free, Linkmeister Steve has a much more mundane objection. It surrounds of course the most important element of American life — parking. Steve writes:

It’s an interesting idea, using the VA to cover the uninsured. But I wonder if that $100B includes such prosaic things as parking. Here’s the VA 7/03 factsheet for Hawaii VA facilities. The Matsunaga clinic is located at Tripler Army Medical Center , which is a huge facility with about 500-750 parking stalls. I can speak from unpleasant experience that that ain’t enough. I doubt whether most VA facilities, particularly non-urban ones, are as large and as well-appointed or supplied with even that sort of infrastructure.

Additionally, Tripler has sentries (well, private rent-a-cops…why our military has to contract out that function is the subject of another article), and access is limited to the number of people who have military ID cards and a legitimate reason to go through. I have to flash my mother’s card AND her written prescription to pass muster.

I’m just sayin’ it would require a lot of mundane planning.

To which Dave replies:

Security should not be a problem for the public, given the added security the public is already used to in airports, museums, and government office buildings. It also represents a wonderful way to employ people getting off Welfare, i.e. expanding security is already a great jobs program for the government.

So there might be some additional expenses for security, but I would think they could legitimately come out of the Dept of Homeland Security (DHS) budget and not out of the US PHS’s budget. At Trippler, the base would just need to apply for extra funding from DHS, if the Pentagon’s budget was too constrained to help (a bit unlikely given the current climate). DHS and the military are already extremely well intertwined. And the US PHS, one needs to remember, is a uniformed service within the Coast Guard, if I’m not mistaken, making it already eligible for DHS funds.

As for parking, the VA has a terrific shuttle and bus system which is utilized well below capacity. In St. Louis, for example, there’s a daily bus to and from the outlying cities 200-300 miles away. The bus seats 60 but never has more than a dozen riders. So if people were worried about finding a parking space in the big city, they could just take the shuttle. For people living in the big city, they would just need to hop a bus to the nearest VA. The medical centers are all located in the center of the city, exactly where the uninsured people are.

So given that Dave thinks that parking isn’t a problem and that the VA Medical Centers are well located near to the uninsured, there are only two questions remaining before I put Dave in charge of the VA in my new adminstration (assuming I win the write-in vote a week from now!).

One: Is the Congress (or anyone else) prepared to front up the extra money required to cover the uninsured, even if it doesn’t require a new institution?

Two: In the year 2004, 50 years on from Brown versus Board of Education of Topeka is “separate but sort of equal” the best we can do in American health care — even if it is better than the current status quo?

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