A Health Care Scandal That's Way Bigger Than the VA

| Tue May 27, 2014 1:46 PM EDT

The VA hospital scandal is basically composed of two separate things:

  1. A longstanding problem of excessive wait times for non-urgent appointments as well as problems with access to the VA system in the first place.
  2. A specific and recent case of hospital officials allegedly gaming the system by putting some vets on a "secret" waiting list so that the performance reports they submitted to Washington would look better than they really were.

We've heard a lot about #1, but this is largely a policy problem, not a scandal. No administration has ever secured enough resources from Congress to properly staff the VA system, and the result has been waiting lists and backlogs. In the past few years this has started to improve as more vets have been allowed into the system; funding has increased; mental health has become a bigger priority; the paper-based approval process has become more automated; and the backlog of vets waiting for approval has been cut in half.

The real scandal—in the normal sense of "scandal" as opposed to inefficiency and underfunding—is #2. As scandalous as these charges are, however, they're localized; small; and entirely nonpartisan. Everyone agrees that heads need to roll if they're confirmed. That's in stark contrast to a far, far larger denial of medical services to sick Americans that could be fixed instantly if there were the political will to do it. Ezra Klein explains:

It's a relief to see so much outrage over poor access to government-provided health-care benefits. But it would be nice to see bipartisan outrage extend to another unfolding health-care scandal in this country: the 4.8 million people living under the poverty line who are eligible for Medicaid but won't get it because their state has refused Obamacare's Medicaid expansion.

As appalling as the wait times are for VA care, the people living in states that refused the Medicaid expansion aren't just waiting too long for care. They're not getting it at all. They're going completely uninsured when federal law grants them comprehensive coverage. Many of these people will get sick and find they can't afford treatment and some of them will die. Many of the victims here, by the way, are also veterans.

....All in all, the Kaiser Family Foundation estimates that more than 7.5 million uninsured adults would be eligible for Medicaid but live in a state that has refused the expansion....The point here isn't to minimize the problems at the VA, which need to be fixed — and fast. But anyone who feels morally outraged over the extended wait times at the VA should be appalled by the literally endless wait times the poor are enduring in the states that are refusing to expand Medicaid.

Fat chance of that, I suppose. Nonetheless, it's at least as big a scandal as VA #1, and far, far bigger than VA #2.