It may come as a surprise to many Americans, but the U.S. government operates at least two fully socialized health care systems, for which it both pays the cost of health care and also directly provides it: the Veterans Health Administration for military veterans and the Indian Health Service for Native Americans.

Both can be considered to be gross failures when it comes to providing timely, quality medical care for the populations they are responsible for serving.

Those failures, and the secret wait list health care rationing scandal that centered on the VA’s practices, are the reason why the U.S. Congress pushed through the Veterans Access, Choice and Accountability Act back in 2014, which was later extended in April 2017. The new law allows veterans who would otherwise face long wait times to receive care from the VA or who live more than 40 miles away from a VA health care facility to obtain medical care from providers outside of the VA-run system through its Veterans Choice Program.

That intended-to-be-temporary program has been in the news during the last few weeks because it is facing another funding crunch, just weeks after receiving $2.1 billion in emergency funding, where it is once again at risk of running out of money before the end of the year.

The funding crunch has led to moves by U.S. politicians to call for reforms in how the VA manages its finances for the program, where the department has significantly underestimated its budget requirements on several occasions in the last year, with each requiring additional emergency funding to resolve.

While the program has made it onto the U.S. General Accountability Office’s high risk list because of its administrative and fiscal issues, at its core, one of the main reasons that the Choice program keeps running out of money sooner than VA management has been projecting is because an increasing number of veterans are turning to it to receive needed medical treatment that the VA itself is not capable of providing in a timely manner. And that is even with the Veterans Choice Program’s “cumbersome authorization and scheduling procedures” and delays in payments to private medical service providers that have resulted in veterans being billed for their treatment, which would discourage them from using the program to seek care outside of the VA’s fully-socialized system.

That an increasing number of veterans are seeking care through the poorly-managed Veterans Choice Program despite its ongoing issues is an indication that the VA’s fully-socialized system for providing health care for America’s veterans must be performing even worse in its core mission of providing needed medical care in a timely fashion. If it were succeeding in achieving that mission, we would see the number of veterans seeking to escape it dwindle over time. That is something that is not happening, where having the safety valve of the temporary Veterans Choice Program is perhaps making it appear as if the regular VA system is working better than it really is, which is a really scary prospect.

The bottom line is that even with new management, the VA still needs a lot of reform. Veterans voting with their feet to seek out medical care provided through practitioners in the private sector are telling us the direction in which that reform needs to move. That direction for reform is something that can also benefit the Native Americans who still don’t even have the choice of going outside of the U.S.’ government-run socialized health care systems for better and more timely service.

At the very least, providing that same basic opportunity to be able to choose whether to stay within the Indian Health Service’s socialized health care system or to go outside of it for their medical care would be a good place to begin that reform.

Featured Image: Louisiana Department of Veterans Affairs