The Veterans Health Administration: A Domestic Model for a National Health Care System?

Health care in the United States is once again emerging as a key issue in national debates leading up to the 2008 presidential election. The discussions reflect, in part, growing public unease about the current health care system, fueled by rising health care costs,1 concerns about the quality of American health care, and the growing number of Americans without health insurance (approaching 45 million).2 These concerns are further ignited by recent reports that put the American health care system in perspective vis-a-vis the rest of the world. For instance, the World Health Organization ranked the US health care system at number 37 among 191 nations.3 The Commonwealth Fund recently ranked the US health care system next to last compared with United Kingdom, Canada, New Zealand, and Australia.4 Even among insured patients, the quality and equity of health care delivered in the United States has been a subject of debate.5 Public concern about the US health care system is starting to show up in public satisfaction ratings. Although most Americans receive medical care locally, patient surveys demonstrate low satisfaction rates with health care quality or access.6