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How well do they feed the Marines?
I do not know. Or how about the Army, Navy, or Air Force?
But my suspicion is this: if you are in the Armed Services, you have the chance to eat better than the average American. Not at gourmet levels, but better than the median. Better taste and better nutrition. The median person in the United States eats some pretty bad food.
And how much does this food cost our government and thus our taxpayers? Again, I am curious to hear what you know. But I've read lots of stories about thousand dollar hammers and toilet seats, but I have never heard a peep about the Pentagon paying $70 for a Brussels Sprout.
So, I'll also predict that this food comes at reasonable cost. We therefore seem to have above-average food service at OK prices.
Given that possibility (fact?), how many of you would advocate government provision of food for the entire economy? How many of you would advocate government-run food finance for everyone, and not just for the poor?
Show of hands?
How many of you know what I am really talking about in this post?
Don't forget this post either.
Addendum: The successes of the VA system stem most of all from avoiding the cost-escalating features of "fee-for-service" for medical suppliers, and not from its single-payer features. Not so many people are willing to advocate abolishing fee-for-service for most of the medical sector; here is further discussion. But unless you abolish fee-for-service, the successes of the VA system are not a replicable model on a larger scale. And it is much easier to workably abolish fee-for-service within the Armed Services than across the entire U.S. medical sector.
Posted by Tyler Cowen on January 3, 2008 at 06:13 AM in Economics | Permalink
Comments
As the son of a son of a sailor, and Naval Reservist myself,
I feel more attention should be paid the VA health system,
as it is an instructive prototype for any of these various
universal health programs.
It's a mixed bag at best. You really can argue it any way
you want in the freedom/cost/value tradespace: the answer
ends up being subjective.
My contention is that, unless
a proposal is an unambiguous win, then the less gubmint, the better.
Posted by: c smith at Jan 3, 2008 7:00:51 AM
And what if you make Army-level food available as a basic provision for all Americans, but allow people to opt out if they like - what then?
Posted by: Ray at Jan 3, 2008 7:08:14 AM
While I am not cognizant of the economics of food purchasing done by the armed services, I can definitely vouch that the food served there (at least as of eight years ago, when my service ended) is usually well-prepared, seemingly nutritious, and I had no complaints about it all. I was stationed on Fort Bragg for most of my term, but the food in Egypt, at the MFO dining facility in South Camp, is some of the best food I've ever eaten in anywhere, even better than in some so-called high-end restaurants. They had broiled, fresh fish there that was to die for.
Posted by: Mike at Jan 3, 2008 7:08:55 AM
When I was stateside in the Army, I ate food prepared by contractors which I would rate as average cafeteria food-- better than I got in dorms in college, not as good as most for-profit cafeterias.
In Germany the grub was made by fellow soldiers who were cooks by trade. Lunch and dinner were about the same, but breakfast was pretty good. Made to order omelets made with fresh local eggs (I think-- the yolks were red).
Cook was a pretty bad MOS to have. Bad hours. More hazardous than you'd think (one of ours set himself on fire in the field with a portable mo-gas heater.) Not surprisingly, it was one of the easiest jobs to get. When I signed up I had my pick of jobs based on my ASVAB, but when I insisted on limiting my enlistment to 2 years, the list of possibilities was cut to 6. I chose combat engineer, but I could have been a cook, and cook was the only job on that list where I could've chosen my duty station. I probably would've been dumb enough to have stayed in Oklahoma and missed out on Europe, so I'm glad I went the route I did.
Posted by: burger flipper at Jan 3, 2008 7:57:43 AM
You are also given little to no choice in what food you eat. Trying being a vegetarian or other restrictive style diet in the Army. When I was in most guys would still go out for dinner, if they could, despite it being free, just to eat something different.
Also the quality of food could vary significantly from Dining Facility to Dining Facility. You quickly learned which ones were better and then went to those (even though you really weren't supposed to).
Posted by: apostate at Jan 3, 2008 8:07:11 AM
Specious analogy alert!
Posted by: neil at Jan 3, 2008 8:26:00 AM
The VA doesn't supply medical care to the armed services. It supplies it to veterans. That isn't the same thing.
Posted by: matt wilbert at Jan 3, 2008 8:27:11 AM
It's the military health care system (not VA) that brought us Walter Reed.
Posted by: Chris at Jan 3, 2008 8:50:16 AM
One of my students was recently assigned to a base in kuwait and is now in southern iraq; he informs me that the kuwait base was almost like a US-style shopping mall with a wide-variety of private firms and fast-food choices, like pizza hut, taco bell, and even starbucks. So it looks like with regard to tyler's posting, it's the other way around!
Posted by: enrique at Jan 3, 2008 9:16:28 AM
There's also the pesky fact that if one considers a military to be a legitimate public good (current military endeavors notwithstanding) then one must also, as a corollary, consider medical care for veterans a public good to the extent that the care is required subsequent to military service (e.g., combat injuries).
Which has absolutely nothing to do with universal health care -- which is an altogether different policy based on an altogether different worldview about the proper scope of government and individual rights.
Stated differently, the VA is nothing but an insolent non sequitur illegitimately invoked by health care socialists.
Posted by: KipEsquire at Jan 3, 2008 9:39:33 AM
The VA has improved, but it would not be a good model for anything but... the VA.
And with the chuckleheads in the Bush administration failing to provide more downstream resources to account for Iraq casualties, the VA is going to be in trouble soon.
Of course the war is only gonna cost $40B because it will be over in a few months and we will get the oil dividend - per Dick Cheney.
Posted by: save_the_rustbelt at Jan 3, 2008 10:04:40 AM
The capitation-based argument makes a lot of sense. Why does this work for the VA, but not for HMOs? I'd always assumed (I've never belonged to one) that they were supposed to keep costs down through capitation.
Posted by: MostlyAPragmatist at Jan 3, 2008 10:16:10 AM
My military experience ended three decades ago, so I'm not sure how relevant it is. Food at my three Air Force bases was much more nutritious than what I ate as a child or as a college student. My unit was detached to an Army post for months, and the food was nowhere near as tasty.
Over the past 35 years, Navy veteran friends have frequently praised the quality of food on board ships. They explained that living in close quarters was a strain on morale, and the Navy wanted to ensure that meals enhanced rather than detracted from the experience.
Similarly, oil companies generally hire quality chefs for offshore oil platforms. My relatives who worked offshore all gained weight.
Posted by: John Dewey at Jan 3, 2008 10:54:35 AM
The fact that medical care is better (and less expensive) in the VA system than in the rest of the U.S. does NOT mean that government provided health care is necessarily better for everyone.
However, it is an "existence proof" that government health care is NOT necessarily worse. Some idealogues assume that anything done by the gov't must, automatically, be worse than the private sector. This is provable false.
There are lots of reasons for and against single payer medical care. When people refer to the VA system, they don't intend that example to be the entire argument. Rather, it is an empirical refutation of the mistaken claim that gov't health care must be worse.
As for food, when I took my first economics course, I was taught that giving cash was always better than giving in-kind benefits. This is standard libertarian/neoclassical reasoning.
Now I believe that view to be mistaken. If it's my money I'm spending or directing, and my own utility is increased by seeing it spent on food instead of liquor or drugs, then why not insist that the money be spent that way, even if the recipient has different preferences? So yes, I could imagine funding gov't soup kitchens as an option for the very poor.
Posted by: A student of economics at Jan 3, 2008 10:57:51 AM
Another huge advantage of the VA is that it is almost 100% utilized--that's why it is so hard to get into the system. Spare capacity is expensive; the VA deals with the issue by letting acute care be done by non-VA providers.
Posted by: SamChevre at Jan 3, 2008 11:23:27 AM
The VA knows that its customers/patients are patients for life. For the VA is worth tracking and preventing issues that may be more expensive to deal with later on. Other insurers may prefer to pay zero now, punt and hope the consumer changes jobs/insurance/whatever before the expensive shit hits the fan.
Posted by: rms at Jan 3, 2008 11:32:00 AM
A favorite memory of mine from Parris Island boot camp 15+ years ago was the senior drill instructor's contempt for the re-modeling of the chow hall: "it'll probably be some Arby's-looking bullshit."
Posted by: Parris_Island at Jan 3, 2008 11:53:12 AM
Typical base chow hall food was not disgusting nor was it absolutely appetizing either. It was just good enough to eat. Although, as a Marine, we always looked forward to backyard operations that took place on an airbase since the Airmen had the best chow halls we had ever seen.
On a typical Marine Corp base, the chow hall was outsourced to sodexho, the same company at Mason's Ciao Hall. The food was never outstanding unless it was seafood. Most foods are cooked by steam as they can make a lot through small amount of work. Steaming a steak that has marks as if it is grilled isn't too appetizing, but steaming/boiling crab legs is delicious.
In the field, the food is cooked similarly. There isnt any real cooking. The eggs are in containers that are slid through a machine that uses steam to heat it up. It was edible and better to eat than MRE's(Meal Ready to Eat packages) so we always enjoyed it when the Mess tent was finally built.
By the way, there are so many fast food restaurants outside military bases because chow halls close too early. By late evening the Marines are still hungry and always make a run to the border. Chow hall isn't free as it is taking out of our paychecks before we see it. I would have rather kept the money and purchased my own food. Also note that some Marines got married just so they didn't have to live by the rules of the barracks and have to eat from the Chow Hall.
Posted by: Ian Dunois at Jan 3, 2008 12:20:17 PM
"Now I believe that view to be mistaken. If it's my money I'm spending or directing, and my own utility is increased by seeing it spent on food instead of liquor or drugs, then why not insist that the money be spent that way, even if the recipient has different preferences?"
1. Infantizing a population can have long term negative social effects.
2. It is far easier to insert pork into services vs. cash payouts. For example, a national soup kitchen program could lead food suppliers to bribe politicians in order to get overpriced contracts.
3. Government services are destructive to diversity. Is this soup kitchen going to accomidate Kosher diets? Hallal? Vegetarians and Vegans? People with peanut alergies? People on the Atkins diet? If you don't accomidate my religious restrictions against eating noodles because it is an affront to the flying spaggeti monster, add a hundred million dollar class-action lawsuit for violating the religious freedoms of pastafarians.
Posted by: Rex Rhino at Jan 3, 2008 12:57:03 PM
The VA does its magic through what can best be described as "line shifting". Let's say you are a WWII veteran who is entitled to some VA support and care because of a disease like Parkinson's. You, your spouse, your extended family and any attorneys you might have at your disposal will not be able to find, complete, or file the correct forms. So you contract with an outside care provider that skims 30% off the top in administrative fees to get you through the VA application and then hire in-home care you need. Or, you go to the county veteran's affairs liaison and wait for a day in line at his office for help figuring out the process. I've seen it first hand. All the inefficiencies are pushed to the line to get in the door. Today, veterans with common sense who have the means to access private insurance and care do just that, but try to keep the door open to the VA in case they contract an illness that the VA pays special attention to. Giant PITA. Any politician who touts the VA as a model for anything is smoking crack.
Posted by: Brad Hutchings at Jan 3, 2008 1:33:38 PM
As Matt said, the VA does NOT provide health care to active duty armed services.
And from what I've heard, while the VA has world-class information systems, the armed forces have pretty bad health information systems. So just having "government" run the system doesn't ensure good management. My guess is the VA just got lucky and had some extraordinarily good leaders for a while.
Posted by: ed at Jan 3, 2008 1:36:57 PM
But my suspicion is this: if you are in the Armed Services, you have the chance to eat better than the average American. Not at gourmet levels, but better than the median. Better taste and better nutrition. The median person in the United States eats some pretty bad food.
Why would you presume this? Isn't it unlikely that one centralised authority could choose food more effectively free people with free choices? For nutrition, yes it's possible. But, of course, for many people food is about much more than nutrition. If you start from this premise, I think you need to explain why people are failing to select well for themselves. Otherwise its a weak basis for an argument.
Posted by: Simon at Jan 3, 2008 2:21:09 PM
All I know is...
"The Navy gets the gravy but the Army gets the beans!"
Posted by: DG at Jan 3, 2008 2:31:56 PM
There are a couple of comments above that when combined generate significant insight into the nature of state run health care.
SamChevre points out that the VA is very efficient in large part because it operates at very high utilization rates. There are two possible explanations for how this is achieved.
(1) The government provides just the right level of capacity required to exactly meet demand.
(2) Demand exceeds capacity and access is rationed
As Brad Hutchings observes the correct explanation is option 2. The VA practices rationing by severely restricting access to the system.
Efficiency and access are desirable but mutually exclusive goals.
I grew up in New Zealand which has a universal access "socialized medicine" system. The New Zealand health care system is also very efficient due to very high utilization rates. However, since access is universal the inevitable rationing occurs through the use of waiting lists.
People without direct experience of waiting for health care do not tend to consider this a big concern. However, access to health care is a huge political issue in New Zealand. The following data gives some indication of why.
Cancer Radiation Treatment Wait Times September 07:
(http://www.moh.govt.nz/cancerwaitingtimes)
Category A = Urgent
Category B = Curative
Category C = Palliative and other radical
Category D = Combined chemotherapy and radiation treatment
100% of Category A patients waited less than 4 weeks
69% of Category B patients waited less than 4 weeks
28% of Category B patients waited less than 8 weeks
3% of Category B patients waited less than 12 weeks
81% of Category C patients waited less than 4 weeks
15% of Category C patients waited less than 8 weeks
3% of Category C patients waited less than 12 weeks
1% of Category C patients waited more than 12 weeks
35% of Category D patients waited less than 4 weeks
24% of Category D patients waited less than 8 weeks
12% of Category D patients waited less than 12 weeks
30% of Category D patients waited more than 12 weeks
There are certain points that should be highlighted about this data:
- In New Zealand, if you are in urgent need of radiation treatment for your imminently lethal cancer 4 weeks is considered an acceptable waiting time.
- Waiting times for category D patients aren't considered overly important because they are receiving some form of treatment (chemotherapy) even though the optimum treatment would include radiation.
- Category C patients are considered important because they have a nasty habit of turning into Category A & B patients while waiting for treatment.
- These figures represent the state of affairs after a major scandal forced the government to pour resources into reducing radiation treatment waiting times.
- Radiation treatment centers in New Zealand are very efficient due to 100% utilization rates.
Efficiency has a very steep price.
Posted by: Deepish Thinker at Jan 3, 2008 2:44:07 PM
How much of the VA's positive perception has to do with the fact that the VA measures itself against the private sector? In other words, without the private health care system, as an example and as a force for medical and logistic innovation, just how good would the VA be? Would it even have attracted administrators who are interested in maintaining a positive perception?
Posted by: Rimfax at Jan 3, 2008 4:02:31 PM
