Redleg, I don’t have personal experience, but research indeed shows that VAs in big cities is superior to the ones in rural areas.
also, note that VA serves reasonably homogenous population used to discipline. So, VA experience is probably better than a similar system applied to the whole country would be.
Government is necessary when there is no effective market solution. Otherwise, it is generally inferior. Most of us do not buy food and clothes from government stores for some reason … So, before calling the government payer, did we exhaust all market approaches? Trump enabled regulations that force hospitals to publish their prices. Not sure whether that had any effect so far. You can allow insurance compete across states; make it easier to take your medical data from one provider to another, etc.
RebE, you can’t provide charity by constraining whole population and antagonizing half of the country. There should be better options.