It is a clearly established fact of economic history that true monopolies are rare, and can only be maintained over time through using the leverage of size to provide more for less, by being the best. Unless you take care of people, market alternatives emerge and slowly take market share. White Castle, in my understanding, was the dominant–really the only–fast food chain for some years. But today, most people have never had a slider (you’re not missing much, although I do like the jalapeno ones).
This is not the case with government monopolies, which do not need to be highly competent, to provide good service, or do anything at the best or even a reasonable price. No market incentives exist. Nothing prevents mediocrity from enduring and dominating indefinitely, but public outrage, and such outrage is necessarily diffused by the very nature of a large bureaucracy and the difficulty of fixing blame, particularly when the TRUE blame lies with the system itself. The VA is a very good example. It is horrible, has been horrible a long time, and has proven very resistant to change and improvement. Why? It is socialized medicine. That is the shortest answer, and privatization–for example, by giving veterans an annual stipend equal to what the government was already willing to pay on their behalf in its own system, which they can use for health insurance, or to pay for health care directly–is the obvious answer.
Right now, veterans have no choice, if they want their care to be paid for by the government. Right now they suffer, and in some cases die unnecessary deaths, because somebody somewhere thought that centralized control was humane and just, and the alternative inhumane, when the opposite is clearly the case.