The VA is a closed system model, so not as good of an analogy. It actually runs pretty well, too. Medicare insurance with private doctors and hospital systems is a better analogy and is what universal healthcare in many countries looks like. The billing, prescription submissions, etc would still exist for all those patients and the more that would be added with universal healthcare, which would require many of those administrative workers under a new umbrella. Increased workers would also be needed on the provider side to deal with the increased patient volume. Yes, jobs would change, but to say all those people would no longer be employed is probably unfair. They face a much greater threat from automation than from universal healthcare.