What is Wrong with “Our” VA
This was an answer in the local Weekly Reader to a couple of others who insisted VA healthcare should be disassembled and handed over to the private sector. I guess I could have said “nuts; I did say “nonsense.”
“All right, they’re on our left, they’re on our right, they’re in front of us, they’re behind us…they can’t get away this time.” You figure out who said this.
Senator Bernie Sanders bill failed by 4 Republican votes to get out of the Senate. Within that bill there were several sections dealing with meeting the needs of veterans.
Section 327 would require VA to develop and transmit to Congress a strategic plan for improving access and quality of health care services for veterans in rural areas. This plan would include goals and objectives for: the recruitment and retention of health care personnel in rural areas; ensuring timeliness and improving quality in the delivery of health care services in rural areas through contract and fee-basis providers; implementation, expansion, and enhanced use of telemedicine services; ensuring the full and effective use of mobile outpatient clinics.
Section 501 would direct VA to reorganize the Veterans Health Administration (VHA) into geographically defined VISNs. In addition, it directs the Secretary to ensure that each VISN provides high quality health care to veterans, increases efficiency in care delivery, implements best practices, enhances collaboration with partner entities, among other management functions. Finally, this section requires the Secretary, at least every three years, to review and assess VISN structure and operations and submit review results to the Committees on Veterans’ Affairs.
Section 502 would require VA to establish not more than four regional support centers within VHA to assess how effectively and efficiently each VISN conducts outreach to veterans who served in contingency operations; administers programs for the benefits of women veterans; manages programs that address homelessness among veterans, and consumes energy. In addition, the regional support centers would assess the quality of work performed within finance operations, compliance related activities and such other matters concerning the operation and activities of each VISN as the Secretary considers appropriate. “Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014”
Here is what some of those needed four Republican Senators said:
“I don’t think our veterans want their program to be enhanced if every penny of the money to enhance those programs is added to the debt of the United States of America,” Senator Jeff Sessions Republican Alabama.
“Greatly expanded spending without any realistic offset,” as he dickered with Reid over sanctions on Iran. Republican Senator Mitch McConnell, Kentucky
“I think the decision we got here, as we debate this legislation, is whether we are going to commit to a promise that is bigger than what our kids can fulfill.”It costs more than our kids can afford (with a little sh*t-eating grin on his face). My colleagues pointed out most of the veteran organizations support this bill in fact correct. Senator Richard Burr Republican North Carolina
“As far as the bill, the chairman has offered here, this bill has already been debated and there are problems with this bill that is an extensive piece of legislation that has many good elements in it. It also has a cost issue at a time when our nation owes $18 trillion and that was the reason why so may on my side of the aisle objected to it and that is why I would object as to the motion made here today by the Senator from Vermont.” Republican Senator Mario Rubio, FLA.
After causing Senator Bernie Sander’s bill to fail by 4 votes, these same 4 Senators are now trying to get to the bottom of why there are delays in getting care for veterans. The VA has always had a degree of issues with it in waiting for the benefits offered and this has been the case for decades. Too often and too late much of the delay is the result of the lack of funding to meet the influx of newly discharged and veterans (disabled and healthy). The issue extends to the Vietnam Veterans who are now arriving at the VA installations with issues resulting from age. Old Mr. Invincible has seen a few instances of physical vulnerability.
To answer to the insistence on leaving Veteran healthcare to the free market, we pretty much have done so with everyday people over the decades. What have we experienced?
– Since the proposal of Hillarycare in the nineties, we have seen the cost of providing healthcare quadruple. There are no controls or incentives to stem the persistent and ever-increasing cost of healthcare by the industry as it is a service- for- fees- cost- model, which makes it money by selling you more. The US has one of the most expensive healthcare systems in the world without the benefit of the best care globally.
– We have left the training of doctors and the supply of them to the free market. Increasingly we are experiencing a shortage of primary care doctors not only at the VA; but, it is being experienced in the private healthcare market today. Only 20% of the students hoping to be doctors are going into primary care and the shortage is growing. “The US is short ~16,000 Primary-Care Doctors. The PPACA attempts to solve the problem by skewing funding and salary to primary care except Congress is cutting PPACA funding “Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts “catastrophic.” Nurse Practitioners are coming on line; but, the time table is long and they will not be abundant for years yet Some of this is a contrived shortage as cited by PNHP:
“(Nursing schools are trying to produce more Nurse Practitioners (NPs) to deal with the crisis in primary care, but have been consistently attacked by MDs who insist that NPs are not well enough educated to provide even routine primary care.)” “Lack of funding is the Real VA scandal”
– Try getting in to see a Cardiologist or specialist or primary care doctor in 2-3 weeks in the commercial market. You can not and the wait times extend outward from 1-3 months in private medical care clinics (my experience). This is typical. Phillip Longman the author of The Best Care Anywhere most recently pointed to the wait for a private clinic doctor’s appointment.
“patients who already have good private insurance have trouble scoring an appointment with a primary care physician. Which is why, (Philip Longman interview at Vox) , wait times for an appointment in Los Angeles are on average up to 59 days and in Boston up to 63. Newspaper reports like that in the New York Times spotlight vets who have been able to get immediate appointments in the private sector.
Well I congratulate them.
Most people I know, even those with good health insurance have a pretty hard time finding a PCP whose practice is even open to new patients and have to wait a good long time for specialist care as well. How will the nation’s overtaxed primary care doctors suddenly be able to accommodate millions of vets when they can’t handle the patients they already have, plus the influx of patients who will now be insured thanks to the Affordable Care Act?”
And the acting VA Chief is planning on dumping thousands of veterans into the commercial market? The placing of Veterans in the commercial market will start an erosion of VA benefits for those who have earned it serving the “4 chicken-hawks” I named above who sent them to war.
– The VA offers more to veterans than what the private healthcare clinics can. As one Livingston Daily Veteran (Jim Pratt) pointed out: “The VA system has major advantages over private hospitals in some things- such as electronic medical records, coordinated care, and early screening and detection of issues that of are particular need for military veterans. U of M medical center does not screen for PTSD, or for titanium dust (Camp Victory), depleted uranium exposure (All our engagements since the 1980’s), or exposure to ionizing radiation. The VA can do those, and more.
Another veteran, Jack Samples points to the efforts of the Ann Arbor VA in handling its patient workload. Having been there myself, I can vouch for it also. Guarantees two-week maximum waits for primary care appointments, Provides 24-hour emergency care, provides daily urgent care for anyone who does not have an appointment but needs or wants to see a doctor, etc.
– VA Primary Care doctors are underpaid and making less than their commercial counterparts do. It is difficult to attract more primary care doctors to the VA when more can be made in commercial hospitals.
The list goes on, on how Congress has failed the veterans of this nation with some lame excuses for not funding the last two wars and preparing adequately to receive veterans. Much of this is not the fault of the VA. The generalities expressed by two readers do not hold up to a close examination and there is no economic reason to give veteran healthcare over to a failed private healthcare system which abandoned millions of people.
“The Architect of the VA’s Quality Transformation Under Clinton Speaks Out”, Phillip Longman
“VA Care: Still the Best Care Anywhere? Part II”, Phillip Longman
“How to Beat the Doctor Shortage”, Marsha Mercer
“The Best Care Anywhere”, Phillip Longman
In 2010, the last time I stepped through the doors of a VA hospital, it was a January, maybe early February, in Gainesville Florida, it was PACKED like a sardine can, one long que. Had to park downtown and take a special bus as the WHOLE neighborhood was packed, let alone use the VA parking lot. The staff was EXCELLENT. That line moved FAST. In&out by lunch. One could EASILY see they were over worked and UNDER STAFFED.
The VA problem= not enough Doctors, not Enough Nurses, not enough hospitals, not enough parking, not enough MONEY, way too many VETS needing treatment. SEZ it all about Congress, The American Citizenry, The USA, and “Thank You For Your Service.”
Yes, republicans say, “Thank you for your service…now go find yourself a bridge to sleep under.”
Jerry Critter; Make no mistake, Jerry, BOTH SIDES are doing it and have been for a long, long time. IN FACT, Jeff Sessions was to one to finally get The VA to treat for AGENT ORANGE back in the 90’s. If it wasn’t for that my Younger Brother would most likely be dead by now. It actually gives me HOPE that my Son will one day get treatment for Gulf War Syndrome.
And the Washington Post editorial prints another lazy editorial without connecting any dots…what a crock.
Don’t know where you get your information Mike but Sessions has been among those getting behind Coburn to limit Agent Orange claims, especially those of blue water veterans.
Both sides do it is generally a bullshit way of providing false equivalency which ultimately wipes away responsibility.
Republicans have continually fought proper funding for the VA. Sessions fought additional $13 billion without equivalent cuts. Really? Should appropriate veterans care come at the expense of some other group? Do we cut SNAP or Head Start to fund veterans care or do we have a responsibility to honor commitments to veterans without qualifications?
As a veteran who was directly affected by this issue I take it personally when excuses are made. The VA provides specifically targeted care to a unique community. It does a reasonably good job given the resources it is given. Those who would privatize the VA, and that is primarily and overwhelmingly a Republican idea, would undermine our commitment to veterans.
Both sides do it is a bullshit excuse that deflects responsibility.
Not enough time to work through all of this, but one thought.
Veterans living more than say 60 miles from a VA facility need some sort of option, other than three hour van rides. Any ideas folks?
What’s Wrong With The VA? Simple answer: Too Damn Many Stupid Wars.
str, I would start with a Medicare Advantage plan for all veterans obtained through the VA with use of the VA pharmacy using all valid prescriptions.
My husband is a disabled vet with authorization to use VA Health and pharmacy. In order to use the pharmacy, a VA doc must issue the prescription leading to at least one visit to a VA doc a year, unnecessarily. Also, he must make two trips to a VA medical facility just to get started. One for the test and one for the doc followup.
He has Medicare and private insurance. His small disability check pays his drug copays for now. (He is Parkinson’s.)
What do you think of VA Medicare Advantage? It should be cheaper to the VA than if we moved next door to the VA medical centers and used them exclusively.
A 90 year old has trouble getting more than 10 miles so 60 is quite arbitrary.
I just don’t know how many VA medical eligibles are over 65 but with the Agent Orange program it should soon be a great number (I think).
I apologize for not getting back to you sooner. I will write to you as a Vietnam era X-Marine would and hopefully with understanding. Fortunately, other than my heart deciding to flutter once, I am healthy (not as healthy as during my Marine days when I could leap over building in a single bound). We are getting older and many of us are suffering from the passage of time and the beating we took while serving. One rehab person mentioned many of us come out of the service much older physically resulting from how we pushed ourselves.
I think if Maggie Mahar was here she would tell you Medicare Advantage duplicates many of the things Medicare and the Supplemental Insurance offers and requires subsidies by the government to get commercial insurers to offer it. I use Wellcare for my Prescriptions which covers my Tier 1 and the one Tier 2 drug I take with a copay for the Tier 2. If I remember correctly, every approved drug at the VA is $7 regardless of Tier.
While I hate to think we all might have to surrender to going to a commercial hospital for VA care, there might be a time when it becomes expedient to do so due to our ages. Commercial hospitals do not have the expertise to handle Agent Orange or contamination from Titanium or exposure to radiation poisoning from expended Uranium. The VA does though and their processes are superior to commercial hospitals. It would be good if they could set up small branch facility within hospitals where the VA hospitals are far and short circuit the need to go great distances.
A friend and mentor of mine who lives 1/2 mile from his primary care physician has to make an annual 180 round trip to see the VA. He is old but healthy and so he and his wife make a day of it with a nice dinner at the end. He won;t always be that healthy.
My late father-in-law always said “why the hell do I want to ride the VFW van for four hours with a bunch of old codgers 🙂 when my own doctor is 10 miles away and my daughter will drive me and buy me lunch.”
On a recent flight I doodled about 4 dozen thoughts about improving VA care (more money being #1) but it will be months before it gets to the top of my writing schedule.
I think Run and me will agree on one thing, this is a complicated situation requiring resources and different/better management.
Quick good news story…
We were in Baltimore airport last week when the hosts and some soldiers arrived to meet an Honor Flight of WWII vets from Cleveland.
With very little prompting a couple of hundred people created a reception line and clapped for the 40 minutes it took to deplane (38 of 45 were in wheel chairs).
The Southwest personnel were really great, fwiw. I had never flown Southwest, but I will again for a number of reasons.
The youngest WWII vets will be 87 this year, an era is ending.
Mark: I don’t know where YOU got that I mentioned taking away someone’s funding for the VA. I just see a shortage in funding. I guess YOU think The Dems can do no wrong and The Repubs can do no right.
I’m NOT making excuses for anyone. And YOU aren’t the ONLY Veteran in the world and certainly not the ONLY one that uses the VA. That line is endless.
It wouldn’t bother me to give up AMTRAK’s federal funding to the VA.
Dilbert Dogbert: More like one long endless STUPID war, none the less, AGREED!!!