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

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