VA healthcare has its faults; but, it still is one of the more successful examples of publicly funded healthcare even while hampered by a lack of funding to provide more capacity in strategic places for new Iraq and Afghanistan veterans and aging Vietnam veterans like myself. Libertarian Pete Hegseth, a veteran of Afghanistan and Iraq and the CVA, both sponsored by the Koch Brothers, are hawking a dismantling of the VA hospitals in favor of higher cost and less result-oriented commercial healthcare and their own ideological interests.
The history of the VA has always included struggles with ideological, political, and commercial (healthcare providers, pharma and hospital supply) interests. In the seventies, activists went as far as to stage scenes (Life Magazine picture depicting care for Vietnam veterans) to make the care look worst than what it was. For commercial interests, it is all about selling more services, healthcare procedures, and pharma as compared to the evidence based treatments received at the VA. For the Kochs, Libertarians, and Pete; it is all about a Randian ideology, an ideology which Ayn Rand could not live up to and forsook to accept Social Security and Medicare.
As you may remember the Koch Brothers are also buying their way on to college campuses such as Western Carolina University by funding Centers for Free Enterprise A Slippery Slope Indeed. The selling of Public Choice and Libertarian ideology under the guise of Economics courses is paramount and they staff these centers accordingly by selecting those who view it favorably. The centers are not a free range of salt water and fresh water economics or intellect as one might find at typical universities. The American Legion and other VSOs have shown similar support for the dismantling of VA Healthcare the same as the Western Carolina University administration showing support for the Free Enterprise Centers. The VSOs have bought into the Koch funded CVA push to do so in favor of commercial healthcare and giving veterans healthcare vouchers.
Together they have orchestrated an attack on the VA by claiming 40 veterans in Phoenix , AZ had died while waiting for their appointments. I did not pick the claim of 40; but, I believe it is time to debunk it and challenge subsequent claims based upon the lack of integrity and truth in the original claim. What was reported to the public by CNN and other news media sources as a failure of the VA to take care of the 40 veterans in critical need by keeping them waiting for care is not true. Yes, there is a longer wait for new patients and first time visits; but, it is not to the extent stated. The Koch Brothers, Pete, and their “web of affiliates have succeeded in manufacturing a ‘scandal’ at the VA as part of a larger campaign to delegitimize publicly provided health care” in favor of the commercial healthcare industry. The exaggeration fed scandal forced the dismissal of Shinseki besides creating another taxpayer-funded commission to investigate the alleged abuses by the VA. “The Best Care Anywhere; Why VA Health Care Would Work Better For Everyone” author Phillip Longman was appointed to this commission. He will need all of the support he can get from veterans who oppose this move by ideological and healthcare industry interests to dismantle VA healthcare.
Former Wall Street Journalist Alicia Mundy (author of Dispensing with the Truth: The Victims, the Drug Companies, and the Dramatic Story Behind the Battle Over Fen-phen) gives a different story of what took place at the VA “The VA isn’t Broken Yet,” The Washington Monthly. Her article and two other articles report on the latest findings and paint a dismal picture of Koch Brothers and the healthcare industry attempts to dismantle the VA using innuendo and exaggerations.
While the allegations of deaths were not proven, the declared accusation of increased deaths resulting from wait times did raise concerns about how effectively the VA was with their care of Veterans. Of course, we all know how effective the overly funded commercial healthcare system is with the care of its patients. If you can afford it you will get every pill, procedure, and practice known to mankind regardless of effectiveness. This is not to say there are not good institutions or professionals; but to say commercial healthcare and wait times are both far better than the VA is simply not true. Indeed, it is the opposite. The overriding interest of those advocating the dismantling of the VA in favor of commercial healthcare is in securing it’s funding for commercial healthcare rather than improving the care for veterans.
One month into his presidency, President Obama appointed former General Eric Shinseki with no opposition in Congress to his appointment as the head the VA. Shinseki immediately set to work transforming a VA burdened by returning Iraq and Afghanistan veterans, a lack of needed capacity in places where needed (Phoenix and Tampa), and funding which did not keep up with the influx of new patients. The Bush administration had failed to close costly unneeded facilities (5 million square feet @ $53 million annually) and add capacity in other places (Phoenix and Tampa) as recommended by the CARES report besides increase the funding necessary to meet the onslaught of new vets. The CARES report listed what facilities needed to be improved and modernized, projected the future demands on VA services through 2022 in each geographic area the VA serves, compared them again to existing infrastructure, and made recommendations on how to meet the future needs of veterans. It was largely ignored as it too needed funding.
Instead of helping to care for all veterans, President Bush had also reversed the decision of former President Clinton to allow all veterans to use the VA and again installed the “proof of need” format for VA care. In other words if you were exposed to Agent Orange, drank bad water at LeJeune, were exposed to radiation from depleted Uranium artillery shells, or indigent; you again had to prove your ailment was military related or provide proof of being indigent. This can be difficult to do and it takes time. Again, presidential enforced bureaucracy ruled at the VA. It could again raise its ugly head with the wrong administration in place.
What about those news broadcasted wait times and other things Shinecki was accused of by Pete, the Koch Brothers, and the CVA? The VA under Shinseki reduced the number of homeless vets by ~25%, reduced the backlog of unprocessed veteran disability claims resulting from increased numbers of new and wounded Iraq and Afghanistan vets by 84 percent, and helped convince Congress to take in Vietnam veterans with chronic illnesses associated with exposure to Agent Orange making them automatically eligible for VA care.” As accused by the Koch Brothers, Pete, the CVA, and the silly news media, this was the man and the General who allowed veterans to wait for appointments and care only to die in the chow line of the VA while side stepping? But wait, there is more:
Under Shinseki, the VA built teams of healthcare providers whose responsibility was the care of its patients. Specific teams of PCPs, nurses, social workers, pharmacists, and health technicians were assigned to manage and coordinate the needs of each patient. This methodology overcomes the fragmentation of care, which can be seen in commercial healthcare today, and was described in Phillip Longman’s “The Best Care Anywhere.” I am taken care of by the VA Blue Team of healthcare providers.
Mental health professionals and substance abuse specialists were integrated into each team and this care excelled beyond that provided by commercial healthcare as it applied proven, evidence based therapy and methodology for mental illness. Insurance companies, Medicare, and Medicaid will not pay for this type of “body and mind” care by commercial healthcare. It is crucial to have it available for veterans as 25% of veterans suffer from chronic mental illness and 16% are addicted.
One study, “The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans” touched upon the differences in the success rate of VA care as compared to commercial healthcare.
” In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.”
Furthermore the study concludes the ‘findings demonstrate the significant advantages accruing from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.'”
Hey, but what about those overly long wait times broadcasted by the news media and pitched by Pete and the CVA which caused the deaths of so many veterans as stated by them? After all, the team methodology and evidence-based physical and mental care put in place by Shinseki does strain the VA capability to set prompt appointments for new veterans coming into the system for the first time. Then too the need for primary care doctors outstrips the supply of them by ~7500 in 2010 and the shortage is estimated to more than double by 2020. This shortage as well as the amount of team care given does place a strain on the VA capability to supply care to new vets. Unlike commercial healthcare, the VA put in place performance measurements which are available to the public. Commercial healthcare does not make its performance measures available beyond the advertisements seen on TV. “Across facilities, veterans waited an average of six and half days from their preferred date of care to their actually seeing a primary care doctor. In comparison, a private survey taken by the consulting firm Merritt Hawkins showed that in fifteen major medical markets across the country, non-VA patients seeking a first-time appointment with a family practice doctor had to wait an average of 19.5 days.”
For the first half of fiscal year 2015 starting October 2014 through March 2015 using the most recent data available from the Assessment B (Health Care Capabilities) Page 190 wait time study, the average number of days “Veterans waited for new patient appointments was approximately six and a half days from the preferred date for primary care, six and a half days from the preferred date for specialty care, and three and a half days from the preferred date for mental health” care as taken from page 190 of the same report.
Indeed, Figure 4-14 shows >93% of all veterans completed their appointments within 30 days. Again to compare, the average wait time for new veteran patient appointments is six and 1/2 days from the preferred date while the average wait time for non-veterans using commercial healthcare as experienced in 15 markets for first time visits is 19.5 days from the preferred date or three times longer.
And those 40 deaths caused by too long of a wait time? As taken another report, Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System, revealed, six and not forty veterans had died experiencing ‘clinically significant delays’ while on waiting lists to see a VA doctor. In each of these six cases, the IG concluded “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.” But for some reason those wishing to dismantle the VA can conclude such. Maybe they have a different source of information? They do not and this gets to the root of the issue. Why would someone make up such stories and the media report on them without adequate research when the end result would potentially cause so many veterans to lose their coverage and surrender to a must worse situation with commercial healthcare? News and especially catastrophic news sells and news today is lazy and lacks integrity. For everyone else concerned, it is the money involved or the VA funding.
My own experience with the VA has been good and that with major US hospitals and commercial doctors has shown similar if not greater wait times. God knows, I have been in enough hospitals since 2012 advocating on my own treatment. If you do not know, ask questions and do not be so ready to accept what is told to you because the person is a doctor. They do make mistakes like being given blood thinners when you have a blood disorder. As Alicia Mundy put it succinctly “while the VA has an assortment of serious problems, it continues to outperform the rest of the U.S. health sector on nearly every metric of quality—a fact that ought to raise fundamental questions about the wisdom of outsourcing VA care to private providers.”
I am not on board with this take over of VA Healthcare by commercial interests as supported by moneyed ideological and political influences. I would urge veterans to speak up as what you are going to get will not match what you have. Once your voucher is spent, game over.
“THe VA Isn’t Broken Yet Alicia Mundy, Washington Monthly
” Assessment B (Health Care Capabilities)” Rand Study on Wait Times 2014/2015