Keep the VA

[Paul Albertine]

RAND Study Finds VA Provides High-Quality Health Care
WASHINGTON — Veterans receive the same or better care at U.S. Department of Veterans Affairs (VA) medical facilities as patients at non-VA hospitals according to a recent RAND Corp. study.

“The RAND study adds to a growing list of research confirming what many Veterans and VA employees believe – VA provides high-quality care,” said VA Acting Secretary Robert Wilkie. “We are constantly striving to improve our care at VA, but this should encourage Veterans and the public that VA care is in many instances as good as or better than the private sector.”

The study, which was published online April 25, compared each VA facility to three non-VA facilities with similar geographic settings (rural/urban,) size (number of beds) and complexity of care. The analysis focused on three of the six “Domains of Quality of Care” as defined by the Institute of Medicine, (now known as the National Academy of Medicine) including safety, effectiveness and patient-centered care.

The authors of the RAND study analyzed inpatient and outpatient performance measures used by VA and non-VA hospitals. On inpatient care, VA hospitals performed on average the same or significantly better than non-VA hospitals on 21 of 26 measures. VA performed significantly better than commercial and Medicaid Health Maintenance Organizations on 28 of 30 measures, with no difference on the other two. There was a wide variation in performance across VA, but an even wider variation among the non-VA hospitals.

For more information, see the quality data available on VA’s Access to Care website at www.accesstocare.va.gov.

[Dan Higgins]

We need the VA medical facilities.  Mid- size and small communities do not have enough doctors for everyone.

[Mike Beinck]

Keep the VA?  Absolutely, but more accurately we should say, keep government-paid, high quality, accessible care for veterans.

There are three major issues that confront healthcare for veterans (really everyone).  Those are cost of, access to, and quality of care.  I will limit this response to Paul’s post to the first two since quality is more difficult to determine and varies greatly in any system – VA or private as Paul pointed out in reference to the recent Rand report.

Cost of care.  It is no secret that healthcare costs continue to increase at rates that put many veterans at risk of not being able to afford care whether through direct payments to providers or through healthcare insurance.  I suspect insurance is beyond the ability of many to afford and even fewer (if any) of us can afford to pay cash for a major-medical event.

Therefore, how do we pay for our care.  Fortunately for many veterans, the VA picks up the tab for those more disabled or indigent, or for those with private health insurance, most of the cost with the insurance program subsidizing the balance or most of the balance.  So to those who decry “privatization of VA healthcare” I would offer two things.  First, the real question facing veterans is who pays for the cost of care and secondly, if the government is picking up the tab for all or most of it, why care about who owns the building where care is provided?  And if the government still pays the bill, is it really “privatized”?   There are still those who say that VA is the perfect example of “socialized” medicine and blame all of VA’s ills on that economic model.  In doing so, they ignore the sometimes less-than-stellar care delivered in the private sector.

Access to care.  In my 15 years as a staff member of the U.S. House Committee on Veterans Affairs, perhaps the most revolutionary legislative change to how the government provides care was the bill that allowed veterans who met certain geographic qualifications (generally called the 40-mile rule) to choose to receive care outside the VA system and have VA pay the bill.

In those 15 years, the most common complaint by far was the distance far too many vets had to drive (or unfortunately need to be driven) to get to a VA healthcare facility.  It was a reasonable attempt to address the distance issue within the funds available and unfortunately VA mismanaged how they determined a vet met the qualification which caused a significant issue in the vet community.  I believe VA has adjusted its regs regarding the 40-mile rule and I understand the issue may be addressed in upcoming legislation to modify or even eliminate the rule to improve access to care.  Even with VA’s expansion of its clinic system that began in the mid-90s, during which VA has added hundreds of small and medium-sized healthcare facilities, too many veterans still face daunting geographic challenges to VA care.  There are only two answers that that issue and they are to continue to build new VA clinics using dollars that could (and should in my view) go to providing direct care to vets.  The other is to allow vets to use their local providers when VA care is not either geographically convenient or when VA does not offer the type of care needed by the vet.

Finally, in any discussion of veterans’ healthcare, there is usually reference to the Concerned Veterans for America (CVA) followed immediately by a statement that CVA is funded by those (implied evil) Koch brothers.  I have never met the Koch brothers (who are billionaire owners of a major corporate conglomerate) but I have met with CVA staff and despite the vilification of their organization, I sincerely believe their goal is to improve care for veterans.  They are no more self-serving in their goals than are the unions at VA who defend every bad apple member and event in the VA system.  Some of their ideas approach a radical change to how VA would exist and provide care and some of their ideas are worthy of discussion with the goal of improving care for veterans.  So, what isbest for veterans? I believe a system that offers government-paid, high quality care in venues most accessible to veterans.