Privatizing VA Health Care

[Mike Worthington]

Received this email from the DAV this morning---this is something I felt was coming over a year ago when the government started the Veterans First Choice Program and sending Vet's to private Doctors---if this goes through be prepared to have your health care decline to the Doctors that are at the bottom of the pile as with Medicare/Medical----I know people that have these Doctors and it is pitiful with the care they do not provide. They have to get referrals to see specialists and can often take 6 months and longer. Take the time to voice your opinion with the survey and contact your Congressmen/Senators

 
 
On April 18, DAV will be briefing the Commission on Care, which will make recommendations about the future of the VA health care system, and we need your help.  Last week, the Commission discussed a plan to close all VA hospitals and clinics within 20 years based on the perception that many veterans prefer the private sector.  Given the wave of negative news over the past year, it appears the Commission has heard little positive about VA health care from veterans.
 
We know the VA is not perfect and there is much change that must occur and DAV has offered a comprehensive “Framework for VA Reform” to Congress.  But we also know the solution is not to dump veterans into the private sector, which is why we launched our “Setting the Record Straight” campaign to support real solutions that strengthen veterans health care.
 
Now we need to add your voice.  Please take a few minutes to share your experiences with VA health care so that veterans who use the system are heard loud and clear in this debate.
 
If you have sought health care from the VA, please click HERE and share your story with us about the kind and quality of care you received from VA, and if it satisfied your needs.  Tell us what worked and what needs improving.
 
Recounting your personal experience is one of the most compelling ways to influence changes to ensure VA better cares for the men and women who served.
 
Thank you for making DAV the leading voice on behalf of injured and ill veterans.

Please click here to share your story.

https://www.dav.org/can/?vvsrc=%2fSurveys%2f3260%2fRespond
 
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[Mike Timothy]

FYI - I have had back surgery going through the Veterans First Choice Program (this doctor was suggested by the VA but i did not have to use him if I didn't want to) and the VA was very good in paying for everything that was billed including the additional doctors that I needed to see while in the hospital for 9 days).  I am also going through physical therapy through the Veterans First Choice Program and once again everything is being paid for by the VA for a total of 60 visits for the year. I have no problem with this program from the VA.

[Paul Albertine]

It's an interesting, but unfortunate conversation.  The money that you received from the VA that went to your doctors, hospitals etc. came from the VA budget and it I $$$ that won't be available to the VA system.  However,  there are veterans who live in rural areas with no access to the VA medical facilities.  There is bad news every few years on the VA system, and the judicial system, the national parks...yes even the DOD. While it's good to get it out in the open, don't assume that the VA Medical care 'sucks', or is ineffective.  Ask anyone who receives care at the VA and they will sing the praises.  Most complaints are not about VA medical care...but how it is allocated by the Veterans Administration.  The Federal government could shut down the VA system and hand you a voucher and allow you to buy your own insurance, and tax saving would seem to be huge.  Of course your voucher could be worth less than the cost of insurance, and as most Medicare recipients already know the base of dctors, hospitals etc. is shrinking. Doctors finish college and med school in debt well over $500,000...and still give up 4 more years of their lives as residents. That bill has to be paid somehow.  Most docs that you see at VA are residents, and are very good.

Rural US is shrinking as cities, suburbs are growing due to jobs etc. With that rural hospitals are closing...  So I would agree with the VFW, keep the VA system, our current and coming veterans need it.  

But it's good your back is better...

Paul Albertine

[Mike Brinck]

The Choice Program is a direct result of the scandal at VA involving nationwide delays in accessing care and secret waiting lists.  The intent of the program, despite what our friends at DAV say is to increase veterans' access to care rather than waiting for a VA appointment.

The vast majority of VA hospitals were keeping secret waiting lists and gaming the appointment system to make it look like vets were getting appointments in a few days rather than the reality of many months and in far too many cases more than a year.  If you have been following scandal involving the Phoenix VAMC, over 40 vets died while waiting for appointments.  There is also ample evidence that the gaming continues at many hospitals.

Why would hospital staff do that?  2 main reasons.  First, VA pays bonuses (often 5 figures) to senior managers based on reaching performance goals.  Those managers pressure appointment staff to cook the books to ensure they get their bonuses.  Second, it is to make VA look good to the Congress.

There are lots of reasons for the long waits.  In some cases, VA docs see too few patients in a day compared to their private sector counterparts...often fewer than half the number your local doc sees in a day.  VA has also been lax in keeping clinics open enough hours.  Too often we have found that clinics work less than 8 hours per day and many VA hospitals have very limited surgery hours.

VA has always had authority to send vets to local docs and had budgeted about $7 billion for community-based care last year but hospital directors often tried to keep the funds in house rather than send vets to community physicians.  That also resulted in long waits for appointments.

The nation's obligation is to provide care for, as Lincoln said, "him who has born the battle, his widow and his orphan".  I am confident that Lincoln would not care if the vet received care in a VA facility or in the community as long as the gov't paid for the care.  We should not lose focus on the fact that the issue is what is good for veterans, not on maintaining VA's monopoly over your care.

Since the mid-90s, Congress has funded several new VA hospitals despite huge cost overruns.  for example, the new Denver VAMC will cost about $1.6 billion instead of the $600 million originally estimated, totally because of inept project management by VA.  There have also been added  nearly 1,000 new clinics, and additional $billions to the VA budget for healthcare.  In the early 90s, the total VA budget was about $25 billion.  This year, the president has asked for about $178 billion - about $75 billion for medical care and an additional $103 billion for benefits.  VA staff has grown from about 203,000 in 2005 to the estimated 360,000 in 2017.

So is Congress trying to "privatize" VA?  No.  What Congress seeks is to provide care for vets in a timely and quality manner.  Unfortunately, a VA that is unable or refuses to hold its employees accountable for poor performance, whether in a hospital or a benefits office, fails to do that in far too many cases.  So if you want to believe that maintaining VA's monopoly on healthcare for vets, then go ahead and sign the petitions and circle the wagons around an organization whose first priority is itself, not you.

Finally, in VA's defense, there are thousands of hard working VA staff who are trying to do the right thing for vets.  But they are hamstrung by too many deadbeats who only see VA as a job, not a mission.  Imagine working in an office with someone convicted of armed robbery who was put on admin leave, eventually reinstated and given full back pay. Or in an office with an employee who drove a drug addict under treatment to a crack house and it took VA 2 years to fire.  Tough to do your best when forced to put up with that sort of colleague.  

[Mike Brinck]

Despite my previous post, I agree with lots of what Paul said.  There are many good docs at VA who provide high quality care and I suspect if their leaders had vets' best interest in mind, there would be more of that good care to go around.

VA's community-based outpatient clinics were instituted to get access to care closer to vets, especially in the rural areas.  The clinics also take a load off the hospitals which are the most expensive places to provide care.

But in the end it is about the corrupt culture at VA that prioritizes the "don't make waves" attitude and punishes those who do.  In short, like any monopoly, VA fears competition for the healthcare dollars given to them by the taxpayers and like any monopoly, there are those who benefit from its resistance to change.

[Mike Worthington]

I am also in the Veterans First Choice Program for outpatient acupuncture ---all paid for by VA---the problem with the program is that is has taken the VA Doc out of the equation as to my needs. The TRI-WEST who handles the program is basically a call center---there is no one there that can make a decision. Secondly, the program was only good for a 60 day period and now it is 90 days and then you have to re-submit for more Doc visits. I have heard that for those that require and have been seeing---like me ---an acupuncturist-- that you can get a year visit instead of the 60/90 day deal. The problem I had was that after 5 years I am only needing to go every 3 weeks---I get between 8 & 12 visits approved--so you can do the math. Before the program I would get an OK from the VA to do my 8 visits and would request 30 weeks, allowing for sickness,etc--since the program started I had to go weekly visits or I would only get 3-4 visits and have to wait 6 weeks to 2months or more to get a new set of sessions. The deal with acupuncture is that going every week does not give time to see if we are going in the right direction.

I agree that the Doctors at the Fresno VA are top notch---just underpaid and over worked.

[Lee Hirschel]

I have been using the local VA hospital here in Spokane for about 6 years now. I do not need a lot of care. I go for my annual checkup to stay in the system. They give me hearing aids and adjustments to them as well as well as all of my Rx from the VA due to Service Connected at 60 %. I have not had any problem getting an appointment or anything else scheduled. For my more urgent needs I have relied on Medicare since last May and employers health care prior to retirement. The local VA had to shut down the ER after 5PM early in 2015, due to a shortage of doctors. They are still in big need of Drs. but have a hard time finding them. They claim they will reopen the ER when staffing reaches the correct level. I Have had no need to use the Choice program as yet. I would hate to see the VA get privatized. I think there is a big difference between the VA Administration and the VA hospital system. One is political driven the other is need driven. Could more vets get seen sooner and with positive results, yes! Not all VA medical centers are the same and there are many very dedicated and caring and hard working people staffing them on both the admin side and the medical side, but just like in private practice, results will vary.

[jess bradbury]

Hade to use the choise once va did not do sleep study at slc took them 3 months to call the final time to find out where I wanted to do it. the big problem they are on the east coast.