Friday, May 30, 2014

Fixing the VA...Once and For All

Yet, once again, we hear President Obama say the same thing, this time about the scandal at the VA where dozens of veterans have died waiting to be treated or operated on.

A friend of ours (Ann Stone) says the President's response is distressingly similar to every other scandal that has plagued this President: the IRS targeting of Tea Party groups; the NSA eavesdropping of everyone it seems and now the VA scandal:
'Step one : I didn't know about it...I heard about it on TV
Step two: Express outrage
Step three: Call for a study
Step four: Fire a low level bureaucrat who likely was just following orders
Step five: Announce that you will wait on further action until the AG, IG, FBI finishes their investigation...then
Step six: Six months later announce it is all done or blame it on a political witchhunt by the Republicans ....
Repeat as needed....sigh'
At some point in time, you just want to throw up your hands and say: 'Take some responsibility for your own Administration and leadership or lack thereof!'

Here's one thing that President Obama could lead the charge on, however, and aim the VA towards a better solution once and for all:

'Allow federal allocated money to follow any vet who wants to go to a private hospital such as Duke University Medical Center...just exactly like VA money follows the vet around in the GI Bill and VA housing loans'

We generally are not in favor of expanding government programs or spending for the most part. We spent 22 years in Washington, DC with 12 of those being on Capitol Hill in a responsible public service position in Congress and 4 on the House Budget Committee.

22 years inside the belly of the beast showed us beyond a shadow of a doubt that we could cut and reform, reform and cut the US federal budget til the end of our lives and we would never really get to the point where every single tax dollar was spent to its fullest potential and produced optimal outcomes.

The one area where we are for more support, though, is for our veterans. Of any war, in any capacity. They could be peeling potatoes for 5 years in Singapore for all we know and we would still be in favor of full, high-quality benefits for them.


Because we never had the guts to join the military and serve our country in uniform. Anyone who does have those guts in these days of an all-volunteer military is far more brave than any professional athlete whom commentators praise beyond belief for 'playing with a bad ankle'. Or any person we know for that matter.

Any person who is willing to risk their lives for the rest of us deserves to be treated like a king or queen after their service to our nation and our freedom is over.

The way the VA hospitals have been operated in the past, and apparently, are still being operated, has been disgraceful. Maybe this scandal will rock the VA world to the point that the Obama Administration will actually take the bold steps necessary to resolve the problem and reform the VA hospital system in America forever.

How so?

'Adopt the same model as the VA has for the GI Bill where the government gives veterans money for scholarships to go to college and for VA-assisted housing where the government offers lower terms so vets can buy their own homes'

The concept is pretty simple:  Have the government money follow the vet around to wherever they want to receive health care. The vets get the federal support for health care and then they get to make their own individual choice as to where they want to go get treatment or schedule an operation to fix their war wounds.

We don't have 'Medicare-only' hospitals where only old people can get their health care, do we? We don't have 'Medicaid-only' hospitals where only poor people can go to get their health care, do we?

So why do we segment our veterans in a 'veterans-only' hospital system somewhat isolated from the truly great and exceptional health care that sometimes is being offered right across the street in a private medical center?

For some reason, VA medical care is the only program in the VA that doesn't use some form of vouchers or subsidized help in the private sector to benefit our veterans. There is some sort of mystical notion that the VA hospital system is the be-all, end-all for every veteran who returns to this nation alive and intact.

Former Congressman Alex McMillan had many conversations with veterans or their families about some problem they were having with the VA at the time between 1985-1995, usually a lack of admittance or a screw-up during their treatment.

Generally, the vets and their families were adamant about wanting to go to the VA, come hell or high water, regardless of the level of care they were receiving.
'Let's say you and I were driving down the road to your appointment at the VA in Durham, North Carolina on Erwin Road' Congressman McMillan would postulate.
'On the left side of Erwin Road is the entrance to the VA hospital. 100 yards ahead on the right is the entrance to world-renowned Duke University Medical Center where people come from all over the world for treatment.
Suppose you had a voucher to go to either hospital, the VA on the left or DUMC on the right.
Which would you choose?'
You would think that ended the conversation right there. While the delivery of care today in the VA system is far better than it was 30 years ago, there is still no comparison to the level of care a vet could receive at Duke Medical Center versus the VA Hospital across Erwin Road.

Yet the vet and his family would vociferously insist on getting help to go to the VA on the left side of Erwin Road in Durham. They deemed it to be their 'constitutional right' based on the social contract they believed they had agree to when they entered the service in the first place.

The point of this vignette is not to curse the VA or damn its fine doctors and nurses, especially in the wake of the VA scandal now brewing in Washington. We have a son who is now doing a surgery rotation in the VA so we know that many good-to-great doctors are helping our veterans get well.

The point we are trying to get across has more to do with prudential decision-making on the part of our duly-elected representatives and senators on Capitol Hill to use scarce resources, both financial and human medical talent, in optimal ways to provide the very best medical care we can for our returning, recovering veterans who keep us free every day of our blessed lives.

We can do better. We can fold the VA system into the general medical system of the US and allow medical care vouchers to follow the vet either in the form of paying for their insurance on the open market or just contracting directly with private institutions such as DUMC.

The existing VA capital plant of hospitals can be merged with the private sector hospital system and all of that money spent to keep up the plant and equipment can be used for other purposes. In many states, many of the more rural hospitals are struggling to fill its allotment of beds and use of their MRI machines. The larger hospital system could direct many VA cases to these under-utilized rural hospitals and provide much higher care for the vets with their experienced doctor and nursing staffs.

This VA scandal can actually be helpful if it leads to more clear-headed and clear-eyed policy on how we treat and deal with returning veterans.

Allowing VA benefits and cash to follow the vets around and allow them to make their own healthcare decisions would be a good place to start.

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