Thursday, May 29, 2014

Don't Privatize the VA Hospitals

The problems with the VA is not something that can be stopped with just removing Eric Shinseki, even though people like Rick Weiland and I think it would be an appropriate first step.  It did not take long, but the GOP are now scheming for ways to turn the care our veterans receive into a voucher system and privatize the VA.  This is a horrible, horrible, horrible idea for many different reasons.  I think it is important to look at some of the many reasons why we should not privatize the VA.

One of the reasons not to privatize the VA is that the VA is successful at many things.  The VA must handle some of the most difficult treatment cases.  The VA specializes in brain injuries, spinal injuries, treating amputations, burns, PTSD, and much more that private hospitals are able to handle.  As a poster shared with me, the VA has a better satisfaction rating than private hospitals:
The VA’s satisfaction index for inpatient care, 84, and its index for outpatient care, 82, remained consistent for the second straight year and have held steady for the past decade — a sign that, generally, VA patients are content with their health care....When compared with general satisfaction ratings of civilian hospitals, the VA results compared favorably: Under the ACSI system, civilian U.S. hospitals earned an index of 80 for inpatient customer satisfaction and 83 for outpatient care.
The acting executive director of the Disabled American's Veterans organization stated in a hearing about the inquiry into VA problems:
The simple truth is the VA is the best health care provider for veterans. In fact, the VA’s specialized services are incomparable resources that often cannot be duplicated in the private sector. 
Suzanne Gordan stated in the Boston Globe:
The VA has singular expertise in the treatment of post-traumatic stress disorder. Many injured soldiers have returned from Iraq and Afghanistan with what is known as poly-trauma — PTSD plus traumatic brain injury and limb amputations. Few primary care physicians — or even specialists — have much experience treating such cases in the private sector. In fact, without the VA, vets would have trouble getting any primary care services given the serious shortage of primary care providers in this country. 
Despite the horror show of the VA expressed in the media, it seems that there are a lot of successes with the organization.  That does not mean that the wait times and the ongoing problems are not real.  They are very real and must be dealt with.  What are some of the reasons behind the incredibly long wait period for some veterans?  There is a wide mixture.  One of the key issues is a lack of support by Congress.  The National Director for National Veteran's Services with the VFW stated in the hearing:

The lack of timely care for veterans is unacceptable. The VFW certainly hopes that VA would never intentionally deny care to veterans, but there have to be reasons why care takes so long to be delivered. We know capacity is an issue. The VFW, in partnership with the Independent Budget, has highlighted for years the need to increase VA medical facility capacity. Even VA’s own 10-year Strategic Capital Investment Plan (SCIP) identifies capacity as an issue. In 2004, VA’s medical center capacity was 80 percent. It peaked at 122 percent capacity in 2010, and in 2013 capacity remained unacceptably high at 119 percent. Since FY 2010, appropriations for major construction projects have decreased from $1.2 billion annually to an FY 2014 appropriation of less than $350 million for the same account. Access to care can be directly linked to capacity. VA’s major lease authority is also placing a burden on capacity, which directly effects access. Since FY 2012, Congress has not authorized VA major medical lease authority. That is 27 facilities in 18 states, most of which should be providing direct care to veterans. 
Another issue is the red tape; however Phillip Longman testified to Congress that they established much of the red tape to limit who gets service:
Here, the Veterans Benefits Administration must accept blame for not doing a better job of streamlining administrative procedures. But in all fairness, it is Congress, and by extension the American people as a whole, who have established the laws that require most vets to prove that they have service-related disabilities before becoming eligible for VA care. 
This is the perverse root cause of the waiting time and other problems of access. Who can say if a Vietnam vet is losing his hearing due to expose to too much artillery fire, or exposure to too many Who concerts? 
We need to open up the VA and grow it, extending no-questions-asked eligibility not only to all vets but to their family members as well. This not only makes clinical sense, it also makes economic sense. So long as the VA remains one of, if not the most, cost- effective, scientifically driven, integrated health care delivery systems in the country, the more patients it treats, the better for everyone. 
So as you can see that the VA has very, very good qualities and it has some issues.  Why the push for privatization for the GOP?  One answer is simple as a commenter pointed out:  Money.
Why is there no outrage at Senator McCain, the Senator from AZ who should have been aware of what is going on at the VA there. When will there be Mandatory funding of the VA? Here is a comment that was posted on line last night to an article on Senator Burr's comments to the VSOs. Here is what is really going on:
1. Campaign Cash. Burr has received $1,156,200 in campaign cash from the Health care related companies.
2. Funnel Billions To His Campaign Contributors. Burr is on record wanting to privatize the VA, which would mean billions of dollars flowing into the hands of private health care companies. (Lanny Stricherz, May 27, 2014)
To me that seems as good as a reason as any.  They have heard testimony from the veteran groups that they don't want the VA privatized:

Ryan M. Gallucci, VFW
In doing so, however, we must resist any suggestion that VHA is a fundamental failure which should be dismantled in favor of an alternative model. Such suggestions not only serve to relieve VA of its responsibilities, but fail to take into account the contributions that VHA makes to veterans, their families, and the medical community as a whole. 
Carl Blake, DAV (emphasis is mine) 
And unfortunately for those clamoring for it, contract health care is not the answer to this problem. Studies have shown that contract health care providers cannot provide the same quality of care as the VA at any less cost, despite claims by some that it can. Similarly, contract care simply is not a viable option for veterans with the most complex and specialized health care needs. A veteran with a cervical spine injury whose autonomic dysreflexia was mistakenly treated as a stroke is not better served at a local outpatient clinic or the local doctor’s office closer to his or her home. Sending those individuals outside of the VA actually places their health at significant risk while abrogating VA of the responsibility to ensure timely delivery of high quality health care for our Nation’s veterans. 
GOP.  Instead of trying to scrap ad ignore a problem by screaming "PRIVATIZE IT," why don't you do the hard work and try to make it better. 

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