DM Register: Overhaul the VA?
Yesterday's Des Moines Register featured an editorial promoting the elimination of the VA Hospital system.
I'll point out the motivation behind the article:
The
Department of Veterans Affairs underestimated the cost of veterans'
health care this year by $1 billion. Now, Congress is rightly
scrambling to find the needed dollars. Soldiers who risk their lives
for this country are promised health care. Congress has an obligation
to keep that promise.
The
Register starts off with a very salient point. The VA budget –
written two years ago for a FY 2004-2005 request – was drastically
underestimated. Sometimes underestimation happens in forecasting,
but in this case, something else happened between now and when the VA
budget was forecasted 2 years ago. From Reuters:
“The
bottom line is there is a surge in demand in VA (health) services
across the board,” said Veterans Affairs Secretary James Nicholson.
The
Veterans Administration assumed it would have to take care of 23,553
patients who are veterans from the wars in Iraq and Afghanistan but
that number had been revised upward to 103,000, Nicholson told a House
of Representatives panel.
Nicholson
told a House Appropriations subcommittee that his agency's estimate of
Iraq and Afghanistan veterans in need of health care services was now
four times greater than thought.
The VA
budget is vastly underfunded – because the number of veterans has
increased by 103,000 in the last two years! The VA has also been
facing the strain of another aging population: The Vietnam
Veterans.
The Register editorial continues:
But
Congress also has an obligation to use taxpayer dollars efficiently.
The outdated VA system doesn't make sense in the 21st century.
The
veterans health-care system runs parallel to the country's existing
network of clinics and hospitals. That duplication is inherently
inefficient.
Tax
dollars support staffing and maintaining clinics and hospitals that
serve only one segment of the population. And sending veterans to
specific locations means some are forced to drive long distances for
their care and medication. It limits their choices in care. It further
fragments an already fragmented health-care system.
What
makes more sense: The government should grant insurance coverage to
veterans, similar to the way it insures millions of Americans through
government programs such as Medicare or Medicaid. With an insurance
card in their billfolds, veterans could receive free care at any
hospital. The government would reimburse the hospital for that care.
That
would allow veterans to receive state-of-the-art treatment at
facilities of their choosing. It would allow them to visit doctors and
pharmacies closer to home. Existing hospitals could add staff to serve
the special needs of veterans the way hospitals already staff diabetic
educators or social workers. Perhaps federal dollars could even pay
their salaries.
The Register here is following a few older assumptions here. To refute a few of them:
– The
Medicare and Medicaid programs are facing financial problems, far more
severe than any predicted shortfalls in the Social Security
budget. The VA costs were underestimated for easily understood
reasons – the Medicare/Medicaid financial shortfalls are due to medical
costs of the program spiralling out of control.
– The VA
does run several satellite clinics to handle routine care, such as
simple checkups, etc. The costs of medicine purchased through the
VA system are also much cheaper than pharmacy-based programs due to the
VA having the ability to negotiate lower prices. (This is what
should have been done with the Medicare Drug Benefit.) For the
most part, the VA prescription system is one of the more popular VA
programs.
– The assumption that VA hospitals are of drastically lower quality. Washington Monthly summed up just how false that assumption has become:
Yet
here's a curious fact that few conservatives or liberals know. Who do
you think receives higher-quality health care. Medicare patients who
are free to pick their own doctors and specialists? Or aging veterans
stuck in those presumably filthy VA hospitals with their antiquated
equipment, uncaring administrators, and incompetent staff? An answer
came in 2003, when the prestigious New England Journal of Medicine
published a study that compared veterans health facilities on 11
measures of quality with fee-for-service Medicare. On all 11 measures,
the quality of care in veterans facilities proved to be “significantly
better.”
Here's
another curious fact. The Annals of Internal Medicine recently
published a study that compared veterans health facilities with
commercial managed-care systems in their treatment of diabetes
patients. In seven out of seven measures of quality, the VA provided
better care. It gets stranger. Pushed by large employers who are eager
to know what they are buying when they purchase health care for their
employees, an outfit called the National Committee for Quality
Assurance today ranks health-care plans on 17 different performance
measures. These include how well the plans manage high blood pressure
or how precisely they adhere to standard protocols of evidence-based
medicine such as prescribing beta blockers for patients recovering from
a heart attack. Winning NCQA's seal of approval is the gold standard in
the health-care industry. And who do you suppose this year's winner is:
Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every
single category, the VHA system outperforms the highest rated non-VHA
hospitals.
The
difference is that the VA system in the 1980s and 1990s was forced to
adopt computerized systems to track patients in response to calls for
the VA system to become more efficient.
In fact
(from the same article), the director of the VA during much of the
transformation in the 1990s was singled out in a book on business
management:
By
1998, Kizer's shake-up of the VHA's operating system was already
earning him management guru status in an era in which management gurus
were practically demigods. His story appeared that year in a book
titled 'Straight from the CEO: The World's Top Business Leaders Reveal
Ideas That Every Manager Can Use' published by Price Waterhouse and
Simon & Schuster. Yet the most
dramatic transformation of the VHA didn't just involve such trendy,
1990s ideas as downsizing and reengineering. It also involved an
obsession with systematically improving quality and safety that to this
day is still largely lacking throughout the rest of the private
health-care system.
The
difference between the VA system and the private health-care system is
that the VA has been able to focus on the quality and affordibility of
patient care – not profits.
That's not something we should abandon for another 'privatized' system that degrades quality and pads private profit margins.
Blog For Iowa 
Of course some want the VA done away with. Dont you know that military members are supposed to do the right thing and die on their last duty day. Now you know why I'm
proudtobeaburdenonsociety
mark
carlisle
LikeLike
You need to send you great counterpoint to the DM Register
Editior as a letter.
LikeLike
Positive RESPONSE FROM MY Iowa Veterans for Kerry Yahoo member about Chad's post:
——————————
From: “Fr. Terry Gomer” Add to Address Book
Yahoo! DomainKeys has confirmed that this message was sent by yahoogroups.com. Learn more
Date: Sat, 16 Jul 2005 06:19:50 -0400 (EDT)
Subject: RE: [IowaVets4Kerry-Edwards] DM Register: Overhaul the VA?
Dear Iowa Vets: well i can add this. my ex wife worked for the VA in the 90's before returning to college to get another degree. she went through the change in how the VA is managed on a local basis and the one important change was more imput from the employees on how to deliver better care and perhaps doing it at a lower cost. yes there were problems and probably still are some after all this is a huge health care system. The Register has it backward what we need in this country are clinics and hospitals run like the VA not for profit as all the other ones are.
The VA in Iowa City is a great care provider over all. I have had problems in only one dept and so i went outside for my care in that area but i would not go outside for anything else as the new clinic system is in a new building so most of my visits won't require me going up to the old one and fight for a parking space. but the care my doctor provides is as good if not better than any private care i've had. And there has never been an arugement about getting the narcotics for the pain that i have to live with everyday for the rest of my life and i take a lot of narcs and exotic drugs, but i know the va gets them at the best price, unlike my medicare drug plan (haha) that is a joke and prohibits this from happening. And the VA supplies the products needed for the insulin pump they purchased for me 10 years ago.
The only thing that upsets me is the lack of promised dental care for most vets. i have a rated disability and receive a small disability payment but to get dental care i think you have to be something like 75% rated with a military caused disability. when i joined the air force 41 years ago full health care was promised to me for the rest of my life. but each president has cut back care coverage and that includes clinton.
one reason why the Register wrote about the VA is that the one in des moines is not well regarded my many vets. when i lived in johnston i still went to the va in iowa city and over the time i was in johnston i asked some of the people i met at the rest stops along the way who had va plates why they were going to iowa city and they said they got better care, with less wait time and no arguments about the drugs they have been taking for years. when i lived in so dakota the worst VA there was in sioux falls which is the center for disabiltiy claims and other area wide benefits and wound up there one day as i forgot my insulin, before i got the new pump. and went there and was there waiting for 2 hours to get something that was listed in my chart which should have been accessed via the new computer system but theirs was not up to par yet. but i finally got it, i should have just went to the store and bought it. now sd, nd iowa and missouri i believe are all in one big center so expenisve things can be shared so each hosp that does not need a CT scan every day gets one for 2-3 days per week. the only problem is when a ct is needed and the scanner is someplace else and in the past when that happened the va would take the patient to a local hosp for the scan if it was felt it was needed now, not when the machine came. i see the one in iowa city that used to have it's own ct had a trailer there for ct's as south dakota did. now it may be that they have moved all ct's to a trailer that is then taken out to other clinics a certain number of days per week but is based in iowa city, i am not sure about this but i imagine this is why they use a trailer now so the machine is shared.
anyway i would like to toss my hat into the ring about what you said as it's true. the VA is a lot like Kaiser HMO in Calif. kaiser was the first large hmo in the country and i believe they studied the va for how to set up a system of clinincs that cover a wide area and can keep costs reasonable. so yep i love this VA and have no desire to leave it. Infact one reason why i remain in iowa is so i don't have to switch VA's again, like any thing else one never knows how good it will be but based upon what i found out 2 weeks ago most hospitals are now running smoothly and delivering great health care. ALSO THE VA IS INVOLVED IN RESEARCH PROJECTS AND VETS CAN JOIN ONE IF THEY DESIRE. THE VA IN SO DAKOTA PUT ME ON THE LIST FOR MS PATIENTS TO GET UPDATED ON NEW MEDS AND MEDS THAT ARE FINISED TRIALS AND WHEN THEY WILL BE RELEASED.
so hats off to your response as it's great.
Fr. Terry Gomer
LikeLike