Is the VA a Good Model for Health-Care Reform?

Progressive health-care advocates often tout the Veterans Administration health-care system as a model for reform. But is it really as great as its boosters claim? Ray Nothstine takes a closer look at the VA and finds a system that's far from perfect:

The VA manages the largest U.S. health care system, with more than 1,400 medical facilities. It's true that veterans treated at VA hospitals generally receive quality care. Yet this fact overlooks major drawbacks, such as backlogged claims, rationing of treatment, and waiting periods for appointments.

Those who have service-related disabilities are the VA's primary responsibility. Plans have been made to expand care to veterans who meet income qualifications. Yet cost and rationing are already problems in the VA. Expansion will aggravate rather than mitigate these difficulties.

In an interview, Rep. Gene Taylor (D-Miss) described the problem of using the VA as a model for a bigger public plan. "We [government] can't pay for the promises we've already made on health care," he said, "and it only gets worse for the next fifty years."

Read the whole thing here.

Comments

[jsh]

The VA is simultaneously proof of the wonderfulness of govt health care, and proof of the damage heartless fiscal conservatives do by not spending enough (and their hypocrisy about "supporting the troops" when applicable). It is both enough of a success to prove govt deserves more money, and enough of a failure to prove govt needs more money and that money should be spent by liberals.

[Cabeza de Vaca]

I remember the time my grandfather went to have a minor surgery done at the VA hospital. After the surgery was over the VA called my mom to come pick him up. My mom lives 3 blocks away from the hospital. By the time she got there 5 minutes later the staff had lost my grandfather. No one knew where he was at, or seemed to care that a patient was missing. My mom had to walk through the hospital checking every room, because no one would help her. Finally, she found my still sedated & a sleep grandfather in a room sitting in a wheelchair. Someone had pushed him in there turned the lights out & left him alone. I can't wait until all our medical care is delivered by government employees that could careless if you live or die.

[Forty-Two]

Has everyone already forgotten "Article 99"??!?

Is Ray Liotta really who you want as your family practitioner, America?

[Warren]

I was able to get care at the VA when I was unemployed. It was the best medical care I've gotten as an adult. I had to make appointments months ahead of time. On the other hand I spent the same three hours at the doctors office. The difference being, with private doctors two hours and fifty five minutes is spent not being seen by the doctor, at the VA the doctor spent over 40 minutes talking to me and examining me.

[Lamar]

The VA system is a success? Are you completely freaking high? It is the worst health care system in this country, and probably worse than most of the Euro systems. If you want to live, do not go to a VA hospital. Seriously, what am I missing here? Is it unpatriotic to criticize what a killer system?

[Lamar]

Warren,

Don't have a heart attack near a shift change. And if you must try to die, don't make it anywhere near a holiday weekend.

[Enough About Palin]

Back when Bush was president, I seem to recall a very well covered story about the appalling conditions of a VA facility in DC (or near there). It was considered shocking and a slap in the face of those who served. I also seem to recall someone having to resign.

So I guess it's all rainbows and unicorns now.

[brotherben]

Is that a democrat suggesting that it isn't economically feasible?

[brotherben]

E.A. Palin, I mentioned that problem here sometime ago and was soundly beat down. Apparently, it was an isolated incident and I was annointed "King Of The Douchebags" for even bringing it up.

[Enough About Palin]

"I was annointed "King Of The Douchebags" for even bringing it up."

No doubt there were other reasons as well. ;0)

My oldest friend big brother served in Nam. Special Forces. Did three tours. When he agrred to his second tour, he got a bonus big enough to buy a brand new 1968 Torino. And no I haven't seen the Eastwood film.

Anyway, I have heard VA horror stories from this guy (he's suffered the effects of agent orange and severe PTSD). My favorite was the one about the guy who went in for a tooth ache. A tooth ache. The VA remedy was to pull out every tooth in this guy's head except for one. One tooth! We guessed that the needed the one tooth as an anchor or something.

[Jake Boone]

Those who have service-related disabilities are the VA's primary responsibility.

That's me. I'm rated 100% permanently and totally disabled by the VA, so I am in the absolute top priority category for care. If anyone's happy with the health care they receive from the VA, it should be me, right?

Well, it isn't. The people who are most happy with the VA's level of care appear primarily to be in one of three categories:

1) VA administrators.
2) Big-government fans who've never actually set foot in a VA facility.
3) Warren.

It generally takes months to get an appointment. If I have something seriously wrong, I can sometimes get in in as little as three weeks. The appointments are full of bullshit bureaucratic one-size-fits-all requirements (canned speeches that have to be given to everyone in certain categories, regardless of their applicability to the individual patient).

Yes, many doctors are willing to sit around and bullshit with their patients, largely because they aren't paid by the patient. If they get through their appointments more quickly by not wasting time, they don't get any extra money; they just end up having to work more. As long as they get through their assigned appointments, they're in no danger of losing their jobs, so why work any harder?

Here's a thought experiment for you. Let's say you're a disabled vet, and you get a November respiratory infection. Antibiotics would probably clear something like that up in a jiffy, so when it doesn't go away on its own, you call your assigned VA clinic to make an appointment. The phone rings several times, then an automated system answers the phone. Rather than taking a message, however, the system tells you to try again later and hangs up.

You continue trying to get an appointment for several days, until you finally get through to a human. She tells you the earliest appointment you can get is two months away.

On Christmas Eve you start having trouble breathing, and end up in the local emergency room. Now the VA is on the hook for thousands of dollars.

The emergency room doctor tells you to follow up with your primary care provider within the week. You call the VA clinic again (though, since it's Christmas Eve, you have to wait for the next business day, as they don't bother with any sort of emergency line staffing). When you finally get through (again, after trying multiple times to get past the automated hang-up-on-you machine), you explain the situation and they say "well, I'll transfer you to Dr. Primary Health Provider's nurse. She can make a special appointment for you." So she transfers you... to the nurse's voicemail.

Several days later, the nurse calls you back. While your previously-scheduled appointment is still a month away, she can squeeze you in... in three weeks.

Three weeks later, the doctor asks why you're there. You explain that it's for a follow-up from the emergency room. Of course, you no longer really need the appointment, because if something had gone wrong you'd be dead by now, so obviously you're fine. You've just completed an odyssey into the best health care the United States Federal Government has to offer.

Oh, and by the way, this "thought experiment" happened to me last winter. It's not just a hypothetical. And I'm in the most favored class for healthcare. Most of you (and your loved ones) are not.

[Ellie]

I have a bed-bound caregiving client who gets his care through the VA. A nurse came in for an inspection and said, "He doesn't have any bedsores, so he doesn't need a bedsore-preventing mattress." They swapped it out for a regular air mattress. Four months later, when his backside is a mess of sores, they bring back the bedsore-prevention mattress. Thanks, VA!

I know it's just one person's experience, but boooooo on them.

[Isaac Bartram]

Enough About Palin

The story you're referring to happened in a section of the Walter Reid Army Medical Center, not the VA.

From my limited experience talking to vets that use VA facilities is that quality varies widely from one location to another.

But then I've heard the same sorts of things about hospitals in the military system as well.

[wingnutx]

I've gotten great care at the VA, but the time it takes to actually get in are absurd.

[Enough About Palin]

The story you're referring to happened in a section of the Walter Reid Army Medical Center, not the VA.

Thanks!

[Kyle Roberts]

I can't believe that no one has brought up the case of the El Paso VA hospital that was re-using sheaths for diabetes patients. They exposed over 1000 patients to AIDS and hepatitis. That was in the news around, what, March or so?

[Kyle Roberts]

Hmmm... Guess I was confused. It looks like it was people who received colonscopies in Murfeesboro, August, and Miami who were exposed.

[rogue cancer unit = model for]

At V.A. Hospital, a Rogue Cancer Unit

By WALT BOGDANICH
Published: June 20, 2009

For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans' hospital in Philadelphia, his aim was more than a little off.

Most of the seeds, 40 in all, landed in the patient's healthy bladder, not the prostate.

It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.

He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.

The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.

Two years later, in 2005, Dr. Kao rewrote another surgical plan after putting half the seeds in the wrong organ. Once again, regulators did not object.

Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years - and then kept quiet about it, according to interviews with investigators, government officials and public records.

The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.

[Warren]

I'm not saying the VA is good for urgent care situations. I have no experience with that. But when it comes to diagnosing and treating. My VA doctors have been ten times better than any in private practice.

I have BCBS PPO. I go to the best doctor I can. (Unfortunately good doctors "aren't accepting new patients" unless you have a name to drop) They spend five minutes with me twice a year and brush off my questions about medications, dosage, and side effects. At the VA I got four appointments in nine months. Switched medications twice and dialed in the dosage. Plus, the VA was quicker to order tests (MRI e.g.) than my other doctors.

[Paul]

So I guess it's all rainbows and unicorns now.

Yes, because Home and Change(tm) has come to America. However, it's being held up in the immigration process and may end up being held indefinitely.

[Alan Vanneman]

This is not a "closer look." This is a handful of unsupported assertions with an anecdote or two.

[Will]

I'm a vet, and I'm not impressed with the VA system. Despite being rated for bi-lateral soft-tissue shoulder disability (rotator cuffs), it took 7 years in the system to see a specialist. He talked to me for 5 minutes and told me they wouldn't do anything for me until my shoulders had degraded, which it will without proper care. No pictures other than x-rays. No scoping for scar-tissue removal. Nothing. Uh yeah, thanks a lot. My primary caretaker for the past 5 years is a PA, not a physician. Ug, there are many, many more things to whine about. If it were private health care I would take my business elsewhere, but I can't. I'm still plugging away at trying to find a job that offers health insurance and/or being able to afford my own.

[linda]

I'm just a girl who was searching the net for the proper mattress for my son who is quadriplegic... getting my shi*t together prior to another masshealth battle for him.. ANYWAYS, I just want to stop and say thank you to all of you.. for fighting for my freedom and rights.. and I'm so sorry the system has failed you.. how could it not.. It's a failure, a disgrace. I know this just from the endless battle I fight for my boy.
I'm just one girl... but i bet and need to believe that there are an infinite number of others who wish all of you could receive the honor you deserve. My thanks and prayers remain yours, Linda

[Etheros]

Ah yes, the VA
All of you OIF/OEF veterans
Get your disability rating and money
then get as far away from the VA system as possible. It is simply slap in the face joke, and will take years off your life in stress anyways. There is no true help there, only uppity ethnics and doctors who graduated at the bottom of their class. The VA is a disgrace, the recruiters don't tell you that shit do they.