Lanterns: What’s Wrong With VA Health Care?

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What’s Wrong With VA Health Care?

It has long been accepted that when we, as a nation, ask men and women to go into harm's way, that we, as a nation, are there for them should the need arise later in life.

The Continental Congress made provisions for veterans' pensions for soldiers who were disabled while medical and hospital care was offered by the individual states. In 1811 the first medical facility was authorized, but it was not opened until 1834. The National Veterans Assistance Program was expanded to include their widows and dependents.

After the Civil War, many states opened veterans' homes. Since domiciliary care was available in all state veteran homes, incidental medical and hospital treatments were offered even if it was not service related. Veterans of all wars and those discharged from service were cared for in these facilities.

When the US entered WWI, Congress created a new system of benefits including programs for disability compensation, insurance for service persons and veterans, and vocational rehabilitation for the disabled. By the 1920s, benefits were being administered by three government agencies. In 1930 Congress authorized the President to consolidate and coordinate government activities affecting war veterans.

The number of veterans grew significantly after WWII, and so did the number of benefits authorized by Congress. While the administration of veteran affairs was federal, the facilities were still all run by the states. By the start of WWII, there were four million WWI veterans, but after WWII, that number grew by 15 million.  Due to scandals in the Veterans Bureau, programs were centralized in Washington DC. The centralization caused delays and problems leading to an eventual decentralization to field offices.

The Korean Conflict, Vietnam, and subsequent wars and conflicts have all been addressed with legislation. The 54 hospitals in 1930 have grown to 153 medical centers, 700 outpatient and community clinics, 126 nursing care facilities and 35 domiciliaries. In 1989, the VA became a cabinet-level agency.

Long Beach VA Hospital from Flickr via Wylio
© 2010 SupportPDXFlickr | CC-BY

As of 2013, the VA employed 312,841 and had a budget of $78.4 billion. According to the Census Bureau, there are 21.8 million veterans alive today. As the number of vets and the size of the agency has grown, so do the problems. Is every facility and every case a disaster? Of course not. I personally know people who have received excellent care through the VA.

Aside from the medical problems encountered are the psychological ones. Suicides have been in the news a lot these past few years. My research shows that most of the suicides are older vets, not to say that age matters for anyone who feels hopeless enough to end their own life. Figures range from 18-22 suicides per day among veterans. According to Military Times, the number is 20 per day and about 70 percent of veteran suicides were not regular users of VA services. 

While suicide makes headlines, what of those who suffer in silence and just go on day after day? Two years after making the headlines regarding fraud and other problems at the Phoenix facility, reports of falsified waiting lists and failure to discipline wrongdoing are ongoing. Who would have thought a government agency might not be as efficient as a private for-profit entity? (Sarcasm intended.)

John Cooper, a spokesman for Concerned Veterans for America, said, “The VA is still struggling with a lack of accountability, an inability to properly manage a budget rapidly approaching $200 billion, and a failure to provide veterans with timely access to care and benefits. The VA is broken, and if we want veterans to be assured of a VA that works, we need to systemically reform it.”

The agency seems to be loathed to discipline workers, and in cases where it does act to punish employees, it is fought by union-backed civil service rules.

A VA employee in Puerto Rico who was fired after being arrested for armed robbery was reinstated with back pay. She even pleaded guilty of the crime.

A VA nursing assistant in Alexandria, LA is still on the payroll while awaiting trial for a 2013 manslaughter charge in the death of a 70-year-old Air Force Veteran. The hospital initially called the death accidental. However, a coroner ruled the veteran died from blunt force trauma to the head.

The rules for civil service are only a small part of the problem. Last spring, the agency’s inspector general released twelve reports on the VA healthcare systems in Texas revealing that seven have scheduling mismanagement leading to extended waiting times for veterans. The reports blamed the lack of supervision, poor training, and weak management controls for the manipulation of data. The IG also discovered that the San Diego Veterans Affairs Medical Center manipulated waiting list data to make it appear that patients received mental health care more quickly than in reality.

USA Today reported the inspector general found 51 cases of scheduling problems among the 73 that were investigated. Cost overruns in the construction of the Denver facility have pushed the cost to $1.7 billion. Some of the executives responsible left the agency while three others were transferred or demoted. The facility in Jackson, MS has had two surgeons on paid leave for more than two years. Their annual salaries total more than $500,000 and count against the facility budget, yet no care is received in return.

At “risk” seems to be annual bonuses. Incentives are in place to encourage facilities to hit certain benchmarks. Of course, the benchmarks are set to encourage efficiency and appropriate care. However, for the lazy and unscrupulous, the ability to lie and get money for nothing (sorry for the Dire Straits reference) is too great a temptation.

140911-F-EX835-074 from Flickr via Wylio
© 2014 U.S. Department of Defense Current PhotosFlickr | GOV

My two cents in this mess-- get the government out of it. 

People who have nothing invested and nothing at risk are much less likely to do a good job. In the near future, I will highlight some specific horror stories, but they will not make the case any more than has been made. You will never get the fraud and abuse 100% removed from any government sponsored system. It was reported in 2014 there was $60 billion in fraud and abuse in Medicare. That’s in one year!

We have an evolution beginning with good intentions and ending with unintended consequences. The problem here is that lives are at stake. People are suffering and dying. They are dying from neglect and feelings of hopelessness. 

 

We need to make some serious changes in this country, from when and how we use our military to how we will care for them once they leave active duty. 

Next time we will look at some examples and options.

 

Photo Credit: "Soldiers Organized Services (SOS) Might Shut Down", © 2009 Jayel AheramFlickr | CC-BY

Written by Michael Murphy The Voice of Reason

The Voice of Reason

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