Problems With VA Medical Care

[heironymouspasparagus]

I don't give a ____ about blame on this issue. People spend too much time (me included on occasion) looking to blame someone rather than going about fixing the problem. And I know a little about the VA, personally and professionally, so reminding me about how long the problem has existed does nothing for me. That approach reminds of this colloquy from South Park (episode dealing with global warming flooding and people stranded on roofs):

That IS a big part of the problem - too many want to ignore the history, thereby eliminating ANY possibility of learning from it.  It's all about the "sound bite" quick fix!!  Partially right about South Park - the "stick our heads in the sand approach" is exactly what South Park, Simpson's, Family Guy, American Dad, et al are all about - it's what the American people are all about!!

And after the next election, the neglect of VA will continue - possibly sooner if/when the RWRE sees there really isn't an issue...

Here is some interesting data about how many vets for some different events and annual VA budgets for those vets.   We finally passed post-WWII spending in about 2008 or so.  But since there were potentially WWII and a big portion of WWI vets still around, the $ per person is pretty weak.  About $4 per vet in '47 or '48 - hard to tell years on that graph.  

NOW, since the WWI group is gone and probably 90% of the WWII group is gone (maybe more?), we only have maybe 16 million vets left to care for....many Korean, most VietNam, etc, etc.  And with $120 million per year in 2012, we are up to a WHOPPING  $7.50 per vet!!!   Yay, team!!   (Did anyone miss the sarcasm - if so, send me a PM so I can explain.)

And the recent big increases are under Obama - for whatever reason...  

Got to give Baby Bush credit where credit is due - he presided over increases in the last year or two of his regime to over $5.60 per vet!!!  Up from the $4.06 or so for most of his time...if anyone is keeping score on Presidents!!

And as I have said so many times before, it is a shameful way ALL the previous Presidents have just let this issue slide - but in fairness, it's absolutely, directly because the American people don't give a rat's you-know-what....even with all the flag waving and "rah-rah" going on for the last 13 years!

1940 - 2012 VA budgets
https://www.fas.org/sgp/crs/misc/RS22897.pdf

Number of military and casualties - WWI through 1st Gulf War;
http://www.pbs.org/greatwar/resources/casdeath_pop.html

[heironymouspasparagus]

It's just like with everything else.  This is a reaction.


Just like with everything else.....

Just like with everything else.....

It's BS when Obama improves it, but wasn't when Bush didn't....or made it worse - like the "Save Daddy's Face War"....

See the previous note.

No knowledge or sense of history!!

[Gaspar]

Just like with everything else.....

It's BS when Obama improves it, but wasn't when Bush didn't....or made it worse - like the "Save Daddy's Face War"....

See the previous note.

No knowledge or sense of history!!

The gyrations are fun at this point. I bet that after 8 years, Obama's legacy will be that nothing was his responsibility, because nothing was his fault.

It's like my 8yo. "I did't do it, so it's not my responsibility!"

[Conan71]

If Obamacare eventually morphs into single-payer, which seems to be the ultimate design, the VA scandal is a really good look at how single-payer health care is meted out in the United States.  What are the chances this really does get fixed to the benefit of the vets under this or subsequent administrations?  Maybe now that light has been shown on this on-going problem it will get corrected, but probably not before those responsible for this are given generous bonuses and promoted.

[AquaMan]

It seems a lot of people are organizationally naive or at least uninformed. My good friend who was an exec at a major oil company once told me that the executive leadership of most government functions is pretty much powerless. Presidents, Directors, Department heads come and go.  Its the long term civil service employees that run the country. The system protects us against patronage but doesn't do much for efficiency.

Now that we have this preference for picking leadership of these functions from the private sector, the first thing they have to learn is how well protected incompetence is in the public sector. You can fire an incompetent, (or more likely transfer him out of the line of fire) in the private world but at all levels of the government it is a much longer, more complicated task. In fact, its infinitely easier to travel from public leadership into the private world because of all the great contacts you made in government than vice versa.

You can fire Shinseki but that doesn't solve anything. The next guy must be willing to raise hell with his functionaries and see the job as short term or be comfortable with failure and just bank the benefits.

And of course as Conan points out, it all comes back to Obamacare.

[Conan71]

I simply pointed out, correctly, that the VA health system is a single-payer system.  Our vets are considered our most sacred citizens.  If this is how the most sacred of our society are treated, who is to believe that the rest of us would be treated any better if the ACA eventually morphs into single-payer for everyone.  We already know there are doctors who are refusing to participate in Medicare and Medicaid or who have stopped taking new patients on government-paid plans.

I have no idea if it will morph into SP.  But, there were no shortage of advocates for it and plenty of people who believe that what we ended up with would be such a muddled mess the only fix would eventually be a conversion to single-payer.

Aqua, there's the whole problem in getting rid of incompetence: it's the protected nature of civil service jobs.  If you or I engaged in sweeping deceit along the lines it appears to have happened in the VA system, chances are we'd be fired and quite possibly facing criminal charges or civil suits from families of deceased patients. 

At least in my encounters with municipal, state, and federal agencies there's never an incentive for department heads to cut waste, spending, or to jettison bad employees.  Instead, when they are asked to investigate where they can cut money from their budget, they circle the wagons and put together reasons why they can't cut their budget.  Redundancy and incompetence just keep getting rewarded with more spending and department heads seem more than happy to cover-up incompetence so it doesn't reflect poorly on them.  At least that's my experience. 

There apparently needs to be a better system for whistle blowers to feel confident in exposing corruption, waste, and deceit without worrying about facing consequences for doing so. 

[Gaspar]

I simply pointed out, correctly, that the VA health system is a single-payer system.  Our vets are considered our most sacred citizens.  If this is how the most sacred of our society are treated, who is to believe that the rest of us would be treated any better if the ACA eventually morphs into single-payer for everyone.  We already know there are doctors who are refusing to participate in Medicare and Medicaid or who have stopped taking new patients on government-paid plans.

I have no idea if it will morph into SP.  But, there were no shortage of advocates for it and plenty of people who believe that what we ended up with would be such a muddled mess the only fix would eventually be a conversion to single-payer.

Aqua, there's the whole problem in getting rid of incompetence: it's the protected nature of civil service jobs.  If you or I engaged in sweeping deceit along the lines it appears to have happened in the VA system, chances are we'd be fired and quite possibly facing criminal charges or civil suits from families of deceased patients. 

At least in my encounters with municipal, state, and federal agencies there's never an incentive for department heads to cut waste, spending, or to jettison bad employees.  Instead, when they are asked to investigate where they can cut money from their budget, they circle the wagons and put together reasons why they can't cut their budget.  Redundancy and incompetence just keep getting rewarded with more spending and department heads seem more than happy to cover-up incompetence so it doesn't reflect poorly on them.  At least that's my experience. 

There apparently needs to be a better system for whistle blowers to feel confident in exposing corruption, waste, and deceit without worrying about facing consequences for doing so. 

Or, and I know this sounds completely crazy, why don't we do away with the VA system all together and simply cover veterans under the private system?  The private system is more efficient, offers a broader range of services, and would allow vets to make more of their own medical decisions. Most vets are currently involved in what is called "dual-care" situations anyway because the VA system does not cover many things that they can receive coverage for under medicare.

If you have ever been in a VA hospital, it's painfully obvious that you are in a government run facility. Kinda like a DMV with beds.  I'm sure vets would love to receive a higher quality of care in their own choice of facility with their choice of doctor.  I am also sure that the American public would rather see their vets taken care of at the same standard they expect for themselves. 

Why do vets have to be a secondary class of citizen receiving secondary care?

[Conan71]

Looks like someone else failed by the VA.  Comes closely on the heels of the vet who committed suicide in Broken Arrow recently.  From KOTV:

Family: Man Killed By Tulsa Police Was National Guard Veteran

TULSA, Oklahoma -
Authorities have released the name of a man shot and killed by Tulsa Police early on the morning of Wednesday, May 21, 2014.

Police say an officer shot Cody W. Young, 22, after Young fired a rifle out of a window of an apartment building in the 1100 block of South Rockford Avenue.

Young's mother tells News On 6 her son would have turned 23 next month. She said he served with the Oklahoma National Guard out of Sand Springs and Vinita and spent about 18 months in Afghanistan before coming home two years ago.

Young was honorably discharged, according to his mother. She said he had PTSD but could never get the treatment he needed from the Veteran's Administration.

5/21/2014 Related Story: Tulsa Police Kill Man They Say Fired Rifle From Apartment Building

The night he was killed, police say they had 10 calls from different people who reported gunshots at the apartment building just before 1 a.m. Officers heard shots fired inside the building as they set up at the scene.

Homicide Sergeant Dave Walker said Young appeared in a second story window holding a rifle and fired one round. He was shot and killed by 17-year veteran Tulsa Police Officer Gene Hogan.

[heironymouspasparagus]

Or, and I know this sounds completely crazy, why don't we do away with the VA system all together and simply cover veterans under the private system?  The private system is more efficient, offers a broader range of services, and would allow vets to make more of their own medical decisions. Most vets are currently involved in what is called "dual-care" situations anyway because the VA system does not cover many things that they can receive coverage for under medicare.

If you have ever been in a VA hospital, it's painfully obvious that you are in a government run facility. Kinda like a DMV with beds.  I'm sure vets would love to receive a higher quality of care in their own choice of facility with their choice of doctor.  I am also sure that the American public would rather see their vets taken care of at the same standard they expect for themselves. 

Why do vets have to be a secondary class of citizen receiving secondary care?

And then you will be complaining because it costs 10 times as much.   Kind of like when the commodity food system at half billion a year went to food stamps at $15 billion a year....but it was in the private system giving a huge bonus to Safeway and A&P.


Have been to VA hospitals - visiting various friends and family.  The people who DO get into the care mainstream most the time are treated fairly well, and if poll most of them, you are gonna get a fairly positive response.  The BIG complaint is the wait and delay to get into that stream of consciousness...and yeah, there are many instances of bad care, but probably no worse than in the private system.  Especially in the long term facility - close family in Claremore for several years - plain facility, but treatment/housing was good.  Transferred to Forest Hills in Tulsa for a couple years...well, it is an Oklahoma nursing home, so what can ya say...or expect...

[AquaMan]

Sometimes I can't even agree with you guys. Yes civil service protects incompetence but private business largely hides it or gives incompetents a payoff and huge severance then they move on to the next golden lamb.

Large organizations often are like the VA. But not always. There are lots of big smart, lean companies. Same with the public sector. Your politics led you to compare ACA with the VA but not with SocialSecurity which provides much better service than many similar sized public companies.

[heironymouspasparagus]

Sometimes I can't even agree with you guys. Yes civil service protects incompetence but private business largely hides it or gives incompetents a payoff and huge severance then they move on to the next golden lamb.

Large organizations often are like the VA. But not always. There are lots of big smart, lean companies. Same with the public sector. Your politics led you to compare ACA with the VA but not with SocialSecurity which provides much better service than many similar sized public companies.

Truthiness abounds....



I suspect VA problems are more closely related to the interaction of funding (inadequate - listen for it....hear the you-know-who screaming!) to bureaucratic management rather than care in absolute terms. 

[Conan71]

Sometimes I can't even agree with you guys. Yes civil service protects incompetence but private business largely hides it or gives incompetents a payoff and huge severance then they move on to the next golden lamb.

Large organizations often are like the VA. But not always. There are lots of big smart, lean companies. Same with the public sector. Your politics led you to compare ACA with the VA but not with SocialSecurity which provides much better service than many similar sized public companies.

I compared it for a simple reason: This is what government single-payer looks like and it's not good.  My politics has nothing to do with it.  It's long-held beliefs based on experience, not dogma, I assure you.

Corporations don't tolerate incompetence in the rank and file worker.  It affects the bottom line and creates liability.  Upper management might look out for each other, but jobs are not protected like civil service jobs, unless it's a union shop.

[AquaMan]

Isn't SS a single payer service?

Also, given the time I can relate more than one instance where big companies I worked for not only tolerated but rewarded incompetence, larceny and malfeasance in their middle to upper mgmt ranks. Rank and file? Yeah, fire the bastards unless they are unionized. Bottom line is organizations public and private have much in common with each other when it comes to duplicitous jobs, protecting each other and incompetence.

[heironymouspasparagus]

Corporations don't tolerate incompetence in the rank and file worker.  It affects the bottom line and creates liability.  Upper management might look out for each other, but jobs are not protected like civil service jobs, unless it's a union shop.

If you really believe that, it points to a very limited range of experience and view of the world....both rank and file AND management....

I thought you were much older, I guess....

[Conan71]

If you really believe that, it points to a very limited range of experience and view of the world....both rank and file AND management....

I thought you were much older, I guess....

Nope, I've been a mid-level manager in a Fortune 500.  You don't protect turds in the field, they cost you money.  You cultivate the best and the brightest and jettison the f-ups quickly as possible to find someone who can do the job.