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Thursday, October 10. 2013
He always told me if I'd like a glimpse at what a government run program for health provision would resemble, take a look at the VA. My extended family members who have utilized the VA did so mainly because they could, and they lacked any other access to health services. None were particularly happy with it, except to say it didn't cost them much when they needed it.
I don't want to imply this kind of abuse can't happen in private practice. Certainly Hollywood stars have managed to find their fair share of enablers. But when it is the government running things, we're supposed to expect better, and when it's a single payer system, we won't have the range of choice to avoid charlatans.
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I first used the VA over 40 years ago as a newly returned , wounded and disabled Vietnam vet. I had found military hospitals to be good in so far as you had guys from your unit visiting and keeping staff on their toes. Absent that, not so good.
VA facilities were an order of magnitude worse than service hospitals. I had one ear op in the VA hosp. in Durham , NC ( right across the street from Duke Hosp). When my parents came to see me the next day they were so appalled by the filth and the attitude of staff, they swore to never let me set foot in such a place again. They footed all my bills until I could do so myself.
From all I have heard VA has just gotten worse in the interval. People who praise it have an interest in expanding government or are assuaging their own guilt over having their loved ones in the care of such an institution. Possibly there are a few exceptions. Not many.
Sorry about the rant. Touched a nerve.
No, I appreciate it. Without personal experience, I'm hesitant to say what they are like one way or another. My father was very critical of them, as I mentioned. Some in my family accept them as their 'insurance' because it means they don't have to buy any on their own.
Nobody I know has come forward to tell me how they are, good or bad, but I know very few who utilize(d) them.
That said, I appreciate your point of view and hope others who have VA experience will share their thoughts. My father, as I said, felt that when the government is running health, we'll all have the VA.
An organization like the VA will never be any better than it has to be in light of the options available to its patients. When the patients have no choice, some VA staff will rise to the occasion and do a wonderful job. Not everyone, unfortunately, is so inner-directed. Institutions are never staffed 100% by people like that. There will always be people who work there because it's very hard to be fired.
I had excellent care after a severe injury in the 7625th USAF hospital back in 1965. Upon discharge later due to my condition, I went to college, and since I was eligible for VA care decided to use it. I was required to go the hospital nearest my "home of record" which was about 250 miles from me instead of the nearest hospital which was only about 25 miles away. Oh, well, the military.
So I went to St. Louis. And I waited. And waited. Finally got in. Waited some more. [I had made an appointment.] Finally,on the third day I finally saw a doctor. He had been unable to access my service hospital records. It went downhill from there.
The hospital was shabby, not very clean, and incredibly slow. I have never returned. I sure as hell hope it's better today.
I have a colleague who assures me the VA hospital in Ann Arbor [near where I now live] is quite good, probably because it's very near the U of Michigan hospital, one of the best in the country. I suppose competition counts.
It's distressing to hear stories like these about VA hospitals, but then I'm not surprised. Why would it be any more efficient than any other government run operation. I once talked with a Vietnam vet who had a leg fused after half a dozen operations couldn't fix it. It's maddening because our vets deserve the best.
To all the vets who read this or not, deployed or not, wounded or not: please accept my sincere thanks for your service to our country.
VA hospitals are the DMV of hospitals. Bad service, uncaring staff and long waits. It would be cheaper for the government to simply pay for any veterans care with a regular doctor and hospital. The only reason we have VA hospitals today is because it is a way for congress to bring home the pork. It is exactly the same reason we have post offices in towns with under 100 people etc.
One thing to remember in most nations with single payer, private health insurance (which most NHS doctors in the UK carry for themselves) and private you pay medical care is still available. Canada is the main exception.
Though the political furball if there was a proposed mandate monopoly on health care would be amusing. Though if that we to happen, suggested viewing is Hospital.
In my experience, the VA has done very well by me and I don't have a complaint. I have two VA doctors in my amateur radio club and both are great docs - one of them is my primary care physician at the VA and in a case of odd coincidence, the other is my hematologist.
Now have I accessed the hospital itself? No, but I have experienced the emergency care facility and it was top notch emergency care - better than what I've received in the civilian world to tell the truth. I've visited the regular sniffy nose clinic and received quick, efficient care with a follow up from the Primary Care doc. Admittedly by telephone, but still. I get a complete physical once a year, meds adjusted as necessary, I have contact with the Primary Care doc through the Nurse Practitioner assigned to his clinic - I just don't know what more I could ask of the VA that would make it better.
I know vets who have had heart issues who are on VA care and they were treated in a local heart hospital with the bill picked up by the VA no questions asked. I had an accident with a sharp knife that was bleeding pretty good, called the emergency center at the VA and they told me to go to the local urgent care center. Never got a bill, never heard another word - problem solved.
I think sometimes people confuse efficiency with effectiveness. If they feel they aren't being paid enough attention to, they get upset as their problem, to them, is immediate and important. Where else can you go, see a different physician, have a full blood test scan soup to nuts with immediate results, have all your medical records on computer file so the Doc can see it all at a glance, get immediate x-rays with minimum wait times and see a specialist all in the space of 3/12 hours start to finish?
Find me a private practice doc that can do that - bet 'cha can't.
I grant that others have had bad experiences but I've had some horrific ones at the hands of private practice and HMO providers including an idiot neurologist who confused a middle ear infection with MS. Moron.
So, that is one individual's experience. Just as a counter balance you understand.
Completely understand, and I figured some people have had good experiences, so thanks for sharing.
However, your question of where I can go to see a different physician and have a full battery of tests run, etc. all in 3 1/2 hours - I got that beat by a long shot with my doctor's group. They have a several satellite offices, but a big facility nearby. They don't want to send you to the hospitals they are affiliated with if they don't have to. So if you've got an issue, they send you to their main facility. In and out in minimal time.
Glad I found them, great group. Never had a complaint in 10 years.
One year, I had a subluxation of my elbow (I think it was dislocated because I pulled it back into place and hit was the most painful thing I've ever had). I couldn't get in to see them first thing in the morning, but another local orthopedist had an opening. So I headed over to see him. Worst decision of my life. The elbow has never been the same, I have worked incredibly hard to rebuild strength, and it's taken 7 years to do so.
This doctor, upon hearing my father was a doctor, replied "doctor's sons are the worst patients" and proceeded to completely screw up my arm. He told me there's no way I had a dislocation, I never could have pulled it back in place. Meanwhile, I've got a huge knot on my elbow that was never there before...so when I suggested a subluxation, he said no to that as well.
It took me 13 weeks and a surgery before I could move my arm again. His initial diagnosis had been 'nursemaid's elbow' and put me in a sling. "you'll be fine in a four days".
Yup, there are lousy doctors out there in private practice, no question. Which is why I didn't bash the VA.
However, what will you do when you don't have a choice?
That's the issue, isn't it? No one denies there are bad private doctors, too, but the question is: how is the system likely to respond to them? What power do they have to force patients to keep coming back to them, no matter how bad they are?
My husband has, over the past 20 years or so, been treated in two VA hospitals and in a VA clinic on a regular basis and has received excellent care.
I can't help but wonder if the conditions of the hospitals--the two that he has been in were very clean and efficient--and the services of the clinic are related to location. The hospitals were in Cheyenne, Wyoming and Salt Lake City, Utah and other than having to travel quite a way the experience couldn't have been better. Far less population to service probably has quite an effect on cleanliness and efficiency.
Competition is critical to getting the appropriate care for the dollar expended. Choice is your vote.
I've had several relatives who are/were veterans treated at the VA, but they only chose to go in an emergency. One still serves as a colonel over a branch of medical services in a major venue. It's the same old, same old. The bigger the bureaucracy, the worse the service or product. If you're related to a colonel in charge, you get attention. If not, ?
If you want to experiment with ACA on the way to a single-payer system, you'll see a drastic change in delivery of services. Meanwhile, the basics of our healthcare system will be dismantled and it will be difficult to reconstruct a private pay system that attracts the best providers.
The insurance system needs to be reorganized; it's a product of the big employers rush to attract employees when wages were controlled during WWII. Big Auto, Big Steel, Big Big should never have been forced into the health insurance business. Big Government is even worse. I've worked with some of the insurance companies and the salaries are outrageous for the jobs done. What makes you think this is going to change by turning over insuring and delivering services to the government?
Make it employee-based, sell it across state lines, create pools for those with pre-existing conditions, tackle tort law, and allow tax- deductible medical savings accounts teamed with catastrophic insurance. My friends who use the docs accepting cash only payments have slashed their medical costs already.
I've had a little experience with a more modern VA. The biggest problems encountered were getting enrolled...it took MONTHS. And then getting seen...that also took MONTHS.
The best experience is really for those who live in areas that are rural where a full-blown VA facility is unavailable. Then, you get to see a regular specialist as a referral from the VA b/c the gov't decides it would be a hardship for you to travel to the nearest VA facility for treatment.
I don't think the people at the VA are horrible, per se, but the system MAKES them worse caregivers b/c of the mess of the system itself.
I agree. The tragedies faced by the medical staffs treating our active duty soldiers from WWII through today required they devise some of the most advanced and successful treatments for a wide variety of injuries and illnesses. The men and women who trained for medical services under war time conditions are exceptional caregivers. We had a large, urban, county hospital where many surgeons returning from Vietnam quickly found jobs as it was always understaffed and they were masters at treating gunshot wounds and burns. Docs and nurses at private hospitals were amazed at the survival rate.
It's the system, the bureaucracy, that makes delivery very difficult and sporadic. Unfortunately, I'm hearing that thanks to cutbacks, the DOD is trying to require that those eligible for VA care actually travel many, many miles to the VA hospital/campus to get care. Dumb move.
Based on my father's time there, he'd agree. He's not critical of the caregivers, but of the administration of the system.
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I worked as pediatrician/GP for Indian Health Service as locum tenens.
I loved it. No limits on what I wanted to do in best interest of patient. Good resources. I didn't worry about being sued (so I didn't have to order tests to cover my ass). The patients were deeply appreciative.
Only problem I saw was that the regular docs for IHS were old, retired and many evangelical christians who would lecure on Christ during morning rounds. I solved that problem by making my rounds early in the morning so I di dthem alone. The Indians (who were Christian) appreciated that I didn't hector them about religion; just practiced medicine.
No doubt there are those docs who are too quick to prescribe opiates at Va hospitals; what I and many others see is inordinate pressure from patients to prescribe them and anger to the point of abuse and threats of violence when such pressure is resisted. All this in the face of an unprecedented wave of deaths from opiate overdose in the recent past. The pro-pain control activists of the past 15 years have a lot to answer for--that is, in so far as their efforts have led to the undiscriminating use of opiates when less or other measures would have been medically better--which is what has happened.