We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Sunday, June 1. 2014
The joint medical school-VA staff there were wonderful and more practically-minded than the full-time academics and researchers at the med school. They let us do things and procedures which the regular med center would never have let us do, and that was good experience. The patients, mostly WW 2 and Korea vets, but some Vietnam vets (they were still youthful and healthy then) were poor, on the whole, lacking in financial and overall life resources. There were plenty of veterans admitted to the regular medical center too but, at the time, I had no interest in how these systems worked.
Now I understand the the VA is plain old government medicine. Here's Charles Krauthammer, MD:
This article is good: Transform The VA Into A Pro-Growth Model For First Rate Health Care. There is no reason for the VA to exist today. It's an obsolete government program and does no favors to American vets.
Display comments as (Linear | Threaded)
The VA scandal is a perfect time for Pubbies to say something to the effect of:
"The VA has been a failure to our veterans for decades regardless of the administration in power. It's clear that the model it operates under (government command and control) does not work even for the small scale of the VA. Rather than put our veterans at any more risk than necessary, we introduce legislation to provide a choice of quality private health insurance plans that allow them to go to the largest number of doctors and hospitals possible so they can get quality and timely care. It is the least we can do for those who have given so much - including risking their life - for us.
"This should also be a lesson (along with the failures in other countries with government run health care like Canada and England) that government is not capable of providing quality health care to our citizens. The administration's health care reform should have centered on opening up health care options and transparency of cost and quality to give consumers more choices and better information to make those choices. We will continue in our efforts to redraw health care reform under models that actually work."
But then, we are talking about Pubbies, aren't we?
This is a good idea generally. But what about the vets who have catastrophic and life limiting service related diseases like ALS? Vets are twice as likely to get this horrible disease as the general population, and it is now considered an automatic 100 per cent service related disability. Handing one of these afflicted vets ten grand for a disease with care costs of up to a hundred grand a year is wrong on many levels.
ALS is a terrible genetic mutation with no cure and no effective treatment.
Vet or non-Vet, everybody gets the same supportive treatment.
Yes, genetic mutation causes familial ALS. Sporadic ALS, maybe not.
"Factors that might feed into the increased risk of ALS in veterans include exposure to lead, pesticides or other environmental contacts..." Burning oil as well. The Gulf War produced a cluster of cases.
General practice neurologists do not see very many ALS patients in a career. 2 cases per 100,000 people makes it a somewhat rare disease. Many have no clue that there is a higher rate of ALS among vets, and they fail vets in not knowing this and not getting them in touch with VSOs who can get them fast tracked for compensation, free medical care and grants for modifying living spaces, purchasing a modified van and getting the medical equipment.
I know ALS patients who are not vets, and a fair number of them are bankrupted by the enormous costs of equipment, home health care and Rilutek.
The VA health insurance plan the giverment would give vets should include coverage (or an option for coverage) for that.
TODAY, you have 6.5 million signed up for care in VA facilities.
Many who would qualify don't want anything to do with the VA and its level of care. They have better options.
But for a $10k voucher, many more would flock to sign up and either the cost would go up or the vouchers would get smaller - or both.
Lots of these guys have employer-subsidized insurance too. What to do in that case?
Good principle but lets think it through some more first.
I don't mind the voucher idea for normal circumstances, but in the case of actual war veterans with war related injuries or mental issues I think state of the art, specialized facilities not only aren't too much to ask but are the very least we can do.
People who have literally given part of themselves to protect me deserve something extra.
"People who have literally given part of themselves to protect me deserve something extra."
I think that's right, and just.
Vouchers seem like a good idea but not necessarily so.
I currently am qualified to receive medications at a reduced cost but not treatment or hospitalization. How reduced? I use two types of insulin that is sold retail for $268/vial. Every three months I go through 30 vials. That's a retail cost of over $8,000 every three months or $32,000+/year. My reimbursement to the VA for a year's worth of insulin is $216.
I think it's a great deal and well worth my time serving in the U. S. Navy with honor but not distinction or enthusiasm for six years.
Would I want to us the VA hospital in may area? Nope.
For reference: I'm an Army retiree, 22 yrs service and 70% rating at the VA; my husband is also a retiree, 24 yrs service and 30%; and my sister is a neurologist for the VA. I don't get treatment at the VA for anything, nor does my husband.
What people don't realize is that the VA is two healthcare programs bolted together: one for "service connected" problems, and the other for "poor" veterans.
Service connected is anything caused by, or worsened by, your time in the service-- which could be anything from combat to a car crash while you were on leave. (Agent Orange is the #1 driver of new cases now; it swamps Iraq/Afghan in both numbers and cost.) Those conditions are fully treated at no cost to the veteran; preferably at a VA facility, but they will automatically refer out (and pay for at TRICARE/Medicare rates) if there's a significant wait. There's also a lot of non-medical help provided: housing grants, transportation grants, training, even clothing allowances if you have prosthetics/orthotics.
"Poor" is a much more difficult thing to define. Initially, it meant "below the poverty line", but Congress has added so many special groups, extra considerations, carve outs, geographic caveats etc. that there's no easy way to work it out. A good estimate is Medicaid-eligible people account for most of the patients seen at the VA. But here's the thing: they get space-available treatment; if they do get referred, it's at Medicaid rates. Most specialists won't take them, since (bizarrely) it's often actually cheaper for the doc to simply treat them for free (as charity) than to accept Medicaid. And the overall budget is fixed; so everybody with service connected problems is taken care of first, and then, well, they try.
Or, to put it more bluntly, you're looking at the face of poor-people medicine. As a society, we generally assume that veterans are "deserving" poor, and the VA is part of some spasmodic attempts to make it less sucky for them, especially in certain Congressional districts. Life on Medicaid SUCKS. But eliminating the suck is way too expensive, even for the richest society that has ever existed. And it will keep getting worse, too.
I would expect that vouchers would end up being salami-sliced into worthlessness, just like Medicaid. You'll "have" "health care", but no doc can actually afford to take your voucher in exchange for treatment. Veterans aren't a big enough group to get the "herd immunity" given to Medicare (and also, all voters expect to one day get Medicare; almost all voters know they won't be getting a VA voucher). If there's a VA facility, there is at least the possibility of holding someone to account for actual medical treatment provided/denied, unlike a voucher that no one will accept.
And most veterans don't need any help with general healthcare, hence shouldn't be getting a voucher for it. A voucher to someone like me is functionally equivalent to billing my kids for it (plus interest), and I will fight any such plan tooth-and-nail.
I have a close friend who was a Marine in Korea. Perhaps because we live in the Boston area, where there are several teaching hospitals, he is very well taken care of at the VA. Much better in fact than I will be at his age on Medicare. I think he also likes being treated in a hospital for veterans, where the other patients are veterans and where being a vet is treated with respect. I gather this is not true everywhere but I would not like to see the change to vouchers. Then he would be just another poor anonymous Medicare patient in one of the huge city hospitals.
I'm thinkin' that I've no more respect for this proposal now than I did when President Obama's VA floated a trial balloon a few years ago. I get good care from my local VA for my everyday medical needs, I have a small co-pay for any prescriptions and they bill my insurance. Were I to need care for a service-connected problem, I'm pretty sure that the VA doctors would be much more familiar with any illness/injury that's likely plague a vet than most doctors, simply because of familiarity. I don't want to be shoveled off to some GP who is willing to take my VA voucher but knows little or nothing about Agent Orange, TBI or any other complaint that a vet might have.
Bring any sub-standard VA facilities up to snuff, attract more of the good caregivers like the ones I see and stuff your vouchers where they belong. A country that won't take care of those who served will someday have trouble findin' enough who're willing.
As a retired military person I am eligible for the VA but have made my wife promise that no matter what in the event I could not make the decision myself that she would not allow me to go to a VA hospital. My son is a disabled vet and must go to the VA hospital to receive treatment. So far so good; that is I mean they haven't killed him. Waiting times run to months with treatment suddenly canceled for no explained reason. When he finally gets back onto a list for treatment it is common that he gets one or two appointments before the system is reset again and he must go back to the beginning. I could go on and on about the nightmare the VA is for vets I know. But the solution is simple; abolish the VA and provide the vets with legitimate service related problems with insurance that would be adequate enough to provide them treatment at civilian hospitals. I have no doubt that there are good and competent health care providers who work in the VA. Abolishing the VA would give them the opportunity to work in one of the many first class civilian hospitals in the country. A win/win.