Lambert here. Don McCann of PNHP has this to say about the VA “scandal”:
The uproar over the manipulation of wait times at the Phoenix VA hospital and other VA sites has tended to overshadow the larger issue of whether U.S. veterans have sufficient, unimpeded access to care. The short answer is they don’t, due to the inherent limitations of the VA program and the fragmented nature of our current health system. Among other problems, many veterans don’t even qualify for VA care and are completely uninsured….
Over the years there have been long waits for different kinds of care at the VA, even as the overall population of veterans is declining. …
But the longest and most onerous waits are associated with the time it takes to determine if veterans are eligible to receive care at the VA, and at what level. This determination is done precisely because the VA is not a single-payer system. It doesn’t cover everyone; it’s not accessible to every veteran; it is just one payer among many in our fragmented system. Currently about 2.3 million veterans and their family members are completely uninsured.
In contrast, a single-payer national health program would cover everyone and allow them to choose any provider and source of care in the U.S.
In other words, real issue at the VA isn’t the waiting list; it’s the eligibility system. From a systems perspective, that’s exactly the same problem that ObamaCare has. Both the VA and ObamaCare substitute complex, unfair, and gameable gatekeeping systems for simple, rugged, reliable and proven single payer.
Worse, the neoliberals that infest all our governmental systems are — and I don’t know whether this is stupid, or evil — crapifying these gatekeeping systems wherever they find them as a way of degrading the quality of government service provided to the public, thereby justifying privatization and looting. This is happening with Post Office closures, it’s happening with Social Security offices, and as the author of this post points out, it’s happening with the VA as well.
By run75441. Originally published at Angry Bear.
Today, “Economist’s View showcased Paul Krugman’s latest NYT article“Veterans and Zombies”. Paul discusses how the hyped-up VA issues are being used as an example of under performing government healthcare to emphasize how bad the much larger PPACA healthcare reform could be if allowed to proceed. Of course this is not true; but both Mark and Paul missed the data found by the most recent VA audit. The results of the audit were released June 9th. I left a long reply on the thread detailing the findings of the recent VA audit.
There is no comparison to be made of the VA healthcare to private healthcare. The VA is ahead of private healthcare and where private healthcare should be if it were going to improve. In a nutshell, the VA is well beyond the typical private healthcare system in providing “evidence-based protocols of care — not inadvertently ordering up dangerous combinations of drugs, or performing unnecessary surgeries and tests just to make a buck and treating the whole patient and not just one part at a time.” The services for fees cost model does not exist in VA healthcare for veterans.
If you remember, I had recently written “Wait Times at the VA” detailing what the recent Inspector General had discovered in the audit of the VA as reported June 9th “U.S. Department of Veterans Affairs VA Access Audit & Wait Times Fact Sheet System-Wide Overview”. Phillip Longman the author of the “Best Care Anywhere” featured the Inspector General’s report on the Washington Monthly “Just How Long Is The Wait”
“The nationwide Access Audit covered a total of 731 separate points of access, and involved over 3,772 interviews of clinical and administrative staff involved in the scheduling process at VA Medical Centers (VAMC), large Community Based Outpatient Clinics (CBOC) serving at least 10,000 Veterans and a sampling of smaller clinics.” Included in the finding were these issues:
– A complicated scheduling process resulted in confusion among scheduling clerks and front-line supervisors.
– A 14 day wait-time performance target for new appointments was not only inconsistently deployed throughout the health care system but was not
attainable given growing demand for services and lack of planning for resource requirements.
– Overall, 13% of scheduling staff interviewed indicated they received instruction (from supervisors or others) to enter a date different than what
the Veteran had requested.
– 8% of scheduling staff indicated they used alternatives to the official Electronic Wait List (EWL). In some cases, pressures were placed on
schedulers to utilize unofficial lists or engage in inappropriate practices.
Immediate Actions to Be taken as a result of the Audit:
– VA has accelerated care for Veterans currently waiting for health care services. VHA is in the process of contacting in excess of 90,000 Veterans
during the first phase of VA’s “Accelerating Access to Care Initiative.” The first phase is the first appointment.
– VHA will provide Veterans who do not currently have an appointment, or are waiting for additional care or services longer than 30 days the option
to be rescheduled sooner if VA capacity exists, keep their scheduled appointment, or be referred to non-VA providers in the community.
– VA has suspended all VHA Senior Executive Performance Awards for FY14
– VHA will remove 14-day performance goal from employee performance plans
– VHA will revise, enhance and deploy Scheduling Training
– VHA will implement a site inspection process.
What is so different about this if one were to compare the VA to private healthcare is, if the issue occurred in private healthcare nothing would have happened or reported to correct the issue. The VA had set up guidelines for scheduling people, a 14 day window, and a procedure to report on it. People created work-a-rounds to the procedures and processes to surpass the reporting and they got caught. The issue went public. Little if any of this reporting occurs in private healthcare, much less public reporting. Yet Congress and critics think that closing down the VA and turning veterans over to the private healthcare system is a benefit to veterans. It is not a benefit to veterans and is a detriment
Audit Findings: Long Term and Other Actions:
– VHA will overhaul the scheduling and access management directive.
– VHA will roll out near-term changes to the legacy scheduling system.
– VHA will acquire and deploy long-term scheduling software solutions.
– VHA will reassess and establish access timeliness goals.
– VHA will strengthen accountability for integrity in scheduling and access management.
The VA is implementing change to again take on scheduling of Veterans for appointments. That the VA even had a 14 day goal for appointments is far beyond what can be see in private healthcare except if one goes to the ER.
Wait Time Information
On May 15th, the VA had ~ 6 million appointments scheduled across its system. ~57,000 Veterans are waiting to be scheduled for care. ~ 63,000 veterans over the past ten years have enrolled in the VA healthcare system and have not been seen for an appointment. The VA is making contact with those who need scheduling and the new enrollees to clear up the backlog.
– Of the 6,004,350 total appointments scheduled, 96% of them or 5,763,291 appointment were made in 30 days or less.
– Conversely, 242,059 veterans or 4% of the 6,004,350 scheduled appointments were made after 30 days.
– The audit shows that even appointments at the Phoenix, AZ VA (the ground zero of the VA scandal), 89 percent of people enrolled in the system
received an appointment in less than 30 days. The average wait for established patients to see a primary care doc coming to just over 14 days.– Most everywhere else in the VA system, average wait times for established patients to see a primary care doc are in the range of 2 to 4 days, as
are waiting times to receive specialty care.
Mind you, three months for a doctor’s visit is too long; but, it is not so out of the ordinary as what is being experienced in private healthcare today. The audit did reveal there are ~ 57,000 veterans who have waited for a doctor’s visit longer than 90 days and representing ~ 1% of the 6 million vets taken care of by the VA. Furthermore, there are ~ 63,000 veterans who are more-than-likely not the newly arrived veterans from Iraq/Afghanistan as claimed by CNN and the rest of the media. Much of this numeric can probably be explained by the relaxing of VA regulations on admission into VA care. Many Vietnam Veterans have reapplied to the VA with the idea we may be accepted. I would urge any veteran to apply as the regs do change as well as your income and you can be grandfathered even if the next president tightens the regulations as Bush did.
The VA is not flawless as many of veterans today know and I surely do. Of the 57,000 veterans waiting for an appointment, some veterans may have been forgotten by the VA, some may have moved to another city and missed the appointment, some may have gotten group insurance, and many may have enrolled immediately upon discharge to insure grandfathering and not need an appointment. This was the broad base upon which CNN made up its news story along with other media outlets and politicians with unsubstantiated data which is proving to be more hyperbole than fact.
Sending veterans to private healthcare after breaking up the VA is what CNN, the media, and the politician’s call a “benefit” bestowed upon Veterans. It is not a benefit and will only make healthcare treatment worse for veterans.
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The VA has been in the cons cross-hairs for years. As soon as Bush II came to the imperial throne he further restricted VA health care access based on income, never mind your illnesses were service related. And never mind King Bush was engaged in two nation building exercises where mayhem reigned.
Visiting the lobby of a VA health care clinic should be a requirement for every American. There you will see lots of maimed young men and women cut down early in life waiting to be seen by staff, usually safe behind thick uninviting walls. You will quickly become saddened and enraged at what the politicians did to these brave Americans. Yes, they are responsible.
Yes, the politicians “pulled the trigger” on the various shock doctrine events that have resulted in the VA’s current sad state of affairs, but someone had to support them (and still does, for the most part) in the first place. That answer isn’t nearly as comforting.
I don’t know which VA facilities you have been to, but the only thick and uninviting walls I’ve seen are those of the pharmacy dispensaries at the VA facilities and my mother’s private primary doctor’s office. Other than that I agree with you.
Any Nation that treats its Veterans the way this nation treats its Veterans does not deserve to have ONE SINGLE VETERAN! Period exclamation point – end of discussion!
Any country which starts wars of choice for the purpose of invading and conquering countries which didn’t do anything to us…
…and then LOSES those wars…
…should not have anyone signing up for the military. The treatment of the veterans afterwards is just adding insult to injury.
Worse, the neoliberals that infest all our governmental systems are — and I don’t know whether this is stupid, or evil — crapifying these gatekeeping systems wherever they find them as a way of degrading the quality of government service provided to the public, thereby justifying privatization and looting
It’s ignorance, coupled with uninking, reflexive stupidity coated with confirmation bias. Anyone who observes news media on a daily basis, who is educated at an elite institution or has attended an econ 101 class knows markets are better than everything, given we are bombarded with the word a hundred times a day. But it isn’t the econ definition used when referring to the word, it’s the political use which means “non-government” and so a concept which only applies under specific circumstances is being implemented in every facet of life where markets cannot exist.
Free market reforms are instituted in health care, where there is not and cannot be a market due to asymmetry of information coupled with what econometric models would lable “irrational” behaviors when attempting to protect one’s health. Surely were it otherwise, out of the 190-odd nations in the world, someone would have instituted a functional market-based health system by now.
Yet the thinking, whether on free-market reforms or austerity, remains that if it isn’t working we just didn’t do it right, that government distortions (as an aside, ask yourself when you last recall a free-marketeer discussing non-government distortions, because they most certainly exist) are yet again demonstrating just how pernicious the public sector is. So the failure of the market reform becomes confirmation that more reform is needed. Eventually when the institution being reformed fails due to the reality that a market cannot exist there, it is privatized as government is clearly so distortive it cannot even be reformed effectively. Whether the newly privatized institution is effective or not is quickly neglected as the attention of reformers moves on to the next government-induced market distortion.
What neoclassical propaganda has done, fundamentally, is make us dumber: less adaptable, more path dependent, lowered imagination and inhibited our creativity. Teaching economic “laws” as something written into the fabric of the universe makes the reform being instituted something that must be made to work no matter how hard we have to beat it and the people it will affect with a hammer.
“It’s ignorance, coupled with uninking, reflexive stupidity coated with confirmation bias. Anyone who observes news media on a daily basis, who is educated at an elite institution or has attended an econ 101 class knows markets are better than everything, given we are bombarded with the word a hundred times a day. But it isn’t the econ definition used when referring to the word, it’s the political use which means “non-government” and so a concept which only applies under specific circumstances is being implemented in every facet of life where markets cannot exist.”
As a patient in the VA system for the past 10 plus years, I can say that the care I received when I first entered was outstanding and measured up in every way against the private care I had received for the previous 40 years. I am convinced that the wording quoted above succinctly describes the self-fulfilling prophecy that the current political class so favors. This begs the question, how did government do such a good job in the past but is now so completely incompetent? Time to throw the bums out!
If throwing the corporate-fed bums out only brings in anew crop of corporate-fed bums, that’s no improvement. The U.S. is now owned by corporations and banks, whose legally-bribed lackeys at all levels of politics do whatever they are bribed to do. The republic expired long ago. Face the fact that corporations rule, and we and the planet mean nothing to them unless we can increase their profits.
“It’s ignorance, coupled with unthinking, reflexive stupidity”
maybe with some of the underlings. Far more evil driving this than stupidity.
Ben, no, I’m sorry to say, you’re wrong. The neoliberals are – just as lambert says here:
“Worse, the neoliberals that infest all our governmental systems are — and I don’t know whether this is stupid, or evil — crapifying these gatekeeping systems wherever they find them as a way of degrading the quality of government service provided to the public, thereby justifying privatization and looting”
deliberately dismantling anything that can be called a public service in part because of GATS, the WTO GATS agreement and its mandate to privatize everything. perhaps it is most informative to steer you to a Canadian NGO that has a great deal of lucid writing on the GATS. You could try a search like this, inserting GATS as your search term. note the ones on postal services, healthcare, local autonomy, privatization, TPP, TISA and GATS are all relevant.
Some of this should also be illuminating:
Many of the Policy Alternatives briefs were written by this fellow..
Scott Sinclair, Senior Research Fellow, Canadian Policy Alternatives (he explains GATS and TISA and how they relate)
Sanya Reid Smith, Legal Advisor and Senior Researcher, Third World Network (She seems very good, she gives a overview of TISA – also she describes the US approach – what it is, something a lot of people (like you it seems) seem to be in denial about. Its not innocent! its not unintentional- They REALLY want to privatize and outsource/offshore..
(which is probably why that services are forced to be privatized by default!)
Its all about control during these waning days of the 20th century industrial era of work as we know it.
The pushback is already strong. The governments in the US and most of Europe exist only due to the population having difficulty finding alternatives to vote for; they lost democratic legitimacy some time back. The elite can retain power for a while by shenanigans, but after a while that stops working. They can attempt to resort to violence, but the security forces don’t really have any loyalty to them either, because they’ve screwed the military and police over too.
This means we’re going to get change within our lifetimes. 10-20 years.
Ben, I’m having trouble following your rant. It sounds like you’re inventing a convenient rightist villain rather than dealing with the actual situation. What does ignorance and stupidity have to do with the crime spree through which we are living?
First, there is massive public support for federal involvement in ensuring quality, affordable healthcare for all Americans. It simply isn’t true to say that people think markets are better at everything.
Second, the healthcare sector in the US is the antithesis of market-based economics. From drugs to hospital chains, the government has a huge array of subsidies and prohibitions. What free market reforms have been instituted in healthcare?
Veterans aren’t the only ones waiting for health care. The latest wrinkle where I live is that doctors are all joining hospital-affiliated groups (mostly due to the high cost of trying to run your own office, I suspect). These hospital-affiliated groups have several different locations–some are nearby, others are a half-hour drive. If I want to see a particular doctor at a location convenient to me, I can easily wait over 30 days.
As an aside, the best endocrinologist within 20 miles of where I live is affiliated with the VA, so I can’t even use her. Otherwise, I need to travel between 40-60 miles if I want to see an endocrinologist. So much for private health care solutions.
grayslady:
As the media and the Washington hit-guys make it out to be, the wait time is exclusive to the VA. It is not as you pointed out. You can wait well beyond a month for primary care and months for a specialist at Univ. of Michigan. Getting in to see a specialist in just over 30 days is actually pretty good although not ideal.
The latest wrinkle you point to is the consolidation process which doctors and hospitals are going through. Much of this is due to the PPACA as joining a clinic or a group of hospitals give them the ability to negotiate better with the PPACA maintaining the Charge Master rates they have in place for various services. More of that is occurring today with the implementation of the PPACA. More information can be found on the issue here: http://angrybearblog.com/2014/01/on-the-horizon-for-healthcare-costs.html “On the Horizon ‘After Obamacare.'”
One of the reasons Docs are joining affiliate groups is the pricing tier structure that medicare uses. If you are an independent doctor, your reimbursement is much less than if you are in the top tier, a hospital group.
Well, that’s horrible.
When I first entered health care decades ago, the VA had a terrible reputation. Physicians, who did parts of their residencies there, returned with VA bureaucratic horror stories.
Years later, I read Phillip Longman’s “Best Care Anywhere: Why VA Healthcare is Better Than Yours.”
It was an amazing transformation. The VA had become one of the best health systems anywhere.
This was anecdotally confirmed by VA patients sent to our hospital when the local VA Medical Center was on diversion.
I wondered what Longman would have to say about the current VA scandal:
“What’s really has me enervated is how the dominant media narrative of the VA “scandal” has become so essentially misleading and damaging to the cause of health care delivery system reform…
If care is really so bad, for example, why did all the major veterans services remain unanimous in recent testimony before Congress in their long-stranding praise for the quality of VA health care? And why have they remained stalwart in defending the VA against its many ideological enemies who want to see it privatized? It’s because, by and large, VA care is as good, if not better than what vets can find outside the system, including by such metrics as wait times…
The key question to ask when confronting the real deficiencies of the VA is “compared to what?” Once that context is established, it becomes clear that VA as a whole continues to outperform the rest of the American health system, making its true lessons extremely important to learn.” – Phillip Longman, “VA Care: Still the Best Care Anywhere?”
http://www.washingtonmonthly.com/political-animal-a/2014_06/va_care_still_the_best_care_an050598.php
Dismantle quality VA health care? Privatization of the VA?
“The VA pioneered this model of an integrated, evidence-based, health care delivery system platform that is aligned with the interests of its patients. The last thing we should want to see is more veterans getting treatment in the comparatively more chaotic, fragmented, dangerous, profit-maximizing world of U.S. medicine outside the VA. Instead, the challenge before us is to stop excluding so many vets from VA care with absurd eligibility standards, while giving the VA the capacity it needs to bring its superior model of care to a larger population. Eventually, we need a VA that is open to not only all vets and their family members, but more public health care systems like it that anyone can join.”
http://www.washingtonmonthly.com/political-animal-a/2014_06/how_va_outsourcing_hurts_veter050680.php
Dakota:
Much of run75441’s (me) commentary is derived from what Longman had to say about the current issue at the VA. On June 13th, he had a post up on Washington Monthly and if you click on the orange “Just How Long Is The Wait” within my commentary, it will also take you to his post. “evidence-based protocols of care” . . . in orange will also take you to another comment by Longman.
I had taken several of his articles and expanded upon them using the VA Audit from June 9th. He has more posts up at the Washington Monthly as he is the senior editor there. I too am a veteran and I clearly understand what is abound in Washington and their designs on the VA. Turning us over to private healthcare would not be good and neither could private healthcare handle some of the more recent issues such as exposure to expended Uranium rounds. Taking Longman’s comments and writing about them and the VA gets the truth and the word out there about the issue.
Not much has changed to jeopardize the care received at the VA and which Longman wrote about in his book “Best Care Anywhere.” and as you already know which is the same as what I experienced, the VA has come a long way since the seventies.
I have been in the VA system for almost 9 years and I have no doubt that it is far better than my experiences in the private system. I had seen the horror stories in the media, so imagine my pleasant surprise at the reality of efficient care I did receive and continue to receive. Yet the media continues its campaign to demonize the VA and to spread the TINA of privatization. The neoliberal machine needs to keep sucking the life out of all that is good and decent in society lest the people notice that there are in fact alternatives to the anti-human agenda of TPTB and their media propaganda organs.
And so I’d be curious to know, from both run75441 and OIF Vet–what do you make of the Phoenix and other “whistleblowers?”
Is there any “there” there?
There are plenty of supporters of private “healthcare” in the US too. I hear that some even call it “the best ‘healthcare’ on the planet.” Funny thing, though. The loudest voices just never seem to be those who got short-shrift or left out completely.
Maybe both systems operate on the same basic premise. Your experience will be good enough if you can manage to get your foot in the door, jump through the hoops needed to keep it there, and steer clear of the bureaucratic and clinical potholes that could turn you into medical collateral damage.
But maybe “healthcare” in America was never meant to be available to everyone. Maybe that’s just not how America does it.
From what I have seen about Phoenix there is “there” there, the question is why. I submit that the VA is underfunded and that, combined with a misguided and defective bonus program, is at the core of the problem. Underfunding is probably particularly acute in areas of the South with large veteran populations, and likely in some rural areas too. An acquaintance of mine is a VA doctor at the Hynes VA in Chicago-Maywood, where the Phoenix administrator at the center of the scandal cut her teeth and according to him there were some problems at Hynes too though not as pronounced as those in Phoenix.
I also agree with run75411 about the problems presented by the complicated eligibility requirements, those can be very hard to navigate without a good councilor. Mine was outstanding and had me set up and being taken care of the same day, though it greatly helped that there is a special department for OEF/OIF veterans and priority in the first two or three years after discharge. As mine was a medical discharge (service-connected and well-documented) it made it easier, but it is likely much harder for others whose issues are not as well-documented.
katniss:
Yes people fudged the numbers, it is in my post on NC near the beginning. Longman writes about it here: http://www.washingtonmonthly.com/political-animal-a/2014_06/va_care_still_the_best_care_an050598.php , here: http://www.washingtonmonthly.com/political-animal-a/2014_06/just_how_long_are_those_wait_t050776.php and other places as well.
“Yes” and in 20 years since the quest for Hillarycare, what has happened to healthcare costs? Quintupled? And what has the industry done, not a damn thing.
A few words from Longman:
“But let’s get real. The fundamental reason for the still huge backlog of cases does not lie with inefficiencies of the VA’s bureaucrats, most of whom are vets themselves. Nor does it come from an increase in the numbers of vets because, as explained in my last post, the number of veterans is actually shrinking dramatically. Rather, it fundamentally lies with the American people and their representatives in Congress, who despite all their fine talk about honoring those who have served their country, have tasked the VA with administering laws and regulations that presume most vets don’t deserve VA care unless they can prove otherwise.
It wasn’t always so. As I describe in my book, the Clinton Administration opened the doors to the VA in 1996 to anyone with an honorable discharge, and many folks who got in then remain grandfathered. But the Bush Administration slammed that door shut again in 2003, and while it has reopened a bit under Obama, we are still spending enormous resources enforcing policies designed to exclude most vets from VA care.
If you don’t think most vets deserve any better, then fine. You are hardly alone. But don’t imagine that the VA’s bureaucracy should be blamed for carrying out laws and policies that reflect your views.” http://www.washingtonmonthly.com/political-animal-a/2014_06/va_care_still_the_best_care_an_1050629.php
They basically have to privatize everything, as the US promotes a negative list approach in the FTAs which forces privatization by default. Please read this it will explain a lot.: GATS and Public Service Systems and this: Trading Health Care Away
Basically, the United States has traded away its “right” to have public healthcare without telling the people, in order to force other countries to do it too, thereby increasing profits for US corporations in the insurance and drug industries globally. We are collateral damage of that decision. And now they are doing the same thing with other services like financial services, delivery services, water services, prison services, etc.
This is very good too: PUTTING HEALTH FIRST: Canadian Health Care Reform, Trade Treaties and Foreign Policy It will explain the real, hidden “why” of what’s probably going on with the VA.
This paper is good too. About the huge conflict of interest between the FTAs and health care in the US.
Luckily, the entire WTO/GATT/NAFTA world trade system is on the verge of collapse. Countries are begining to notice that they don’t benefit from it.
It’ll be interesting watching it collapse catastrophically. This happened once before, in the runup to World War I.
Good point about the eligibility process being a huge problem. My husband is a retired vet and although we have a VA facility in our town, is not eligible because our income, although very modest, puts him onto a long wait lis. A little too much to get on a higher priority list. Of course, if we had a single payer system, not only for the VA, but for everyone, then we would have leverage to get lower drug and procedure prices, allowing more of the money to go into actual healthcare than to the middlemen, and encourage more and better physicians to participate in the system. I think that obviously superior model is being headed off by those who would profit by characterizing the VA treatment as inferior, therefore making an argument for privatization, which is always a goal for the middlemen, as in closing the post office and SS offices.
I visited my brother in many of the West Coast VA hospitals and VA homes since he was in them from the Viet War era until his death, over thirty years later. I can tell you the care spans all levels, depending on the hospital and the patients’ needs. I do think that the staff were mostly wonderful and caring, but way too few. I sometimes fed some of the patients myself because they couldn’t feed themselves and their breakfasts were still sitting in front of them, cold, when I got there at 11:00am. It was shocking. The doctors were all the way from extremely dedicated and skillful to very inexperienced. My opinion is that the level of care was extremely uneven and if you had a problem with the system, you were out of luck. Maybe it has improved which is great, but to me, that’s not the point. If all those resources were spent on the system rather than on deciding eligibility, then that would be a great step forward. To privatize would be a disaster.
We need to get rid of the free trade agreements because they are what’s forcing the privatization.
And they are lying about it. A lot.
“[The] real issue at the VA isn’t the waiting list; it’s the eligibility system.”
Won’t find that concise and accurate line in the NYT or any of the other corporate news behemoths.
The waiting, the waiting… endlessly put out to sow fear, to discredit any single payer system, whether Canadian, British, the VA…
And it’s effective. The corporate media parrots the corporate shills, too many of the ignorant public parrot the corporate media…and round and round it goes till the looting begins. or ends. Repeated enough it takes on “truth,” and the propaganda mills know this.
Just like ‘bad teachers’ in order to privatize public schools, or ‘bankruptcy’ or ‘bankrupting our children’ re SS or medicare, whatever…These catchwords/catchphrases are used purposefully, evilly, and effectively to create the breach in public trust of what’s public, and public belief in corporate ownership to the rescue…
When it comes to anything public, it’s always, Oh, flaws!- ditch it! Not, address the flaws, improve it, better it. And of course, ditch it means privatize means looting.
We need leaders, we need organizers to make the 99% mad as hell, and not take this devolution of of western civilization any more. Instead we get blog blather, and a couple of head case loners with guns taking it out on other poor shlubs. How much more inspired were the Bonus Marchers of the 1930’s, than the veterans of today? Yes, they got it on their backsides by “Dugout Doug MacArthur and his aid-de-camp Dwight Eisenhower, but they were willing to organize themselves into a body of men demanding to be heard and collect what was owed them. Before the Resurrection there is the Road to Calvary, but the public today are sitting around the table mulling the menu at the last supper. Forgive us all, dear lord, for we don’t seem to know what to do! ( Sorry about all the religiousity, but it is Sunday)
If you can have a national warfare system second to none, if you can have an international spying system second to none, then you can have a national health care system which is also superior…but this is not the issue.
The issue is examining the reality of health care, and what is possible to achieve investing a responsible amount of resources per capita. It’s simple a matter of math. If the society decided that it wants x,y, and z, then it needs to design a system capable of providing such.
One hundred years of experience suggests that a national health care system model will provide the highest levels of efficiency and over all care for the majority of the population. Just as the residents of California are not better protected than the residents of any other state [in securing our boarders], so must the same morality apply to insuring each citizen has equal access to health care.
Beyond the illusion of being able to finance the above into a technologically-based/driven future [that should cause an explosion in health care costs], people might want to consider a more reasonable path and adopt a prevention-only health care system that will create financial stability/sustainability and a MUCH healthier/productive population.
prevention-only health care system
Uh oh… You do know that single payer is CHEAPER, don’t you?
There are some good references here. You see, catching illnesses early is a GOOD investment. But, tell that to the steakholders. Carving up the nation. One would almost think they were trying to make healthcare more expensive, imagine that.
Myth: User Fees Ensure Better Use of Health Services
> Visiting the lobby of a VA health care clinic should be a requirement for every American. There you
> will see lots of maimed young men and women cut down early in life waiting to be seen by
> staff, usually safe behind thick uninviting walls. You will quickly become saddened and
> enraged at what the politicians did to these brave Americans.
I would be interested in some hard numbers about who the clients of the VA actually are–and whether their need for care is service-injury related, or whether they are seeking care for some that happened to them that is not-service related.
We have men and women from WWII, Korean War, Viet Name War and various posted VN conflicts needing care. Most of these are probably not “young men”. Conditions like Cancer, or old-age-related maladies can not be directly blamed on Military Service–as much as 70 years ago.
Claims that the VA is “better”–based on individual comments, or people in the media, like Paul Krugman–is hard to accept. An incredible amount of analysis would have to be performed–which I suspect has not now, or will ever, be performed.
My father was a VA client for most of his adult life. Luckily, he was an outpatient all of those years, and didn’t need much in the way of care. He never complained about the service in the VA centers, although I vaguely remember the waiting rooms being drab, and colorless. Of course, my father was member of America’s “Greatest Generation” .. and he really never complained about anything associated with his time in the Service, and the horrific injuries that befell him (five years in a military hospital to recover).
Some of the problems facing the VA involve shifting to a more Information Technology-based service delivery model. This is something that the average people can not fully understand–and with about 200K unionized workers in the VA, it’s hard to believe that there won’t be a lot of resistence.
We are spending about $150B this year on VA services to veterans. No one has yet provided us with a clear explaination as to why this is not enough–and how much we really need to spend to deliver the care to those who served the nation when it called.
What a steaming heaping pile of horse manure. Your ” Information Technology-based service delivery model” already is a fact in the VA and is world class, particularly compared to the joke that are private care IT and electronic records. When my VA general practitioner orders a test all I have to do is walk over to the department in question and give them my name and last four for them to pull out the test orders. In the UChicago Medical Center (“At the Frontier of Medicine” as their motto says), my mother still needs to carry a handwritten note from her doctor to the medical imaging dept. And that at costs greatly exceeding those of the VA. As for studies on quality of care, don’t take individual experiences if you don’t want to, but methinks the RAND Corp. is not a source you should object to: http://www.rand.org/blog/2012/08/socialized-or-not-we-can-learn-from-the-va.html.
OIF
Thank you
No, thank you for your good work and for all the informative links. The VA is the most essential benefit a veteran has and is very much worth fighting for. The importance of destroying the propaganda myths perpetuated by the organized media campaign against the VA is hard to overstate.
Soldiers are expendable! All the flag waving only serves to fill the ranks! You name the war, most who see combat are totally FUBAR’d for a very lonf time, many never recover. Non-veterans have no idea how screwed up the Military really is, and frankly don’t care. The VA is National Disgrace and Congress is to blame, but let’s face the fact, Congress does not give a tinkers dam either! Money talks and Bullmanure walks and congress is full of Liars!
Jim:
No, the VA is not a disgrace. The Repubs, Teabaggers, and even McCain try to make it out to be one; but, it is no disgrace. The VA is doing what is legislated for it to do. Phillip Longman said this recently:
“But let’s get real. The fundamental reason for the still huge backlog of cases does not lie with inefficiencies of the VA’s bureaucrats, most of whom are vets themselves. Nor does it come from an increase in the numbers of vets because, as explained in my last post, the number of veterans is actually shrinking dramatically. Rather, it fundamentally lies with the American people and their representatives in Congress, who despite all their fine talk about honoring those who have served their country, have tasked the VA with administering laws and regulations that presume most vets don’t deserve VA care unless they can prove otherwise.
It wasn’t always so. As I describe in my book, the Clinton Administration opened the doors to the VA in 1996 to anyone with an honorable discharge, and many folks who got in then remain grandfathered. But the Bush Administration slammed that door shut again in 2003, and while it has reopened a bit under Obama, we are still spending enormous resources enforcing policies designed to exclude most vets from VA care.
If you don’t think most vets deserve any better, then fine. You are hardly alone. But don’t imagine that the VA’s bureaucracy should be blamed for carrying out laws and policies that reflect your views.
“http://www.washingtonmonthly.com/political-animal-a/2014_06/va_care_still_the_best_care_an_1050629.php
Cause for VA Cheating: Pay for Performance
Factor? Try cause. Extrinsic motivators cause major harm to any organization that performs complex work which requires teamwork. Motivation expert Alfie Kohn, author of “Punished by Rewards” wrote:
Not a single controlled study has shown a long-term improvement in the quality of work as a result of any reward system. That would be an astonishing fact were it not for the existence of scores of studies – conducted with adults as well as children, in real workplaces among other venues – that have demonstrated how rewards tend to be not merely ineffective but powerfully counterproductive.
Bribing people to do good work and management by fear are root causes of systemic cheating.
The pattern of widespread cheating under pay for performance systems is long established, but apparently invisible to most leaders. Lying, cheating and stealing occurred in the 1990’s under executive stock options, sold at the time as the most pure incentive reward. Thirty percent of executive stock options were backdated.
PPACA’s larger aim is to reshuffle the healthcare deck. President Obama’s health reformer Nancy-Ann DeParle came from private equity, CCMP Capital Partners, and returned to it post “public service,” as a founder of Covenant Capital. How did Nancy-Ann receive a distribution for a PEU investment not shown on her federal financial filing? It happened.
Former Office of Management and Budget Chief Peter Orszag told Carlyle Group co-founder David Rubenstein the feds would throw a lot of “stuff against the wall to see what sticks.” Medicare/Medicaid Chief Marilynn Tavenner, a former HCA executive, leads implementation of federal bribes, manipulations and sticks. They’ll end up like executive stock options, school testing and the Veterans Administration, distorting behavior and turning people’s attention to money, instead of the important work of improvement/innovation.
Dr. Deming decried leveraged buyout organizations for lack of constancy of purpose. They re-branded as private equity and today are as widespread as school cheating or corporate lying. Private equity firms have billions in dry powder with healthcare clearly in their sights.
http://peureport.blogspot.com/2014/06/cause-for-va-cheating-pay-for.html
Thanks for the reminder about the negative impact of financial rewards, and the links.
“Performance-related pay” is so deeply ingrained and on the surface it seems reasonable and fair. Anything based on metrics seems like it would be preferred by many involved in HR policy.
Research has shown what factors do make a difference–but I have yet to see a model for implementing something different other than what Ricardo Semco describes (people setting their own pay, informed by complete transparency of the company’s finances, and their workgroup’s feedback on who is needed for the next 6 months), which probably wouldn’t be legal in some states / countries.
This is good.. about how physicians are again being pressured to withhold care, basically they get paid more to deny care, they make the most if the patient doesn’t even come in.
http://org.salsalabs.com/o/307/images/JGIM%20ACO%20Article%20Himmelstein%20Woolhandler.pdf
Mellon:
The present cost model for commercial private healthcare is “services for fees” and not withholding care.