“The Battle for VA Healthcare and Its Funding”

By run75441. Originally published at Angry Bear

VA healthcare has its faults; but, it still is one of the more successful examples of publicly funded healthcare even while hampered by a lack of funding to provide more capacity in strategic places for new Iraq and Afghanistan veterans and aging Vietnam veterans like myself. Libertarian Pete Hegseth, a veteran of Afghanistan and Iraq and the CVA, both sponsored by the Koch Brothers, are hawking a dismantling of the VA hospitals in favor of higher cost and less result-oriented commercial healthcare and their own ideological interests.

Life-MagazineThe history of the VA has always included struggles with ideological, political, and commercial (healthcare providers, pharma and hospital supply) interests. In the seventies, activists went as far as to stage scenes (Life Magazine picture depicting care for Vietnam veterans) to make the care look worst than what it was. For commercial interests, it is all about selling more services, healthcare procedures, and pharma as compared to the evidence based treatments received at the VA. For the Kochs, Libertarians, and Pete; it is all about a Randian ideology, an ideology which Ayn Rand could not live up to and forsook to accept Social Security and Medicare.

As you may remember the Koch Brothers are also buying their way on to college campuses such as Western Carolina University by funding Centers for Free Enterprise A Slippery Slope Indeed. The selling of Public Choice and Libertarian ideology under the guise of Economics courses is paramount and they staff these centers accordingly by selecting those who view it favorably. The centers are not a free range of salt water and fresh water economics or intellect as one might find at typical universities. The American Legion and other VSOs have shown similar support for the dismantling of VA Healthcare the same as the Western Carolina University administration showing support for the Free Enterprise Centers. The VSOs have bought into the Koch funded CVA push to do so in favor of commercial healthcare and giving veterans healthcare vouchers.

Together they have orchestrated an attack on the VA by claiming 40 veterans in Phoenix, AZ had died while waiting for their appointments. I did not pick the claim of 40; but, I believe it is time to debunk it and challenge subsequent claims based upon the lack of integrity and truth in the original claim. What was reported to the public by CNN and other news media sources as a failure of the VA to take care of the 40 veterans in critical need by keeping them waiting for care is not true. Yes, there is a longer wait for new patients and first time visits; but, it is not to the extent stated. The Koch Brothers, Pete, and their “web of affiliates have succeeded in manufacturing a ‘scandal’ at the VA as part of a larger campaign to delegitimize publicly provided health care” in favor of the commercial healthcare industry. The exaggeration fed scandal forced the dismissal of Shinseki besides creating another taxpayer-funded commission to investigate the alleged abuses by the VA. “The Best Care Anywhere; Why VA Health Care Would Work Better For Everyone” author Phillip Longman was appointed to this commission. He will need all of the support he can get from veterans who oppose this move by ideological and healthcare industry interests to dismantle VA healthcare.

Former Wall Street Journalist Alicia Mundy (author of Dispensing with the Truth: The Victims, the Drug Companies, and the Dramatic Story Behind the Battle Over Fen-phen) gives a different story of what took place at the VA “The VA isn’t Broken Yet,” The Washington Monthly. Her article and two other articles report on the latest findings and paint a dismal picture of Koch Brothers and the healthcare industry attempts to dismantle the VA using innuendo and exaggerations.

While the allegations of deaths were not proven, the declared accusation of increased deaths resulting from wait times did raise concerns about how effectively the VA was with their care of Veterans. Of course, we all know how effective the overly funded commercial healthcare system is with the care of its patients. If you can afford it you will get every pill, procedure, and practice known to mankind regardless of effectiveness. This is not to say there are not good institutions or professionals; but to say commercial healthcare and wait times are both far better than the VA is simply not true. Indeed, it is the opposite. The overriding interest of those advocating the dismantling of the VA in favor of commercial healthcare is in securing it’s funding for commercial healthcare rather than improving the care for veterans.

One month into his presidency, President Obama appointed former General Eric Shinseki with no opposition in Congress to his appointment as the head the VA. Shinseki immediately set to work transforming a VA burdened by returning Iraq and Afghanistan veterans, a lack of needed capacity in places where needed (Phoenix and Tampa), and funding which did not keep up with the influx of new patients. The Bush administration had failed to close costly unneeded facilities (5 million square feet @ $53 million annually) and add capacity in other places (Phoenix and Tampa) as recommended by the CARES report besides increase the funding necessary to meet the onslaught of new vets. The CARES report listed what facilities needed to be improved and modernized, projected the future demands on VA services through 2022 in each geographic area the VA serves, compared them again to existing infrastructure, and made recommendations on how to meet the future needs of veterans. It was largely ignored as it too needed funding.

Instead of helping to care for all veterans, President Bush had also reversed the decision of former President Clinton to allow all veterans to use the VA and again installed the “proof of need” format for VA care. In other words if you were exposed to Agent Orange, drank bad water at LeJeune, were exposed to radiation from depleted Uranium artillery shells, or indigent; you again had to prove your ailment was military related or provide proof of being indigent. This can be difficult to do and it takes time. Again, presidential enforced bureaucracy ruled at the VA. It could again raise its ugly head with the wrong administration in place.

What about those news broadcasted wait times and other things Shinecki was accused of by Pete, the Koch Brothers, and the CVA? The VA under Shinseki reduced the number of homeless vets by ~25%, reduced the backlog of unprocessed veteran disability claims resulting from increased numbers of new and wounded Iraq and Afghanistan vets by 84 percent, and helped convince Congress to take in Vietnam veterans with chronic illnesses associated with exposure to Agent Orange making them automatically eligible for VA care.” As accused by the Koch Brothers, Pete, the CVA, and the silly news media, this was the man and the General who allowed veterans to wait for appointments and care only to die in the chow line of the VA while side stepping? But wait, there is more:

Under Shinseki, the VA built teams of healthcare providers whose responsibility was the care of its patients. Specific teams of PCPs, nurses, social workers, pharmacists, and health technicians were assigned to manage and coordinate the needs of each patient. This methodology overcomes the fragmentation of care, which can be seen in commercial healthcare today, and was described in Phillip Longman’s “The Best Care Anywhere.” I am taken care of by the VA Blue Team of healthcare providers.

Mental health professionals and substance abuse specialists were integrated into each team and this care excelled beyond that provided by commercial healthcare as it applied proven, evidence based therapy and methodology for mental illness. Insurance companies, Medicare, and Medicaid will not pay for this type of “body and mind” care by commercial healthcare. It is crucial to have it available for veterans as 25% of veterans suffer from chronic mental illness and 16% are addicted.

One study, “The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans” touched upon the differences in the success rate of VA care as compared to commercial healthcare.

” In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.”

Furthermore the study concludes the ‘findings demonstrate the significant advantages accruing from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.’”

Hey, but what about those overly long wait times broadcasted by the news media and pitched by Pete and the CVA which caused the deaths of so many veterans as stated by them? After all, the team methodology and evidence-based physical and mental care put in place by Shinseki does strain the VA capability to set prompt appointments for new veterans coming into the system for the first time. Then too the need for primary care doctors outstrips the supply of them by ~7500 in 2010 and the shortage is estimated to more than double by 2020. This shortage as well as the amount of team care given does place a strain on the VA capability to supply care to new vets. Unlike commercial healthcare, the VA put in place performance measurements which are available to the public. Commercial healthcare does not make its performance measures available beyond the advertisements seen on TV. “Across facilities, veterans waited an average of six and half days from their preferred date of care to their actually seeing a primary care doctor. In comparison, a private survey taken by the consulting firm Merritt Hawkins showed that in fifteen major medical markets across the country, non-VA patients seeking a first-time appointment with a family practice doctor had to wait an average of 19.5 days.”

For the first half of fiscal year 2015 starting October 2014 through March 2015 using the most recent data available from the Assessment B (Health Care Capabilities) Page 190 wait time study, the average number of days “Veterans waited for new patient appointments was approximately six and a half days from the preferred date for primary care, six and a half days from the preferred date for specialty care, and three and a half days from the preferred date for mental health” care as taken from page 190 of the same report.

Indeed, Figure 4-14 shows >93% of all veterans completed their appointments within 30 days. Again to compare, the average wait time for new veteran patient appointments is six and 1/2 days from the preferred date while the average wait time for non-veterans using commercial healthcare as experienced in 15 markets for first time visits is 19.5 days from the preferred date or three times longer.

VA-Appts-Fiscal-2015And those 40 deaths caused by too long of a wait time? As taken another report, Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System, revealed, six and not forty veterans had died experiencing ‘clinically significant delays’ while on waiting lists to see a VA doctor. In each of these six cases, the IG concluded “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.” But for some reason those wishing to dismantle the VA can conclude such. Maybe they have a different source of information? They do not and this gets to the root of the issue. Why would someone make up such stories and the media report on them without adequate research when the end result would potentially cause so many veterans to lose their coverage and surrender to a must worse situation with commercial healthcare? News and especially catastrophic news sells and news today is lazy and lacks integrity. For everyone else concerned, it is the money involved or the VA funding.

My own experience with the VA has been good and that with major US hospitals and commercial doctors has shown similar if not greater wait times. God knows, I have been in enough hospitals since 2012 advocating on my own treatment. If you do not know, ask questions and do not be so ready to accept what is told to you because the person is a doctor. They do make mistakes like being given blood thinners when you have a blood disorder. As Alicia Mundy put it succinctly “while the VA has an assortment of serious problems, it continues to outperform the rest of the U.S. health sector on nearly every metric of quality—a fact that ought to raise fundamental questions about the wisdom of outsourcing VA care to private providers.”

I am not on board with this take over of VA Healthcare by commercial interests as supported by moneyed ideological and political influences. I would urge veterans to speak up as what you are going to get will not match what you have. Once your voucher is spent, game over.

References:

“THe VA Isn’t Broken Yet Alicia Mundy, Washington Monthly

Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System

” Assessment B (Health Care Capabilities)” Rand Study on Wait Times 2014/2015

” Comparison of Quality of Care in VA and Non-VA Settings: A Systematic Review”

“Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000–2010″

“Department of Veterans Affairs to Realign Its Capital Assets”

“Documents Show the VA Debacle Began Under George W. Bush”

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35 comments

  1. Disturbed Voter

    America’s owners don’t want to spend 14% and increasing amounts of the GDP on health care. Disassembling health care in the US is parallel to the disassembling of the NHS in GB.

    Outsiders will think that delays at the VA is due to incompetence. The larger problem is that the system is underfunded in the context of our permanent war policy, and that there are never enough doctors, particularly psychiatrists. The US wants to make war on everyone, but doesn’t want to pay for the damage to our uniformed warriors. Both war making, and war healing are very expensive, but the war making is very profitable but the war healing isn’t.

    Just more symptoms of imperial over-stretch and collapse.

    1. run75441

      I am going add one thing to your comment as you are correct; but, you miss one element of this issue. The funding and ideology behind this effort with the VA and Western Carolina University are the Koch Brothers. They are definitely and more openly applying the influence in this effort and there are too few of us who understand the danger of it and are pushing back. It is not just here and it will eventually be found in other areas as well.

      1. cwaltz

        There’s money to be made by exploiting people and their human condition.

        It’s a fundamental principle in crony capitalism, whether it be workers or consumers.

  2. run75441

    I am with you on this; but, I would add this comment to yours: “For the Kochs, Libertarians, and Pete; it is all about a Randian ideology, an ideology which Ayn Rand could not live up to and forsook to accept Social Security and Medicare.”

    There is a growing and deceitful influence in the US to manipulate the results of what the electorate thinks and it is using its moneyed efforts not only in government electioneering and influence but also in universities and colleges in the form of economies packaged as Centers for Free Enterprise. Western Carolina University is on the table right now for a $2 million grant from the Koch brothers. Some universities and colleges in conjunction with their students have managed to de-Koch their campuses. It did not happen with out a struggle as the funding is attractive.

    It is behind the scenes struggle which is the more serious one.

  3. TomDority

    My change to the report above…if permmited, would be to ask a slightly different question by making a small change to a question posed by the author
    The important question is,
    what kind of person would make up such stories.
    “Why would someone make up such stories and the media report on them without adequate research when the end result would potentially cause so many veterans to lose their coverage and surrender to a must worse situation with commercial healthcare?”
    My answer would be peppered with words such as, cowards, criminally neglegent, bottom feeders, parasites and etc

    1. abynormal

      “One of his greatest talents was empathy; no sadist can aspire to perfection without that diagnostic ability.” ~Vernor Vinge, A Fire Upon the Deep (amazing to see so many ‘talented’ at the same time)

      Appreciate the Work-up run75441!

    2. run75441

      Thank you Tom for what I have trouble saying without getting “really” angry.

      Many of us faced things we rarely talk about if ever. Some of us actually did drink Camp Lejeune water tainted with Benzene after we came home from being overseas. Some of us are considered to be impaired from what happened to us and we wander the streets of Chicago or other cities (I always have ones and an occasional 5-spot in my pocket). We lost friends in places with strange names such as Quang Tri, Da Nang, and Phu Loc. I escaped whole except for the memories which still linger.

      And we are old now and new ones are just entering the VHA. They do not deserve this. One young Staff Sergeant who was blown up in Iraq was in the other half of the room at the hospital after back surgery. I was joking with him when his mom and others were not around. She, the nurses, and the residents spent the night stabilizing him and afraid they were keeping me awake. I was awake just listening and dosing.

      I have a follow-up which will make you even angrier. I am just waiting permission to write it. These people are in it for the money. People such as Congressmen Jeff Miller and House Majority Leader Paul Ryan, Darin S. Selnick, a part-time employee of the Koch-funded group Concerned Veterans for America (a Koch sponsored veterans group), Stewart M. Hickey, a former leader of Amvets and part of a break away group, etc.

  4. ArkansasAngie

    I work with a nonprofit Soldier ON Service Dogs. We provide service dogs for free to veterans.

    One of the things I believe that the VA is best equipped to do is to identify and provide services for service related issues … from trauma treatment to agent orange.

    Take PTSD. While PTSD is in the general population it’s presence amongst the military is higher. Private counselors are simply not qualified (equipped) to deal with veterans with PTSD.

    Our local VA facility does a fantastic job. Is it perfect? Nope. But there is no way that private healthcare would be able to do a better job with the same level of funding.

    1. run75441

      Angie:

      The VA hospitals are some of the only places which offer treatment for some of the ailments many of us have incurred.

  5. DakotabornKansan

    Any health care program that benefits low-income individuals and families is politically vulnerable to budget cuts or calls for privatization. The VA is no exception because low-income individuals are more likely to join the military. The fundamental problem for patients at the VA has been underfunding.

    Underfund the VA? Dismantle quality VA health care? Privatize 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.” – Phillip Longman, author of Best Care Anywhere: Why VA Health Care Would Work Better For Everyone

    Turning veterans over to private healthcare insurers and for-profit hospitals is not the solution.

  6. onlyme

    Excellent. I have been a patient in the VA system for several years and from my perspective they have two major shortcomings. A shortage of doctors because of inadequate funding I presume. I say this because I used to be seen on a 6 month interval but that has been increased to 8 months. Secondly they, like all medical systems, ignore natural systems of health care.
    Research has shown that TM is beneficial for numerous health conditions yet they do not embrace it. Medical research also indicates that some vitamins and supplements are also beneficial but they do not provide these. Specifically COQ10 and Umbilical for older persons who can not utilize COQ10 efficiently. Full disclosure: I paid for my own TM training and purchase my own vitamins and supplements.

  7. Robert J McElroy, MD

    For decades the VA health system has been the best that American medicine has to offer not only in patient care but also in medical education. In the nine years of my medical education those periods spent at the West 10th Street VA in Indianapolis were the most productive and interesting. The medical faculty in internal medicine and surgery were excellent teachers and care providers. I have viewed the VA health system as a model to be used for medical care. Privatization would result in fragmentation of care and in the instance of veterans care experience is important. It would also seriously effect medical education negatively. The Koch brothers inso far as I know have had no military or medical experience, yet feel they know what is best for millions of veterans on the basis of a discredited and silly theory.

  8. Dan Lynch

    Excellent article.

    Real progressives would advocate VA-Care-For-All, not Medicare-For-All.

    “Single payer” is another way of saying “for-profit provider.”

    1. marym

      HR 676 Expanded and Improved Medicare for all provides for a transition to not-for-profit healthcare providers (Section 103)

      “No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.”

      LINK (PDF)

  9. Jim Elliot

    I’m glad to see the VA getting some mention, even if it deserves more positive press. The only reason it has not been privatized is because it would cost too much money – I did some research in 1990 and found according to a GAO study that VA delivered care at about 67% of the cost of its sister hospitals i.e. Palo Alto VA & Stanford – and the 67% figure included physicians fees, pushing the cost down even farther – I estimated about 33% of private care.

    At the same time, it occurred to me that Medical Insurers were essentially a cost plus business and as an industry, had no incentive to lower costs across the board if that were possible – i.e. lowering costs 50% across the board, by measures as; uniform accounting and billing system, large group buying of selected drugs, elimination/replacement of malpractice insurance – would result in a 50% reduction in profits. Insurers do have an incentive to compete against each other, but that is while they fight to raise costs (as by lobbying for government mandates).

    In about 1990, the VA scored 85th percentile by JHACO – So on that level it was better than 85% of the Hospitals in the US – while generally dealing with an older, more beat up segment of society and all while getting a terrible rap in the press (promoted by privatizers)

    I thought back then (and now) that the VA should be cloned on a limited level as an “experiment” and offered to the public on an at-cost/for-cash (or insurance) basis with no freebies and no negotiating. If the “money-based” medicine advocates were right, the experimental hospitals would soon be un-used due to the competition of private providers, who would do the job cheaper and better. I don’t think private sector can or would do it..

    The VA on whole is the most efficient and best health care delivery system in the US and should be a model for getting it right. Private care can work along side an expanded VA-type system.

    1. run75441

      Jim:

      If you have a chance, pick up Phillip Longman’s “Best Care Anywhere.” He critiques commercial hospital care today and what his wife went through as well as Timothy Noah’s wife. He compares that care to what the VA offers to its veterans.

  10. RUKidding

    Thanks for this post, which highlights how the greedy, rapacious, pillaging Kochs are, yet again, sticking their greedy fingers into the VA pie, attempting to enrich themselves at the expense of Veterans. I would say: For Shame! But of course, the Kochs know no shame. They are greedy profiteering sociopaths bent only on accruing even more money & power for themselves, alone. Heaven knows, these creeps can never ever ever have enough. Disgusting.

    I heard the nooz on National Public Radio about the alleged 40 Vets in AZ who died waiting for VA service. My antenna went up, and I figured it was either an outright lie or spin of some sort. It ALWAYS is. Bank on it. Because of course the rest of the spin of the nooz cast was that the VA is terrible and providing horrid service, so of course, the answer, as always, is to privatize it.

    Yeah, right. NO mention of how the VA has been defunded to death mostly, but not only, by the GOP in collusion with the D Party. I’m sure all those pols got their cut from the Kochs and others greedily awaiting the day when they can literally suck the life blood out of Vets.

    Yeah, Vets mostly come from the lower orders these days, so screw ’em! No doubt they deserve it. Isn’t that the mantra of the .001%?

  11. KYrocky

    “…have succeeded in manufacturing a ‘scandal’ at the VA as part of a larger campaign to delegitimize publicly provided health care.”

    It is what conservatives do. See: Voter Fraud; WMD; Tax cuts pay for themselves; Social Security is bankrupt; Welfare Queens; Inheritance Tax destroying family farms; the IRS scandal; Whitewater; Climate change is a hoax; etc.

    The richest of the rich are playing us all for suckers. They have funded diverse networks of think tanks, media, assorted paid hacks, lobbyists and politicians dependent on their money. There are almost countless people in on the con, people who create the lies, spread the lies, and then use the lies to justify legislation designed to serve the rich.

    40 dead Vets? It is what conservatives have always done.

  12. susan the other

    reminds me of Trump skipping the debate in Iowa and grandstanding for the vets. Trump and his empathetic fellow billionaires raised yuuge amounts of money to help the veterans, etc. And Trump emphasized how awful the VA was. Trump goes all stream of consciousness to hide his agenda, but he’s not that hard to see through. Teddy Cruz is much sneakier.

  13. Suzanne Gordon

    This is a great post. I have been writing about the Veterans Health Administration for two years for a book that will be published next year. I have published many articles on the VHA in The American Prospect and Beyond Chron. Apart from Alicia Mundy, and Phillip Longman, and myself, where are the media voices reporting on the amazing things the VA is doing? I would love it if people read some of my articles on the VA. Here is one http://prospect.org/article/why-veterans-health-system-better-you-think
    People need to get active to protest what is described in this post. Call your Congressional Representative. Write to the Commission on Care. If conservatives get away with dismantling the VA, there is little hope for broader healthcare reform in the US. You don’t have to be a veteran to care about this issue. – See more at http://angrybearblog.com/2016/03/the-battle-for-va-healthcare-and-its-funding.html#comment-2765449

    1. MyLessThanPrimeBeef

      Every consumer is a veteran of the Nature-Conquering GDP Army.

      Most are honorably discharged.

      Some rogue consumers become conscientious objectors.

      So, many can be covered under this proposal.

  14. Dr Duh

    Having spent time during training in the VA spa, personally, I’d rather move to another country than practice in the VA system.

    The bureaucracy is incredible. When I was a resident I saw my boss literally start banging her head against the table in a meeting because of a nonsensical quality goal handed down from on high, ie, DC.

    They constantly try to micromanage you with poorly thought out metrics backed up by highly persuasive ‘sticks’. The net result, everyone constantly has to game the system.

    Wait times are a problem? Ok, then you cant book a surgery until the entire preop workup is done. So instead of having your tumor out in two to four weeks, but running the risk of having to reschedule if primary care and cardiolgy cant get their testing done in time. You have to get that all done first, then book them, then bring them back for another visit because you history and physical has to be within 30 days. Net result patients routinely go two and three months between having their tumor identified and getting it out. But the official wait time starts from the date I booked to do the the surgery on.

    OR tech quit? Hope you’ve got someone in mind because it will just take 2 to 3 months to get another through the labyrinthine hiring sytem. In the meantime just close the ER to surgery patients and transfer them out to another hospital.

    The EMR is by far the worst I’ve ever used. It’s got all the information in there, just in the most nonintuitive fashion possible. You constantly have to figure out how to adapt to the system rather than have the system help you get the job done. I have a collection of ‘this is your brain on VA’ pictures, I used to wait for the moment when the EMR would push my intern over the edge and snap a picture.

    The quality of nursing is substandard. The ICU functions on the level of a good med surg floor, the regular floors are like nursing homes. Getting anyone, even fellow physicians to do something in a timely fashion is like pulling teeth. I once had to fight tooth and nail to keep someone with an upper gi bleed alive over night because GI doesnt scope at night and transferring him literally across the street takes six to eight hours. I was on the verge of wheeling him down into the parking lot and calling 911.

    This is not to say the VA doesnt have some good people and do some things right, but it literally the lowest performing organization I have ever been associated with. The only thing that made it bearable was the patients. The majority of the vets are gold. I would do anything for them. Just not in that system.

      1. Dr Duh

        No one. I’ve been commenting on this blog for eight years.

        What’s the matter, can’t stand it when your shibboleths are put to the sword?

        Let me guess, you fancy yourself a part of the reality community but you’re a bit of an antivaxxer too.

        I’ll let you in on a little secret that I don’t tell the crowd watching Fox News in the physicians’ lounge. I’m voting Bernie even if that means my taxes go up and Medicare for all makes private practice untenable. Getting the kleptostate under control is the most important challenge we face. Medicare for all and a free public school education are the right things for this country.

        If getting rich were my primary goal in life I would have gone to work at a hedge fund.

        But if you think having the government run things isnt going to involve some serious compromises then you probably credulous enough to have bought into that whole hopey changey thing. How’s that workin out for ya?

        1. JTMcPhee

          Dr. D, I’m just a lowly former nurse in the “private sector” who gets Medicare now and also gets VA health care, and would have to observe that all the negatives you lay out against the VA system are present, in spades that are getting bigger every month, in that same “private sector.” (I happen to get very well treated by my local VA and providers — maybe that’s just the luck of the draw). VISTA- the VA EMR or part of it since it’s so many broke-down parts stuck together with bailing wire, is a giant kludge, but so are the three, count ’em, different EMRs that my doctors and us nurses and support staff have to juggle and reconcile somehow, and every time a hospital or practice gets bought up or sold out, the “management” just has to iimpose yet another New, Improved System with their pet drivers and frames and metrics (all about ka-ching,, of course). The VA was going to replace VISTA with something more 20th (not quite 21st) century, but corruption and the stupidities the majority of “managers” and lobbyists are part of killed that off, after more damage to even the known unkowns of VISTA. The privatized EMRs are their own little shops of horrors, and leak private medical information, perpetuate falsehoods in histories and recording, and are all about stripping money out of “the government” (Medicare-Aid, etc) and the premium payers of the UNsurance companies.

          And yes, I and a lot of other mopes in the ranks do what people who care do in such situations, “find the work-arounds” that end up actually seeing that patients, PEOPLE like us who sadly are on the receiving end of “medical UNsurance provision,” get as much of what they need as our invention and adeptness at “institutional judo” can manage. “The System” grinds on, generating huge wealth transfers out of the misfortunes and simple aging of us PEOPLE, and I’ve been around long enough not to see much likelihood that the greedy and bureaucratizing motives that drive all that will change in any significant way. Seems to me that the defects in Medicare and the VA are the result of a long game by the kleptocrats to suppress actual care in favor of billable units of all sorts. So that even the docs I used to work for are considering quitting the profession that has become just another crapified forked-up business. They are resisting, and continuing to practice what I would consider real medicine, but they also fear the power of the financial Borg, and are concerned that there are no niches they can hide in any more.

          You can knock the VA bureaucracy, and it is cumbersome, I’ve seen how it operates, and how the practitioners “work the system” to get care to people. But I see people under “the best private medical care system in the world” also getting the pre-op runaround, nurses and techs quitting wholesale when the New American Business Model (More Work, From Fewer People, For Less Money, Under More Constraints And Metric Demands) at hospitals and clinics, and the sh!ts that manage all that are as bad in their way as the clumsiest most proceduralist ‘crat in the VA system.

          People are adaptable, so to get and keep a place in the System, they go all Milgram Experiment and inhale and learn and inwardly digest the sh!t they are directed by their rulers to ‘implement.” Some of us, sounds like that includes you, have actual hearts and a notion of calling and a sense of decency and empathy and all that, strong enough to recognize the wrongness and find the workarounds and all.

          I wonder how the most of us who want to be cared for by the medicos can somehow find a way to break the grip of neoliberal processing and build some kind of community. Or whether enough of us mopes can do it, to make any kind of reconstitution in a more decent direction… 7.227 billion and counting, February was the hottest month ever recorded on our only planet, the Kochians are plotting and scheming and buying the souls of so many of us… And I love that FOX is on all the VA waiting area TVs, while the old GIs grumble about the goddam govermint getting all into their lives. But FOX is also on the screens at most of the doctors’ offices I now have to spend time waiting for my 3.35 minute appointment, weeks after the latest labs or tests, in order to be told (each “visit” is billable, but if you give the results over the phone, there’s no code for that) what new problem I’m facing.

          Bernie is one little, maybe not so little, rallying point in the fight against the Darkness. So much riding on the life and energy of one older man. He’s got my vote, too, and my efforts to persuade others to stand in the ranks with him.

          1. Cry Shop

            Well said. Anyone who thinks lack of transparency and conflicts of interest are worse in the public sector than any private sector dominated by PLCs is living in a fantasy world.

            That old axiom of Churchill about democracy fits nearly any human endeavor. It’s why Sanders is constantly harping on getting people involved, while the Neo-cons and Neo-libs do everything they can to discourage the people from participating as the ultimate watchdog.

          2. Dr Duh

            I agree JT. Medicine, like all human endeavors, is susceptible to corruption. Given how much money is at stake there are very powerful, very interested parties.

            My issue with the VA is it frequently felt like the system was against me, like I had to fight to do the right thing.

            Every system has its obstacles and twisted incentives including academic and private practice, but corporate medicine has to be the worst. Their raison d’etre is rent extraction.

            Perhaps I’m a sap, but I believe in individuals over institutions. Probably because I’ve been lucky to have good mentors who always taught me to put the patient first. I took an oath. I believe that I have a moral contract with my patients. Old school medicine facilitates this relationship. Third parties, whether private insurance or medicare get in the way.

            As for the encroaching darkness, in the words of my second favorite civil liberties organization, “Stand and fight.”

            PS: You and I both know there’s no such thing as a “lowly nurse” anymore than a lowly infantryman, everyone has their part to play on the team.

  15. Jacob

    “Mental health professionals and substance abuse specialists were integrated into each team and this care excelled beyond that provided by commercial healthcare as it applied proven, evidence based therapy and methodology for mental illness.”

    In almost all cases, substance abuse involving drugs is brought on by prescribed medications, often from a mental health professional. Substance abuse involving drugs is almost always of iatrogenic origin, and the VA is among the worst offenders due to its total reliance on prescription drugs to treat mental problems. Veterans’ high suicide rate is most likely due to this, but the VA will never admit it. In effect, if you want to avoid the likelihood of becoming a drug addict, stay away from doctors, whether civilian or VA. Unfortunately, however, the vet must accept drugs or risk losing his VA benefits. Receipt of the disability benefits is tied directly to the vet’s drug compliance.

  16. TomDority

    The playbook to privatize public space has been to capture the regulator(capture) or officers(capture) or board(capture) to effect change that appears to be wasteful or neglegent or institute operational inefficiencies to discredit and point out failures. This, combined with some more lobby work and falsified reports from a hidden or disguised interest group with a fine sounding name like ‘americans against un-american thinking institute for great good things of american greatness and freedoms and stuff ya have not thought of freedom and good’ Which goes about financializing and privatizing the public space out of existence and hollows it out for public dollars into private hands.
    ‘Making a buck recipe’ provided by special interests incorporated. “We do things to crappify your life”

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