Thoughts on the VA scandal
Here are the results of a poll on who it is that Americans blame for the VA scandal:
Veterans Affairs Secretary Eric Shinseki and the VA (33 percent) receive more blame than either local VA hospitals (28 percent) or President Obama (17 percent). About a quarter of Americans have no opinion…
Americans are split as to the root cause of the long wait times for patients. Forty-two percent think the problems of long waiting times at VA medical facilities are the result of not having enough resources to take care of patients, but 41 percent think it’s more a matter of these hospitals not properly managing their resources. Republicans are more likely than Democrats or independents to say the problems are a management issue.
It seems to me that the poll is asking the wrong questions—or at least not providing enough choice in the answers—as polls often do. Those of us who can remember back many decades know that veterans have been complaining about the VA for—well, for as long as I can remember, anyway. This current crop of problems is only an exacerbation of what I’ve been hearing about since I was in college, which is that the VA has all too often been a faceless, heartless, incompetent and sometimes dangerous bureaucracy that has a tendency to treat people like dirt.
I doubt this was always the case. I’m sure sometimes people are satisfied with the care they get at the VA. But I know that I heard the bitter criticism often enough to have decided there was something very wrong with the system. It seemed to me that this “something” was inherent in a huge federally-run bureaucracy, and I believe I thought that even back when I was a Democrat (in those days Democrats weren’t all for nationalizing the health care system). It seemed to me that the entire concept was at fault, although I certainly understood the need to take care of veterans. But why was a special system needed?
I’m still not sure of the answer to that, but part of it is historical, because the VA system was founded back when the regular health care system and health insurance were nowhere near the big and pervasive businesses they are today. At the time, it probably seemed a huge advance over the alternatives. But now the VA system is all too often a poster child for the saying “good enough for government work.”
The poll didn’t offer a choice that reflected that possibility: that the problem was endemic, and that throwing more resources at the system might not fix it, and that it wasn’t just this particular management. Nor did it offer the choice I’d like to see about Obama: that he was at fault not for the thing itself, but for knowing about the problem, saying he would be on the case, and doing absolutely nothing about it in all these years.
[ADDENDUM: I just noticed this. I guess I’m not the only one thinking this way.]
I’ll import a comment I made under a previous post:
I don’t pin the VA scandal on Obama because the VA’s problems are deep set. For decades, top changes of leadership have promised and tried to reform the agency, and it hasn’t worked. More laws get added, money gets thrown, managers get shuffled, but the problems persist at ground and mid levels where the agency meets the veteran.
Rather than centralized top-down reform, the best practical hope for veterans struggling with the VA is ground-up local/regional efforts, most of all pro bono admin-legal representation of veterans by law firms and law schools, that can get at the ground and mid level problems that are not reached by top VA officials.
Of course, intractable agency shortcomings were blown up and pinned on Bush (eg, FEMA and H.Katrina), but that was activist propaganda by capable left activists. The Right presently lacks the activist capability to make a radically spun narrative stick like that to Obama.
There are several layers of medical care for the military and ex-military.
When on active duty, military medicine takes care of all, both active military and their dependents. It’s a pretty big “universal” healthcare system with some major hospitals spotted around the country. (Walter Reed, Tripler, and Eisenhower to mention only three of the better known.)
Service members who complete 20 years of qualifying service for retirement are given Tri- Care or Life and at age 65 they transition to Medicare as their first insurance with Tri-Care being the back up. Tri-Care works like Medicare. You can see any doctor/hospital who accepts Tri-Care payments.
Service members who complete enlistments short of qualifying for retirement are supposed to get VA care ONLY if their condition is service related. This is where a lot of the problems come. Many veterans cruise through life with insurance, but at some point late in life many have lost their insurance when they lost a job or they could no longer afford it. They’re between regular health insurance and Medicare, so they turn to the VA. In most instances the VA accepts them, but there is a lot of bureaucracy – paper work and waiting that goes into the mix. This is, IMO, where a lot of the problems come.
The VA was originally set up to care only for badly wounded vets who needed wound-related healthcare after discharge. It has morphed into something else. It’s a kind of hybrid government welfare healthcare organization. There are many of the younger vets from Iraq and Afghanistan that need their services now. Add those to the elderly Vietnam vets who are turning to them for care and it amounts to more people than the bureaucracy has been used to handling. Unfortunately, the bureaucrats are not noted for being efficient or working harder when the case load demands it. There maybe other problems that I’m not familiar with, but that’s my take on it.
A couple of thoughts.
Money is not the problem. I just read a news story that VA workers in Virginia received millions of $$ in bonuses.
I recall that as I approached retirement from the USN, I was advised to rush to the Va and get a physical exam, because it was very likely they could find some justification to put me on disability. I did not. I don’t know how many did or do. It was rumored to be a popular ploy among Generals and Admirals–those Sophisticated in the ways of the government.
I drafted a one question poll that could be offered to the American people:
How would you feel if the system of National Health Care were turned over to the same people who run the VA; i.e. federal bureaucrats?
Ecstatic_____________
Not so ecstatic__________
No opinion . What’s the VA?_________
JJ: “There are many of the younger vets from Iraq and Afghanistan that need their services now. Add those to the elderly Vietnam vets who are turning to them for care and it amounts to more people than the bureaucracy has been used to handling.”
Excerpt from a term paper I wrote on the topic:
Footnote: Ken Olson, A Never-Ending Battle, The American Legion, June 2009, at 30.
I’ve always thought the VA should take care of service-related injuries and illnesses only. The VA spent over $300,000 on chemo drugs for my father 50 years after his 4-year enlistment in the Navy. They’re still treating my mom also, who spent 3 years in the Navy in the 1950’s. No insurance in the world can do that and be efficient. They receive(d) top-notch care. My brother has too, from several nagging injuries incurred over his 25-year Navy career.
On the other hand, the guys coming back from the middle east with traumatic injuries should want for nothing.
Eric said:
“Rather than centralized top-down reform, the best practical hope for veterans struggling with the VA is ground-up local/regional efforts, most of all pro bono admin-legal representation of veterans by law firms and law schools, that can get at the ground and mid level problems that are not reached by top VA officials.”
I disagree. This would mostly amount to working within the system to fix it, and would automatically legitimize the system. The problems with that approach are:
-The system CANNOT work, because it is command-control socialism.
-Legal reforms/lawsuits/court orders will have little effect on a bureaucracy, one of whose goals in non-accountability. They will find a way around any “reforms.”
Rush Limbaugh had a fantastic idea: issue veterans healthcare vouchers.
This tactic is so simple and effective that the idea is mind-blowing. The scenario plays out like this:
The public, mostly through mental inertia, would be averse to explicitly gutting the system…they just can’t imagine an alternative.
A Republican president offers to “fix” the system, while offering healthcare vouchers to veterans. The veterans can use the money any way they see fit.
Because the private healthcare system is better (even under Obamacare) than the VA, veterans will vote with their feet.
They will receive better care and will become violently attached to the voucher concept. After that, there’s not much point in having the VA around, is there?
This is genius because as liberals love showing, the military is a dictatorship under the president. The system can be changed with the stroke of a pen, and those with a vested interest in the VA don’t get a vote.
If this new system works, then it serves as an example for the rest of society, doesn’t it?
Brilliant!
I expect the “problem” is at the VA hospitals, and exacerbated by the VA bureaucracy.
LisaM: “I’ve always thought the VA should take care of service-related injuries and illnesses only. … On the other hand, the guys coming back from the middle east with traumatic injuries should want for nothing.”
Your view accords with the original mission. The ‘mission creep’ has tacked on for a long time, though. As with any compassionate policy, it can begin with a rational basis and scope, but it can also be difficult to draw the line.
Excerpt from the same term paper:
Of course, intractable agency shortcomings were blown up and pinned on Bush (eg, FEMA and H.Katrina), but that was activist propaganda by capable left activists.
Don’t forget the Walter Reed Army Medical Center neglect scandal in 2007. It was talked about 24/7 in the MSM, as I recall. The Washington Post even got a Pulitzer for covering/pushing it.
Now that they have broken civilian insurance, the rest will fall like dominoes. They have no choice, many of the stress agents were relieved by seeking outside care that the VA couldn’t or wouldn’t provide for given the bureaucracy. Put all eggs in one basket, watch what happens when the omelet is made by dropping the eggs.
As an example of what has happened in the VA system, many vets with lung cancer were considered to have a service related condition because the military for many years provided free or very low cost cigarettes to service members.
Another one is the Vietnam – Agent Orange connection. Vets who spent any time in country and have developed some internal diseases such as cancer, liver problems, kidney problems, and lung problems can get VA treatment based on the probability of Agent Orange exposure. That is a particularly vague connection and I wonder why I haven’t been affected. For this reason: I spent three summers during my college years working in White Pine Blister Rust control. We used 24D or 245T (both defoliating chemicals, which were called Agent Orange in Vietnam) extensively in spraying wild gooseberry bushes with it. We were soaked in it by day’s end. We were told only to take a thorough shower at day’s end to remove the chemicals from our skin. That was 61 years ago. For 38 years I took two physicals a year and enjoyed good health. That good health continued until about five years ago. I now have a couple of chronic medical problems that may (emphasis on may) kill me in another ten years. But they are most probably due to normal aging, not bathing daily in Agent Orange 61 years ago. Of course, my experience may not be typical. Maybe Agent Orange really is a deadly chemical in which just a hint of it can cause serious health problems. May be not.
I understand that people who get serious medical problems and their insurance is inadequate or non-existent will turn to anywhere to get the care they need. If they are vets, then the VA is the natural choice. This is all a piece of what’s been wrong with our health care since Medicare was passed in 1964.
I’ve commented here a couple of times about the impersonal, low quality of military medical care. Except for battle field trauma care, it isn’t very good. The VA is just another example of poor service from a government run health care organization.
I’d like to comment here. In the mid 80’s I was a nurse in training with the Army reserve and my duty was assigned to the local VA hospital….I will not say where. There I saw what I thought were horrendous practices, not legal in any civilian hospital, to include tying patients to the bed to keep them controlled. The experience left me saying over my dead body would my career soldier husband EVER go to a VA. Ahead to the late 90’s he is discharged from active duty and was advised by his military surgeons to use the local VA…this in San Diego area. I can not speak highly enough of them. He received both VA and military care and was well treated in both. Nowadays my 76 year old neighbor, with any number of chronic diseases, including leukemia and diabetes was finally encouraged by me to avail himself of the VA services he is entitled to. He initially was assigned to Memphis….sorry, I must say a really sub-par facility. He managed to get reassigned to the Nashville hospital and can’t say enough about them….connected to Vanderbilt and in this state there isn’t anything better you can get. Wonderful care! Bottom line….there are really awful facilities in the system and really excellent ones as well. One should not dismiss the whole system out of hand. Just like with the civilian hospitals…..some are better than others. JMHO
The problem, dustoffmom, is that you have to apply for reassignment to one of the “good” facilities.
What happens if your application is rejected? Then you’re screwed.
In fact, this situation is assured for many people since the good facilities don’t have unlimited resources. The good ones will fill up first, and then the rest of the veterans will get the leftovers. Really, it’s analogous to the situation for good charter or public schools within a locality. And I assume that as a rationed good, the politically-connected will be best served (at the expense of everyone else), leading to even more corruption in the system.
I think it would be better to free the veterans to choose for themselves where they want to be treated. Once again, vouchers.
NEO: back when the regular health care system and health insurance were nowhere near the big and pervasive businesses they are today.
Lets put this in the right as the real info makes your point even more so.
if we were to use neo’s source as a measure and its earliest stretch (pilgrims and pequot), then its start was 1636
in the US the medical system was fee-for-service way up and into the 20th century. Hospitals started offering pre-paid services in the 20s, and in the 30s came Blue Cross. First employer plan was for teachers in Texas in 1929.
It was the AMA that prevented Roosevelt from making a national health care system with social security.
and what is going to happen…
its an interesting subject if you read about it..
not that many do
Eric is on target with this comment:
Your view accords with the original mission. The ‘mission creep’ has tacked on for a long time, though. As with any compassionate policy, it can begin with a rational basis and scope, but it can also be difficult to draw the line.”
I say exactly, and would add my observation that “mission creep” is part of the DNA of any bureaucratic organization; just as “unintended consequences” is the most likely product of any governmental program.
I have no doubt that the VA took on ever greater responsibilities during the years when patient load was relatively low, in order to keep the patient count up. .
Karl Rove had some excellent statistical facts on the O’Reilly factor in the last night or so about what Bush found in the VA, and the actions they took to remedy those systemic problems.
Anyway, it seems arbitrary if they are taking responsibility for veterans such as LisaM’s Mom & Dad; because I knew WWII Vets who were not covered by the VA later in life.
Just my opinion, but I think Obama is keeping his face time on this issue to an absolute minimum, in order to avoid the obvious questions about government health care. This is a system that has obvious problems, but it’s got an established infrastructure and plenty of experienced administrators. Probably way too many.
In any case, it’s what a mature government agency looks like – this is probably as GOOD as it gets for a government run health program. It doesn’t take much imagination to foresee the cluster F@&K that BO care will be before it’s matured from an unmitigated disaster, into a mature and semi-functional agency like the VA, depending on who you ask. In other words, the VA will look like the greatest health care going compared to BO care. That’s not a comparison Barry wants to hear at one of his royal lectures, also known as a press conference.
I totally agree Matt-SE……but as I said there are, in fact, both good and bad facilities…..just like as you said about charter vs public schools. My point was merely to say that ~every~ VA facility is not a bad one….although sadly it seems more are deficient than good. And I agree with the voucher idea entirely! Why are they being made to wait months and months to be seen when they could see someone locally in perhaps days?
Matt-SE’s idea for vouchers will not be implemented because, as he pointed out, it would end the need for the VA. Can’t have that now, can we?
Another question I haven’t heard asked is, “Why do we have veteran’s charities such as Wounded Warriors and the Independence Fund?” If the VA was functioning properly, those charities wouldn’t be necessary. We are the most generous people in the world, but when the generosity is funneled through DC in the form of the VA, so much waste and inefficiency occurs that we then have to organize private charities to fill the gap.
I remember when health care was reasonably priced and people paid out of pocket for their care. When big bills came along most people were put on a payment plan. And the hospitals were all non-profits operated by churches, counties, and some large cities. That all changed when Medicare came along. That was the beginning of for profit hospitals. By then job related health insurance was becoming wide spread, but most employees had a deductible and co-pay that was high enough to discourage overuse, but low enough to be afforded. Then unions bargained for “gold-plated” policies with small/no deductibles and tiny co-pays. Congress passed EMTALA and the healthcare system became a big game where providers needed to charge the insured for the pro bono work they had to do under EMTALA. Today, with Medicare, Medicaid, and Tri-Care paying next to nothing, the cost shifting to insured patients is even more pronounced. No one knows what a procedure will cost until they get the bill or see what the provider charged, what the insurance company paid, and what their share is. The whole system is a mess and Obamacare is not going to fix it.
Sorry for the rant. I see the VA problem as another symptom of the problems of the total heath care system.
J.J.,
“Why do we have veteran’s charities such as Wounded Warriors and the Independence Fund? If the VA was functioning properly, those charities wouldn’t be necessary.”
I understand your point, but I think the charities were formed because citizens wanted to help the soldiers, not because they needed to help.
And thank God for that. In the UK, social charity like this is becoming more and more rare because the feeling is, “The government takes care of this, why should I get involved?”
This is the perfect example of the state crowding out private society. We need private social organizations, because without the ability to group together we are just a collection of weak individuals.
I will add that this attitude in the UK may be why a crowd of people stood around while those two Islamists murdered Lee Rigby in broad daylight.
If that happened in Texas, the two would’ve been dead within minutes…even if it meant using bricks and bare hands.
Rush Limbaugh, who I’ve found to be pretty shrewd about the Political Animal’s psychology, says that the Dems are going to blame Bush for the VA scandal — because those Two Unnecessary Wars have created over 2 million more veterans (so sayeth Medusa Pelosi).
Yes, the problems are endemic: but the outrage is that this guy claimed six years ago that he was Outraged by the VA situation back then, and hasn’t done squat about it: except for proposing, in 2009, that the veterans pay for their own healthcare for service-related injuries. Remember that? Even the Dimwit congressmen didn’t go for that one.
Also, This Effin Guy is the one who’s herding All of us onto the government plantation, where we’re All going to get treated like this.
In other words, this scandal is a preview of coming detractions, friends.
Two things about government healthcare: the same people who whine and rant about big, soulless corporations (yep, there are some bad ones out there) are the very people who think that concentrating All Power in the hands of ONE uber-“corporation,” the Government, which you CAN’T SUE, which can throw you in jail if you get uppity, is a Great Idea!!!
Second: think of any government project. Any. Think of the Big Ditch in Boston. Can we say “cost overruns”? By a factor of TEN? Every govt. project ends up costing about TEN TIMES what they say it will — it’s damn near axiomatic.
Third, actually: I worked for NGOs back in the 1990s. A Stalinist I knew who worked for the UN told me that through-put for food aid in sub-Saharan Africa was five percent. Wastage, kleptocrat rakeoff, 95%. And he giggled, obscenely.
So there you have it: even apart from the moral issue of cannibalizing your neighbors, it’s the most tyrannical, most wasteful, most desperate way to do just about anything.
DING! DING! DING! We have a winner!
Beverly: “Rush Limbaugh, who I’ve found to be pretty shrewd about the Political Animal’s psychology, says that the Dems are going to blame Bush for the VA scandal – because those Two Unnecessary Wars have created over 2 million more veterans (so sayeth Medusa Pelosi).”
And that is yet another reason it’s necessary to correct the popular narrative of the Iraq mission in the zeitgeist.
Pelosi would have to be pretty ballsy to characterize OEF like that because OEF is still the righteous 9/11 reaction.
However, she might claim that Afghanistan would have been giftwrapped with low casualities, and done and gone home early had OIF not siphoned off troops and resources – an argument that has been made to me in debate.
The gist of my counter: one, the intrinsic difficulties of building the peace in the ‘graveyard of empires’; two, more troops, funding, and resources don’t compensate for lack of proper method, and COIN wasn’t proven viz Iraq until 2008; three, the one-way AfPak border is effectively like the one-way borders used against us in South Vietnam; and four, it’s not like OEF was starved of US troops, plus OEF is a full-on internationalized NATO mission that shouldn’t need to rely so heavily on US troops.
My take is that we were compelled to go to Afghanistan because of 9/11, but a high-impact strategic victory was always more likely for us in Iraq, comparing conditions and geopolitical value, where there was also a (Saddam) problem that needed to be solved ASAP.
Oldflyer: “Anyway, it seems arbitrary if they are taking responsibility for veterans such as LisaM’s Mom & Dad; because I knew WWII Vets who were not covered by the VA later in life.”
From what I understand, it’s not the laws that are the problem. It’s the bureaucracy, which varies by region and locale. When it works, it’s fine, even praiseworthy. But in too many places, it doesn’t work and screws over veterans with Communist horror stories come to life.
That’s why I recommend activating pro bono lawyers and law students to hack away at bad VA bureaucrats. The laws (mostly) are on the side of the veteran with the legit claim, and pitbull lawyers and law students are the ones who can wield those laws on behalf of clients versus VA bureaucrats running shenanigans.
The system relies upon good people. Thus it really doesn’t matter system one uses, so long as one keeps it full of good people.
The first priority is in choosing the right leaders. The second priority is training up the bottom up leaders.
A benevolent dictatorship works great when the leaders in charge are competent and have the support of loyal citizens. A democracy works the same way. There is no, real, difference between systems, only differences between people. Society itself is a false concept.
To put it into an inverse upside down pyramid, all things are sourced from the individual doing the work, hands on. Thus a society or a system is merely a lens through which the power of individuals are focused, like a general user interface. The only purpose of society has is to allow the user to develop their own personal abilities and talents, and this is often specific to the user in question to the point where one person’s favored gui works horribly for another person.
The modern and popular concept of society is that it organizes individuals, to make people do the right thing. The contra concept is that society is a false concept, merely a distortion, a lens in space, that focuses the power of the individual to a larger area.
A system that breaks down and destroys the user will not function, not because the system is broken but because the user is dead, brainwashed, neural stroked, or rendered incompetent.
Since the majority of the Earth’s population are tools, not users per say, it was easy for them to form the mass manufactured common sense concept that society, the government, and the system itself is something to which we owe our loyalty and survival to. Their numbers overwhelmed better ways of living, similar to farming vs hunting. Farming was something anyone could learn how to do, thus the power was in the numbers. Hunting required kill and the ability to survive, on your own, by your own judgment, which tended to produce casualties amongst the stupid and weaklings. Quality over quantity.
The current day cultural awareness in the US is that our security and wealth comes from our numbers, that our power comes from our quantitative advantage over the world, not because of any qualitative difference. Thus in order to fund Obamacare or any totalitarian philosophies, one needs only produce more slave soldiers and slave workers, one does not need to improve the system or improve the users using the system.
A leader is useless without people to lead, and powerless to begin with. Power only comes from the people. There is no such thing as a country that has no people in it.
that the veterans pay for their own healthcare for service-related injuries. Remember that?
Of course. Hussein knew he had a lot of time to get American citizens killed in Afghanistan, so he wanted to ensure that the government could save money on those fatalities, in order to buy guns to ship to Libya/Syria. Those guns are needed there so that more Americans, like Seal Team Six, could be ambushed and killed using the weapons sold to AQ.