Wednesday, May 28, 2014

Fixing The VA Health Care System: They Fought For Us. It's Time We Fought For Them

The problems at the VA "represents a case study in how a bureaucracy tends to its own interests, even at the expense of veterans relying on it for matters of life and death." Rich Lowry

Perhaps this is the stat that should concern most Americans. At Gitmo today, there are 1.5 health care providers for every terrorist detainee. At VA medical centers, the average is 1 health care provider for every 35 veterans.  (J.D. Gordon, former Pentagon spokesperson). In other words, the first recognition in fixing the problems at the VA is one of priorities. Treating the health of our vets should come well before treating the health of terrorist detainees. With the exception of a few misguided nitwits, few will disagree with that first step. But where do we go from there? I don't presume to know all the answers. But we have to start somewhere.  Let's examine some other reasonable corrections that can be made to this vast government program:

  • Get rid of the entrenched and poor performers in the federal bureaucracy that manages the VA system starting with Secretary Shinseki.  Keep those who have been successful and recruit accomplished private sector executives with a good track record in managing health care settings. And yes, pay them well based on their performance.
  • Establish clear and reasonable benchmarks for and of performance. For example, a 2012 audit by the VA inspector general found that many VA medical centers lacked any method for calculating staffing needs. 
  • Get rid of the American Federation of Government Employees (AFGE), the union most prevalent in the VA medical centers. Place the patient ahead of the employee. That union has also been the primary obstacle to enact the next step.
  • As I promoted in an earlier post, expand the program to refer veterans to civilian medical centers using vouchers. From all reports, the VA is good at treating PTSD, TBI, Agent Orange, and other combat related health injuries. But why should a vet have to go to the VA if she or he needs treatment for a cardiac condition, diabetes, pneumonia, a variety of allergy conditions, etc.? Researchers at RAND reported that veterans often have a better chance of survival for at-risk cancer and heart surgeries at civilian hospitals. In short, civilian hospitals do those procedures more often and have more experience than most VA medical centers (NY Post). Allow referrals to the nearest community hospital to get treatment for those conditions especially those hospitals that have expertise in those areas of health management. This step alone would reduce VA patient rolls significantly and provide the veterans with immediate care (one of the major problems in the VA has not been the care itself as evidenced by veteran patient care surveys, it's been the waiting to get the needed health care. In 2012, the Government Accounting Office published a report on just this very problem entitled, "VA Health Care: Reliability of Reported Outpatient Medical Appointments Wait Times and Scheduling Oversight Need Improvement."). And this problem has been around well before 2012.
  • Urge veterans on Medicare to use the civilian health system. Over 3 million vets uses the VA despite having Medicare. This would lighten VA's patient loads and would save them millions.
  • Borrowing from Col. Allen West, he suggests developing regional "Centers of Excellence." In other words, setting up regions in the North, South, East, Midwest and West, and basing it on the composition of the number of veterans in a particular region. He also suggests developing relationships with local private hospitals. This is significant considering veterans now living in many rural and remote areas need to travel long distances to get to the VA medical center in their catchment area.
As Rich Lowry recently wrote, "The VA is an island of socialism in American health care." But it does not have to be. One of the major problems faced by returning veterans from our recent engagements  is their feelings of being disconnected from their local communities. What better way to re-connect them to the community than giving them the opportunity to use community hospitals? Moreover, this would give communities more opportunities to connect with their veterans. 

Let's get our veterans off that isolated island. They served us. It's now our duty to serve them. That's what a grateful nation does.