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VA privatization continues with MISSION Act

By   Follow Me on Twitter     Message Rick Staggenborg, MD       (Page 1 of 1 pages)     Permalink    (# of views)   6 comments

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The recently passed VA MISSION Act has been billed as a boon to veterans because of provisions that would expand some services, some of which are outside direct health care delivery. While this seems to have convinced major veteran service organizations to support it, the MISSION Act will also bolster ongoing efforts to privatize VA health care delivery that all have publicly opposed. This suggests that they missed the obvious down side of the legislation and will likely withdraw their support when its consequences become apparent.

The MISSION Act creates a permanent Community Care program to replace the ostensibly temporary Choice program that currently refers VA patients to private providers. The new program will divert $22 billion over 5 years that could be used to address staffing shortages that have led to long wait times for care in some VA facilities. The case for investing more VA resources on private care is based on specious claims of pervasive problems in wait times and quality of care. In fact, the VA's record in both is exceptional.

There are many reasons why this is not common knowledge, not the least of which is propaganda from a group backed by those who would profit most from privatization. Highly misleading claims are being promoted by Concerned Veterans of America, a Koch brothers-funded organization with little veteran representation. Their strategy is to portray the VA as failing, making privatization seem a better alternative. What they don't mention is that the diversion of VA funds to pay for private care makes it impossible to address the problems they claim are inherent flaws of the VA. Privatization does, however, generate substantial profits for investors in the health care industry such as Koch Industries. The real motivation behind expanding outsourcing seems to be maximizing private profit, not helping vets get more timely or higher quality care.

The Choice program was introduced as a stopgap measure after the scandal over falsifying wait times at the Phoenix VA. Its stated intent was to improve wait times until the problem could be addressed. However, it has now expanded to the point that over 40% of patient visits are outsourced to the private sector. Under the MISSION Act, referrals will be significantly increased, with more patients being dumped on an overburdened system of private care that has already produced wait times longer than the VA.

Every dollar invested in private care ultimately comes from money necessary to fully fund and staff the VA. This diversion of funds results in fewer services and compromising the system of integrated care that only the VA provides, while the cost of private care is substantially higher than VA care. It is ironic that the Community Care program will require the hiring of large numbers of specialists merely to process referrals and provider billing. At the small facility near where I live, there will be 70 Community Care staff in a system that had less than 900 employees as of 2014. Just imagine the impact that hiring 70 new clinicians could have had!

Privatizing services will result in a degradation of care. Private providers have much less experience meeting the special needs of veterans. Shockingly, the VA is already referring mental health patients to the private sector, which doesn't meet the standards of the VA's cutting-edge suicide prevention practices. As someone who has been both a physician and a patient at the VA, I can attest that the problems the VA does have are not as serious as the flaws in the private health care system. I gave up using private insurance and now get my care entirely through the VA. As a result, I get fully integrated care in a system designed to serve vets. VA care consistently rates higher on key performance and patient satisfaction measures compared to private care, at significantly less cost. Neither the cost savings, the high quality of care or the integrated nature of the system would be possible in the private sector, where the need to generate profits precludes many of the features of the VA system.

Those who put their lives on the line for our country deserve the best care possible. Despite the propaganda about the quality of care at the VA, both objective measures and patient satisfaction ratings indicate otherwise. An essential feature of the VA system that leads to these outcomes is the integrated nature of services. Money taken out of the system and lost to the private sector is not available to fund the VA's comprehensive services and to fix problems such as long wait times at some facilities that are largely the result of inadequate staffing.

If we want to keep our promises to our vets, we cannot accept the stripping down of the VA to generate private profits. If you agree, contact your members of Congress and let them know that they need to take a closer look at what the MISSION Act will do to the VA and the veterans who depend on it.


Dr Staggenborg is a former VA psychiatrist and member of Veterans For Peace. This article may be reproduced, unedited and with attribution, without prior approval.

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I am a former Army and VA psychiatrist who ran for the US Senate in 2010 on a campaign based on a pledge to introduce a constitutional amendment to abolish corporate personhood. Now that the general public is beginning to understand the (more...)
 

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Rick Staggenborg, MD

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The fight to preserve the uniquely effective VA health care system is going to get harder the longer we wait to push back against privatization. If you are a vet or are just concerned about justice for veterans, please let your members of Congress, veteran service organizations and all your contacts know about this travesty and its costs to vets.

And take a minute to write a letter to the editor of your local paper!

Submitted on Thursday, Sep 6, 2018 at 12:52:40 PM

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molly cruz

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Veterans I have known have suggested the VA care is decidedly inferior. It seems to me all veterans, injured or not, should have as a perk a Medicare card and be able to choose where and with whom they consult about their health, for life.

Submitted on Thursday, Sep 6, 2018 at 7:32:39 PM

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Rick Staggenborg, MD

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I firmly believe that all Americans, vets or not, deserve access to quality care. The VA can provide that to qualified vets, and I agree that all vets should qualify. If you read the article you should have noticed that VA care is rated as superior to private care by both patient satisfaction ratings and objective measures (see the link to the RAND study).

It makes no sense to a pay for a system for vets and then allow them to choose more expensive care that is not designed to specifically serve vets, thus bleeding the VA.

Submitted on Friday, Sep 7, 2018 at 12:06:03 AM

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Alexander Kershaw

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I met a German doctor in Boston in 2014 who had been part of an international team to evaluate health care in the US. The US has 4 different systems: Fee for service(pay for services rendered), Private insurance provided by employer or purchased personally, Medicare and the VA. The VA was the highest rated system. They typically received the patients with the worst problems yet had the best outcomes. The next best system was Kaiser Permanente which uses private insurance and Medicare, but they were far behind VA. The team took its results to the Congress. The German doctor was surprised by the brick wall they received for telling the truth. The VA is a totally govt. owned system. The government pays the staff, buys the drugs, builds and maintains the facilities, in a word, Socialism. The VA has many of the finest doctors, nurses and administrators in the country. The reason is obvious. Those professionals chose their career for altruistic reasons. For the veterans they can truly practice their craft without having to call an insurance co. or to worry about how much any procedure would cost. I am sure there are individual disaster stories, but this study compared the outcomes of many thousands of patients over every system and concluded the VA as by far the best.

Submitted on Thursday, Sep 6, 2018 at 10:16:42 PM

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Rick Staggenborg, MD

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Thanks for reinforcing my arguments, Alexander. I agree on every point.

Submitted on Friday, Sep 7, 2018 at 12:08:03 AM

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David William Pear

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Dear Dr. Staggenborg,

Thank you so much for writing this article. I too am a veteran and I qualify for VA medical care. I love the VA!...James Haley VA Hospital in Tampa.

My experience is that the VA gives excellent care, the people are extremely polite, call everybody "sir", and I have only met one staff person that said she was not happy working for VA.

In the past year I have had cataract surgery and the experience was excellent and the outcome was terrific. R-eye now 20/30, L-eye 20/25 and with VA glasses corrected to 20/20.

I also had ear surgery, tympanoplasty L-ear. Very good outcome, and hearing aids are top of the line.

Prostate surgery, well I want go into details but I am sure you can guess what for. No more waking up 3 or 4 time a night. The surgery was really not as bad as it sounds, excellent results...no more caths!

Whenever a vet is sick he does not have to make an appointment, but goes to the ER for triage and a walk in clinic. I have used it several times and wait time was not long for treatment. If it is serious then the vet is hospitalized immediately. Otherwise treatment is provided and a follow up appointment is schedule with primary care doc or specualist, usually only a few weeks to one month wait time.

The eye clinic is the busiest from my experience. Eye emergencies it is walk in. Otherwise it may be a few months for appointment and waiting room is always crowded so it might take a few hours for eye exam and order glasses...follow up appointment schedule annual.

Ear clinic is a puzzle. An appointment might be a month or two, but they take walk ins without a wait. Same service provided as if one had an appointment.

I like the fact that the VA has all my records on their computer, so no matter which department I go to they know my medical history. Primary care doctor excellent and they schedule an annual checkup. Referred to specialist if necessary.

Pharmacy excellent, may be up to 1 hour wait; and the meds can be mailed.

Because of all the BS in the media I always make a point of asking others how they like the care, and I always ask the doctor how he or she likes working at the VA. A few vets may grumble but GI's are known for gripping, and it is much less than one would expect.

I always tell my friends and family how much I love the VA. They are usually surprised because of all the BS bad publicity.

FORGET MEDICARE FOR ALL; IT SHOULD BE VA FOR ALL!

Unfortunately, I know we are fighting a losing battle on privatization. The bastards just want their 20% skim off the system. They will skimp on experienced providers and hire minimum wage workers where ever possible.

We have seen what has happened to the public school system.

First they break it, and then they privatize it, just as they are doing with the Post Office.

The public is easily fooled, but once the system is privatized, the mainstream media will black out on the subject of flaws and expense of the private system is.

I could go on about how they send appointment card reminders, a day or two to confirm the appointment, take surveys after treatment, have an ombudsman, if for whatever reason one does not like a specific doctor he can get a different one, etc. etc.

Every study shows that the VA gives better care than private healthcare, at a lower cost and with better outcome. Yet we know why the press never gives out those results to the public.

Thanks again, for the article, but I am pessimistic that future vets will get such great care because eventually the bastards will privatize it.

Regards,

P.S. As I said, everything is on the computer so I too can login, check my appointments, make appointments, send docs emails, order refills for rx, and no matter what facility I go to in the country they have my records.

Submitted on Sunday, Sep 9, 2018 at 2:00:05 AM

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