If You Think VA Wait Times Are Long, Try the Private Sector

BATTLE FOR VETERANS HEALTHCARE SG COVER (1)New blog post from The American Prospect

Congress Determined To Keep Private Sector In Vets’ Heath Care

Lawmakers on Capitol Hill mulling legislation to extend a program that lets veterans seek health care in the private sector have revived their longstanding complaints about long wait times for care at the Veterans Health Administration facilities. Veterans Affairs Secretary David Shulkin and Dr. Baligh Yehia, the agency’s assistant under secretary, appeared before the House Committee on Veterans Affairs to testify on HR  369, a bill that would allow the Veterans Access, Choice, and Accountability Act to continue past its sunset date of August 2017.

In 2014, after revelations of wait-time problems at some Veterans Health Administration (VHA) facilities, Congress created the three-year Choice program allowing eligible veterans to seek care in the private sector if they live 40 miles from a VHA facility or have to wait for more than 30 days for an appointment. The bill would let the VHA spend what remains of the initial $10 billion (about $1 billion) allocated to Choice on care in the private sector. READ MORE

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VHA Still in Trouble Because of Trump’s Hiring Freeze

As I write in this new blog in The American Prospect, Trump’s hiring freeze is hurting the VHA in spite of exemptions.

Hiring Freeze Spares Some at VA, But Shortages Still Loom

But veterans who rely on the VA for benefits, pensions, compensation, and health care are still in big trouble. Chronic staff shortages and underfunding have been at the heart of a VA crisis centered on long wait times for care. Though doctors, nurses, and certain other essential health-care professionals and support staff have been exempted from the freeze, that still leaves the VA with a multitude of vacancies that will hamper its ability to deliver high-quality care.

To be sure, the recent exemptions have led some who are worried about the VA’s future to breathe a sigh of relief. When Trump announced his blanket federal hiring freeze, it did not exempt anyone at the VA. That led lawmakers and veterans’ advocates to protest that the freeze would cripple the VHA. In response, acting VA Secretary Robert D. Snyder sent out a memorandum on January 27 exempting doctors, nurses, and other health-care professionals and clinical support staff from the freeze. READ MORE

 

Trump Pick Could Help VA

This was just published on the Washington Monthly Site.  It’s a great piece by a Vietnam combat veteran who was also a psychologist at the VHA for many years.  Well worth the read.

VApicTrump’s Pick for VA Secretary Could Continue Obama’s Progress by Edgardo Padin-Rivera

January 20, 2017.

Will Trump Jeopardize Prostate Cancer Research

shulkin_vha-3-960x640Will Trump Jeopardize VA Prostate Research?

by Suzanne Gordon on January 3, 2017  Beyond Chron

President-elect Donald J. Trump will soon announce his pick for Secretary of Veterans Affairs, and his nominee should honor the phenomenal research that the Veterans Health Administration provides. VHA research — the nicotine patch, the first implantable cardiac pacemaker, the Shingles vaccine, among many others — benefits not only veterans but all Americans.  Last year alone, according to VA Undersecretary for Health David Shulkin, VHA researchers published 9,480 papers in the scientific literature.

Most recently, the VHA, in partnership with the Prostate Cancer Foundation, which has helped fund the research for many major treatments,  embarked on another critical research initiative.  The Foundation has donated $50 million to the VHA, making this, Shulkin says, the largest commitment to cancer research the VHA has ever received, one that will help deliver better care to veterans  particularly those in rural and remote areas.  Foundation, CEO and President physician Jonathan Simons says the foundation is eager to work with the VHA because it is the largest health care system in America, with the most men suffering from prostate cancer of any healthcare system or institution.  Because of this the VHA, he says, provides a unique opportunity to help solve some of the most vexing riddles about prostate cancer, democratize treatment through the VHA’s superior telehealth capacity, and accelerate the pace at which new drugs and treatments are made available to the nation’s veterans.   READ MORE

New Blog Post on McCain VHA Bill — Bad News

mccainindexI just posted this on the American Prospect blog on McCain’s attempt to flimflam veterans by privatizing the VHA.

 

Tapped: The Prospect Group Blog

McCain Pulls a Bait-and-Switch on Vets

Almost as soon as Senator John McCain had finished working with Senator Bernie Sanders to craft the veterans’ health-care bill now known as the Choice Act in 2014, the Arizona Republican set out to renege on his promise that Choice would be temporary, and began floating plans to make it permanent.

Part of the Choice Act was the establishment of the Commission on Care, whose deliberations the Prospect has covered extensively. This week that Commission is meeting to hammer out its final report, which will include recommendations about what the VHA should look like in 20 years. Instead of waiting to see what the Commission mandated by his own bill recommends, McCain has once again jumped the gun. He is lobbying hard for a bill that would not only make the Choice program permanent, but would eliminate any restrictions on veterans’ access to private-sector health care.

McCain’s gift to veterans is a bill misleadingly labeled The Care They Deserve Act. The subject of hearings on Capitol Hill the week of June 23, the bill would make the Choice Act—a three-year experiment enacted following revelations of delays in care at VHA facilities in Phoenix and elsewhere—permanent. Choice allows veterans to seek care from private-sector health-care providers if they face more than a 30-day wait for an appointment, or trips of 40 miles or more to the nearest VHA facility.

Under McCain’s new plan, the nine million veterans eligible for VHA care would be free to use any private health-care facility or provider, for any form of service, with the federal government paying the tab—no questions asked. McCain has gathered seven other Republican sponsors for his bill, all of them pushing the new conservative narrative that the VHA is broken beyond repair. This, of course, ignores reports by a Choice Act-mandated Independent Assessment of the VHA, which documents that its veteran/patients actually receive better care, at lower cost, than millions of Americans who rely on private sector health care.

What’s wrong with The Care They Deserve Act? Just about everything, which is why many veterans service organizations like the Disabled American Veterans (DAV) and Vietnam Veterans of America oppose the plan, and why the VHA’s own undersecretary for health, David Shulkin, has proposed a more sensible alternative.

Economists advising the Commission on Care estimate that McCain-style privatization could triple the cost of veterans’ care to almost  $450 billion a year—money that would not be well spent. The VHA’s clinicians and other staff specialize in the complex health problems related to military service, and deal with patients who are older, sicker, and poorer, with more mental health problems that those cared for in the private sector. The average elderly patient in the private sector shows up presenting between three to five physical problems. The “co-morbidities” of a Vietnam vet, for example, can number from nine to 12. That’s why VHA primary care providers spend at least 30 minutes with their patients per visit, compared to the ten or 15 minutes allotted to patients in the private sector. Will private sector providers want to take the time to care for aging, sometimes homeless, often mentally ill, veterans? Even if they do, will they be able to detect the difference between ordinary type 2 and Agent Orange-related diabetes, or be equipped to parse the myriad symptoms of PTSD?

McCain’s bill promises veterans a choice between VHA and private sector care. In reality, it would ultimately erode choice by weakening the VHA option, putting the entire veterans’ health system at risk. The VHA’s current budget is determined by how many veterans use the system and for what services. If far more eligible veterans start using private sector health care, there will be less funding available for VHA services that are unavailable elsewhere, and for maintaining the agency’s highly specialized research and clinical expertise in military-related health problems. As funding for costly private sector care eats up more of the VHA’s annual budget, there will be hospital and clinic closings, along with VHA staff layoffs. To reduce expenditures on veteran health care, Congress may also be tempted to make eligibility for veterans’ health-care benefits even more restrictive than it is today.

If Congress wants to improve the VHA, it should embrace the reform proposals of Shulkin and those Commission on Care members who want to allow veterans access to private sector providers in networks coordinated by the VHA. With luck, this recommendation will appear in the Commission’s June report. Strengthening the VHA, and giving veterans the choice to see outside providers if necessary, would really give veterans the care they deserve.