GOP Attacks on VA Hurt Vets in Need

Just had this published in Beyond Chron

GOP Attacks On VA Hurt Vets in Need

by Suzanne Gordon on July 30, 2015

Secretary of the Department of Veterans Affairs Robert A McDonald

Secretary of the Department of Veterans Affairs Robert A McDonald

Any US veteran who depends on the Veterans Health Administration (VHA) for their healthcare should check out CSPN’s broadcast of the July 25 House Committee on Veterans Affairs. For over two hours, Congressional representatives grilled the Secretary of the Department of Veterans Affairs Robert A McDonald and Acting Principal Deputy Under Secretary for Health, physician James Tuchschmidt.

The level of hostility that Republican committee members displayed toward the VHA should give any veteran – and any citizen who cares about the fate of t he nation’s veterans – pause. It demonstrated how little Republicans – and even some Democrats — on the Committee — understand the complexity of VHA services and perhaps more importantly, what is involved in delivering healthcare to sick, vulnerable human beings.

The topic under discussion last week was the $3 billion dollar shortfall the VHA is experiencing and which threatens to curtail needed services to veterans. Congressional Republicans seemed incredulous that the VA’s leadership did not predict the shortfall earlier. Over and over again members of the Committee asked why VHA leadership could not foresee with total certainty how many veterans the VHA would serve in a given year, how much their medications would cost, what kind of services they would require or demand.

Why, they kept asking, can’t the VHA act like other private sector companies and stick to a predetermined budget? Those unfamiliar with healthcare might consider these legitimate questions. Anyone who understands that sick people are not widgets and that their needs are fluid and predictably unpredictable would find them deeply disturbing.

Republicans pummeled VA leadership with such questions and using the VA wait time crisis that occurred last year as an excuse to continue excoriating the nation’s largest and only publicly funded fully integrated healthcare system. In April of 2014, a whistleblower revealed that some VHA facilities were not only failing to see patients within 30 days of a call for an appointment, but were actually falsifying data about wait times. The media and Congressional Republicans pounced on the VA for failing the nation’s veterans.

Although the wait time crisis was a problem only at some VHA facilities, like the one in Phoenix, Arizona, and was mostly limited to facilities in the South (where many Vietnam veterans were retiring and thus overburdening the system) Republicans act as though each and every one of the VA’s 152 hospitals and 900 clinics was affected and is unworthy of our trust.

Last year Congress gave the VHA money– although not as much as it would need – to improve access. McDonald and his leadership team as well as staff at hundreds of VHA facilities have acted to do just that. Which is why there is a shortfall. As McDonald, explained to the committee, the VHA is the victim of its own success. Over the past year the VHA has had 7 million more appointments – 2.5 million of those appointments were in the VHA itself and 4.5 million were done by non-VHA providers in the outside community. In part, because of what is known as the Choice Act, McDonald was able to report that authorizations for care outside of the VHA increased by 44%. (The Choice Act is a complicated piece of legislation Congress enacted following the wait time crisis which allows veterans to – supposedly – more rapidly access care in the private healthcare system if there are wait times in the VHA)

He also reported that since April of 2014, the VHA increased net staffing by over 12,000 including adding 1000 new physicians, and 3700 medical center staff.   The VHA has added 1.7 million square feet in space to its facilities (if you hire more staff, you need somewhere to put them). The VHA, McDonald reported, has also increased physician productivity by 8.5%.

The VHA has also committed to providing 180,000 veterans who have Hepatitis C with the latest medication, which will cost the system more than $600,000,000. (The cost of this medication and another new Hepatitis C drug is straining the Medicare budget and is a huge problem for all payors).

Yet in spite of all its success, the VA’s health care budget has only increased by 2.8%,

One of the main issues that McDonald highlighted was the fact that Congress has created a system that makes it almost impossible for rational management of the funds it allocates. The VHA has 70 line items in the budget and it can’t move money from one to the other. For example, the VHA has long provided care to veterans in the community. But this care is provided by seven different programs, which produce different data, have different contracting mechanisms and different reimbursement rates. Outside providers, McDonald explained, can cherry pick which program they want to use to get higher reimbursement rates. What he and VA leadership want is to combine all the programs for care in the community – including Choice –into one so that they all use the same information, contracts, and reimbursement rates.

These reasonable explanations and requests were met by a level of hostile repartee that seems almost unprecedented. At one point, after the Secretary again repeated how much enrollment has increased and how much that costs, Congressman Miller demanded that he also furnish information about how many veteran enrollees had died in the past year (as if the deaths of some veterans would offset the cost of care for the living). The Secretary said he did not have the information at his fingertips and that he would get it for Miller.

The Congressman repeated the question and Secretary McDonald, again politely but deftly, responded that since there had been 7 million more appointments during the fiscal year, it was safe to assume that more veterans served were alive than dead. When Representative Doug Lamborn, R- Colorado insisted that the Committee had not gotten a clear answer about the reasons for the shortfall, Secretary McDonald asked if Lamborn wanted him to repeat his entire presentation. “Last year, you said financial mismanagement was not giving veterans care now financial mismanagement is giving veterans too much care,” McDonald added, underlining the fact that it seems that the VHA can’t win no matter how it succeeds in improving access and care.

When asked if he bore any responsibility for not predicting the VHA shortfall, McDonald told the Committee that the first thing he learned when he went to West Point was that leaders do not pass the buck. Not many members of the Committee can boast of a West Point education and five years of military service. Nor did they display any ability to admit that the shortfall was due to any errors of judgment on their part.

During the more than two and a half hour discussion, which consisted mostly of Republican grandstanding, Miller insisted that VA leadership should have included the cost of Hepatitis C vaccine in their fiscal 2015 budget. How, the Secretary responded, could they have known in 2013, when they began preparing the budget, that such a costly drug would be available after they had arrived at their budget request?

Perhaps the most important point the Secretary made was that veteran’s needs and

preferences change over time and “outpace the federal budget cycle.” What he repeatedly tried to tell the Committee was that patient care is very different than selling Tide laundry detergent (McDonald was brand manager for Tide at Procter & Gamble.) Human beings are not predictable products produced by an assembly line. Any healthcare system that purports to serve them well has to have the flexibility to deal with that inherent unpredictability. Let’s hope this message eventually penetrates the ideological walls that now dominate politics in the nation’s capital. Don’t hold your breath.

We Need to Counter the Anti-VA Narrative

imagesRecent Congressional discussions of the shortfall of $2.6 billion at that the Veterans Health Care Administration has resurrected the anti-VA narrative that the Republicans have been promoting so that they can justify further privatization of the nation’s largest and most effective integrated publicly funded healthcare system.  Over the past year, I have previewed some of the themes of a book I am writing about the VHA and the care it provides veterans on this blog.  In a Congressional hearing on the VHA shortfall last week, Jeff Miller, R, Florida and Chairman of the House Veterans Affairs Committee, fulminated that the VA demonstrates “ a startling lack of transparency and accountability.”  While Speaker of the House John Boehner, R, Ohio opined that, “The VA’s problem isn’t funding — it’s outright failure. Absolute failure to take care of our veterans,” No injection of funds, he opined can fix the VA because it is just “ a mess.”

All of this is an orchestrated effort to convince people that the VHA is an inefficient, ineffective system that just can’t get it right.  Republicans hope that this will lead to greater privatization and eventually, in their wildest dreams, to a total dismantling of the healthcare system, which would channel all veterans into a private, market/profit based healthcare system that doesn’t work for those of us with good insurance and surely would not work for veterans — many of whom have such serious mental and physical problems that they must be practically walked through the VHA.

To see why privatization will never work for veterans please read the oped I did for the Boston Globe after the Phoenix wait time scandal hit the news.

The tragedy of most coverage of the Veterans Health Administration is that it exaggerates the breath of any problems the system experiences.   It generally fails to understand, for example, that a problem like that with wait times at the VHA is a result of the failure of our healthcare system to produce enough primary care physicians through a failed medical education and training system.  Coverage and ideologically biased political commentary also neglects to mention how very effective the system is.  Many veterans have evinced support of the Bernie Sanders for President campaign because they applaud the stands he took on the VA when he was the Chairman of the Senate Committee on Veterans Affairs.  Sanders fought to get more money for VHA healthcare.  Vets would hardly be supporting him if the VHA was the system the Republicans portray.

What the nation needs to know are the amazing advances the VHA has made in clinical care, research, mental healthcare, teaching, etc.  Ironically, few people know about VHA innovations because, unlike private sector hospitals and health systems, which waste billions of taxpayer dollars (almost half of hospitals budgets come from Medicare dollars)  on advertising,  the system does not waste taxpayer dollars on advertising and marketing but spends it on clinical care, research, and innovation.  The VHA provides better and more cost effective care than all these institutions combined.  In fact, observing care at the VHA over the past year, I am envious of the care that our nation’s veterans receive. I have the best insurance coverage available — the kind of Cadillac care Obamacare will soon be taxing.  But it provides me nowhere near the quality and comprehensiveness of the services veterans get at the VHA.

Vets Health Problems Go Beyond White House

Just published this in

Beyond Chron

Vets Health Problems Go Beyond White House

by Suzanne Gordon on October 14, 2014

Omar Gonzalez

Omar Gonzalez

Iraq war veteran Omar Gonzalez’ recent assault on the White House has led the press and pundits to focus on White House security failures, which, most recently has led to the resignation of Secret Service Director Julia Pearson. Sadly, there has been little effort to consider an equally pressing security problem the Gonzalez case highlights – one that will not be touched by efforts to enhance White House security.   These are the problems that thousands of communities cope with due to the complex mental health problems of soldiers returning from America’s recent wars Middle Eastern wars.

Most veterans who suffer from combat related mental illness do not end up leading a charge against the President. But literally thousands of them return from war badly damaged by a constellation of mental and physical illness that present problems for their own health and well-being as well as that of their families and communities. Even though, these problems have been widely publicized, many families, friends and neighbors of veterans ( as well as veterans themselves )still do not understand the fighting, alcohol or drug abuse, and out of control rage their loved ones exhibit is, in fact, far more than machismo on steroids. As Erin Finley has explained in her book Field of Combat: Understanding PTSD in Veterans of Iraq and Afghanistan, (http://www.cornellpress.cornell.edu/book/?GCOI=80140100613100 ),they do not understand that these behaviors may be signs of mental illness that can be treated and managed. Nor do enough of them know that hundreds of hospitals and clinics at the Veterans Health Administration have programs that specialize in these problems, can offer significant expertise and help that is far superior, when it comes to combat related mental illness, than is available in the private sector. http://www.ptsd.va.gov/

Tragically, the media’s recent focus on the problems in the VHA system may have made things worse. The drumbeat of media reports about the “scandal ridden,” VA have painted such a bleak picture of the nation’s largest – in fact, only – integrated healthcare system, that many Veterans and their families may now conclude that they cannot access any VHA programs at all. Some are convinced that the system is too broken to offer help. In the course of gathering information for a book I am writing on the VHA, I have talked to dozens of people who, when they hear about the project, wonder why I would want to write anything about a system that is so hopelessly flawed and which, they have been led to believ, is almost beyond repair. When I explain that the VA is actually alive and well and has amazing programs that help Vets – particularly those with mental health problems, they are invariably surprised.

Again media coverage one of the right’s silver bullet for Vets — allowing them to get help from private sector providers may make matters even worse for those veterans who have mental health problems.

An estimated 30 % of returning soldiers suffer from Post Traumatic Stress Disorder (PTSD.) Since the wars in Iraq and Afghanistan, others have had traumatic brain injuries that produce what is known as Post Concussive Syndrome (whose symptoms often mimic those of PTSD). Many Iraq and Afghanistan veterans suffer from both PTSD and PCS. Ever since the Vietnam War pioneering psychiatrists, psychologists, social workers, nurses and others in The Veterans Health Administration have worked diligently to pioneer treatments for PTSD and other combat related mental illnesses. VA mental health professionals have developed expertise in Cognitive Processing therapy, Prolonged Exposure Therapy, and have both out patient and in patient programs to deal with this potentially crippling problem. The VA’s work on post concussive syndrome is also unparalleled.   And the VA’s mental health professionals know how to distinguish the one from the other and treat both.

Few private sector psychiatrists, psychologists and social workers have this kind expertise when dealing with PTSD or many of the other problems that are specific to this population of patients. In fact, VA psychiatrists have told me that mental health professionals in the private sector often prescribe drugs and treatments that make matters worse not better. Even those who have experience with victims of rape or other trauma, may not understand specific component of combat related PTSD. Many veterans with PTSD don’t only suffer because of what was done to them – but from what they did to others. As one VA psychiatrist recently explained to me, soldiers in the heat of battle may have killed civilians, or children or even their own buddies in friendly fire. This is not the typical presentation of patients who community psychiatrists, psychologists or social worker normally see.

As news of Omar Gonzalez’s dramatic assault fades from the front page, it is important not to forget that the problems veterans and their families face day in and day out. Many of these problems are treatable and manageable – with help that they can get from a system that, like the diseases it treats, is too often maligned and misunderstood.

 

 

 

 

 

 

 

New Post on VHA and GM with more stuff

This just appeared in Beyond Chron

Public vs. Private Sector Accountability at VA, GM

by Suzanne Gordon

marry-Eric

If anyone thinks that the private sector can serve the needs of the public with more efficiency, effectiveness, and accountability better than public sector programs, they should contrast two stories of mistakes made, acknowledged and corrected  that have dominated the news over the past month.  One is the story of wait times at the Department of Veterans Health Administration  and the other is the deaths that were the result of a faulty switches and airbags in GM’s  Cobalt. There is perhaps no better recent example of the double standard with which our country deals with accountability in  the private and public sectors than the reaction to these two recent reports.

Over a month ago, a whistleblower  exposed the fact  that the Veterans Health Administration had secret lists that disguised the amount of time veterans had to wait for first appointments in VHA facilities in Phoenix, Arizona first broke.  Veterans who were supposed to be seen for an appointment 14 days after they called for one were waiting far longer.  Allegations that 40 veterans had died because of the wait times were also made.  Congressional Republicans – who have long wanted to privatize the VHA delivery of services to 8,000,000 of the nation’s vets — leaped on the story as an example of the dangers of public sector callousness and bureaucracy. Within less than a week, the Veterans Health Administration had initiated a rigorous investigation into the allegations, confirmed the wrong-doing, identified even more facilities that had longer than hoped for wait times, and two weeks after than delivered a preliminary report detailing the problem.  After another week, at the behest of Republican critics the Secretary of Veterans Affairs, Eric Shineki submitted his resignation, and a bill – brokered by Senators Bernie Sanders (I,VT) and  Senator John McCain (R-AZ) to take steps to assure that the issue of wait times was addressed. Continue reading