Fixing the VA

For John, BLUF:  The VA problem won't be easily fixed.  Nothing to see here; just move along.

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Mr Phillip Carter gives us, via Slate. "How to Fix the VA".  The subtitle is "But with 9 million patients, 320,000 employees, 971 hospitals and clinics—It’s not going to be easy."

I have been reading Phil Carter missives for several years, including on homelessness, especially among Veterans.  Mr Carter has his head on his shoulders.  Here is his lede and following paragraph:

President Barack Obama had no choice but to accept Veteran Affairs Secretary Eric Shinseki’s resignation.  The VA inspector general’s interim report issued this week contained too many damning findings of “systemic” problems that grew under Shinseki’s watch.  Key among these was the finding that the actual VA primary care wait times in Phoenix averaged 115 days—more than four times the VA’s previously reported average of 24 days.  That discrepancy revealed a gap between reality and official reporting, and suggested questions about the VA’s integrity ran all the way up to the secretary’s office.

More broadly, the growing VA scandal cast doubt on the ability of the government to deliver health care, a major Obama administration priority.  If the White House could not deliver on this promise to veterans, a key constituency for whom the president and vice president have frequently described health care as part of a “sacred trust,” then how could the administration be trusted to provide care for all Americans?  Coming after the legal and practical challenges to the Affordable Care Act, the White House could not afford another health care failure. And so Shinseki had to go.

It is enlightening to understand that the civilian health care system is not really a panacea.  Someone I know noted today that the Institute of Medicine has repeatedly shown that the US healthcare system kills about 100k patients each year through errors (roughly 1 in 3,000).  Thus, sending Veterans to the commercial system will increase revenue for commercial insurers, but there is no data that suggest, in aggregate, that the care would be better, as measured by accepted outcomes measures.  And, the VA actually does some things better than the Commercial (public and private) hospitals.  For example, dealing with amputees and PTSD.

I think it is fair to say that the "conversation" we had before Congress passed the PP&ACA was not sufficient to help us move our best care out to the rest of the nation.

But, back to the VA, here is the money paragraph from Mr Carter's article:

Notwithstanding this week’s headlines, the data overwhelmingly show the VA has done well in supporting veterans over the last decade or two.  Patient satisfaction scores are high; the claims backlog is down; the VA has worked with the nonprofit community to reduce veteran homelessness by roughly 24 percent in five years.  The list goes on.  Nonetheless, deep problems remain within the VA that threaten its ability to succeed in the years to come.  Today’s political crisis may offer the strategic shock the VA needs to address these core issues, now under a new secretary, to serve our veterans as well as they have served us.

Regards  —  Cliff