Latest posts by Jane M. Orient, M.D. (see all)
- SOTU 2019 and American Medicine - February 12, 2019
- So What If ACA Is Unconstitutional? - January 8, 2019
- Epidemics, Fear and Denial: How Every American Is Threatened - December 11, 2018
Most veterans get most of their medical care from private doctors through Medicare or private insurance. Just think what those secret waiting lists would be like if they didn’t!
Still, a VA-like system for all has been proposed as a replacement for our unsustainable current system—at least until the recent scandals broke.
One enormous difference between the VA and Medicare is that veterans are free to go elsewhere—if they pay privately. Some veterans use their VA doctor only to get free medications.
Medicare patients, on the other hand, are trapped. There is virtually no private coverage available to persons over 65 to replace Medicare—President Lyndon Johnson wiped it out to prevent competition with “his” beloved system. There are only policies to “supplement” Medicare. And Medicare patients can’t just pay out of pocket for a “covered” service they can’t get otherwise, say because the Medicare-allowed price is too low—unless they see a doctor who is opted out of Medicare or disenrolled. For doctors, Medicare is all or nothing, so most doctors are still enrolled.
Most people don’t care about that—not yet. Who would want to pay for something that is free?
So it’s a good idea to look at those “free” (taxpayer-paid) VA services.
In an online survey by the Association of American Physicians and Surgeons (AAPS), less than two percent of 1,000 respondents said care at the VA was the equivalent of the care in the private sector or a model for the entire U.S. medical system. Only 4 percent said it was “generally good, but uneven.” A bare majority (52 percent) said that VA care was “good in some areas, but fraught with many serious problems,” and 22 percent responded that it was “ok if you can get it, but access is seriously limited.” Nearly 20% checked “other” and suggested a term equivalent to “poor.” One said “hard to tell how bad because they destroy or hide records.”
Only about 9 percent of respondents said the problems could be “fixed” by firing people, and less than 3 percent by large increases in funding. The main problems, elaborated on in the more than 200 comments, are a huge, rigid bureaucracy and the “VA way” at the “VA Spa.”
The bureaucracy interferes with care and punishes anyone who calls attention to problems. The main concern of the unionized workers appears to be to leave work on time. This means that surgery cannot be scheduled to start much later than 1:00 p.m. The response to a request to call a “code” for a patient who has had a cardiac arrest might be “I’m on break” or “it’s not my job.” Staff might record normal vital signs every 4 hours on a patient discovered to be dead and cold when physicians make morning rounds.
“No VA employee, however incompetent, could ever be fired,” stated one physician. Another said, “Incompetence is accepted…, and keeping quiet about it is the accepted norm.”
There are many dedicated physicians and workers who truly care about the veterans, rather than seeing them as “something to be endured in order to receive a paycheck.” And some facilities, mostly associated with medical schools, are described as excellent. But they seem to be exceptions to the rule.
“Basically, patients need a doctor advocate in the private sector,” one respondent commented.
And what will happen to the private sector under ObamaCare? Reformers want to abolish fee-for-service payment (payment for doing work) and replace it with VA-style incentives: a steady paycheck with “bonuses” for making the numbers look good. The VA’s electronic medical record is said to be particularly good for tracking those metrics, though private doctors complain that they cannot get a useful, accurate record for a VA patient, if they can get any record at all.
ObamaCare’s Independent Payment Advisory Board will soon be clamping down on total Medicare expenditures, and then private expenditures also. It is already “fraud” to provide a “medically unnecessary” service to a Medicare patient, and physicians can be excluded from all ObamaCare health plans for not “performing” as the bureaucrats think they should.
Doctors may be soon escaping to the VA, instead of the other way around. But patients will have nowhere in the U.S. to go.