The US Senate Committee on Veteran’s Affairs held a hearing yesterday about the developing scandal concerning a potential coverup of chronic delays in diagnosing and treating sick vets — delays that may have led to deaths. The committee no doubt hopes to get to the bottom of this mess and set some heads to rolling in the Department of Veterans Affairs (VA). So, in the finest tradition of the Senate, the committee got a bunch of people from the VA and veteran’s organizations to wear suits, sit in a row, and talk.
And one of the things they talked about a lot was how awesome the VA is.
True, it's no surprise that VA officials told Senators how awesome the VA is. But everyone else had wonderful things to say about the VA too — including Dan Dellinger, the commander of the American Legion who is calling louder than anyone for the head of the head of the VA, Eric Shinseki. As Dellinger said in his testimony, “Overwhelmingly, our task force finds that veterans are extremely satisfied with their healthcare team and medical providers.”
This actually isn’t a new development in ass-covering technology. Healthcare policy experts have been praising the VA as a model of efficient, centrally managed healthcare for years. This spate of praise for the VA started in the mid-2000s and continued right through the middle of the debate on the Affordable Care Act (ACA) — a.k.a. Obamacare — when health policy wonks were looking to the VA to see what could be done to improve everyone else’s healthcare.
Amid all the praise, pretty much everyone in the hearing also made a point of saying that the VA has some major problems… and is screwing things up in a lot of critical ways… and is generally a total mess. In particular, people pointed out issues with veterans gaining access to health care, the long wait lists they must endure, and the lying VA officials have done about the wait lists — which, by the way, has been a known and documented issue for years.
The VA appears to be a system that provides really good care that doesn't cost a great deal of money — but it’s never going to be particularly speedy.
Everyone — critics and supporters of the VA alike — agreed that the problem wasn’t the health care, it was the wait to get it. Apparently the VA can treat all of the veterans some of the time or some of the veterans all of the time, but treating all the veterans all of the time is a real doozy. According to Carl Blake, who testified on behalf of the Paralyzed Veterans of America, “Many of the problems that the media continues to report are really access problems, not quality-of-care problems. While there are many detractors of the VA who would like to convince veterans and the public at large that the VA is providing poor quality care, that is simply not true.”
The problem stems from a lack of doctors, nurse practitioners, and other clinical care givers. Normally, this is the kind of thing that most people would solve by getting a bigger budget and hiring more doctors. But, according to the Vietnam Veterans of America (VVA), money isn’t the issue. In his testimony, VVA representative Richard Weidman said:
As we did for the 112th Congress, VVA stressed again in our annual statements for the 113th Congress to the Committees on Veterans Affairs that we again wanted to make it clear: “Funding is not the primary issue” when it comes to timely adjudication of claims and of appeals at VA. Similarly, VVA stressed that funding is not the primary issue when it comes to the delivery of timely, quality medical care to veterans at the Veterans Health Administration facilities.
Apparently, the VA is too bureaucratic — shocking! — and hires too many paper-pushers at the expense of people doing actual healthcare. If the VA spent less time on paperwork — including the paperwork bureaucrats had to do to lie about patient wait-time lists — it would have more resources to devote to things like treating patients.
But that’s the rub. What kinds of paperwork are people spending their time processing? A lot of it grows out of things any taxpayer expects out of any government-funded agency: oversight, accountability, and some basic competency. Representing the Disabled American Veterans organization, Joseph Volante said:
Unlike private providers and healthcare systems, VA is required by its own policy to admit and publicly report all medical errors and fully investigate all untimely deaths. VA uses the information from these investigations for self-improvement and to strengthen prevention protocols system wide. To be effective, VA must have sufficient internal monitoring and reporting systems that detect and report problems rapidly through the chain of command in order to correct them and develop prevention strategies nationwide. These recent revelations indicate that there are troubling gaps in this reporting system that need to be addressed.
In other words, because it’s a public agency, there should be more oversight and accountability. Which means more bureaucrats and more paperwork. Which, in turn, will result in studies, policies, guidelines, and all manner of corrective measures that very large government organizations use to try to change themselves. All of this puts the squeeze on care providers, exacerbating the problems that lead to the wait-time cover-ups to begin with.
In his testimony, healthcare researcher Phillip Longman — he wrote Best Care Anywhere, a book about how wonderful VA healthcare is — pointed out that private hospitals don’t have waiting list requirements or an Inspector General’s office. To be sure, that cuts down on staffing costs dramatically. So what? Just privatize the VA and be done with it?
Well, the Veterans of Foreign Wars — represented in today’s hearing by Ryan Galluci — would strongly disagree. “We must resist any suggestion that Veterans Health Administration (VHA) [the VA's network of care facilities] is a fundamental failure which should be dismantled in favor of an alternative model," he said. "Such suggestions not only serve to relieve VA of its responsibilities, but fail to take into account the contributions that VHA makes to veterans, their families, and the medical community as a whole.”
When solving an engineering problem, a designer must generally choose to ignore one parameter: performance, cost, or speed. Something can be solved quickly and cheaply, but it will be a lousy solution. Or a design can solve a problem very elegantly and be implemented quickly, but it will cost a fortune. The VA appears to be a system that provides really good care that doesn't cost a great deal of money — but it’s never going to be particularly speedy.
The American public wants a way to provide high-quality, cost-effective health care to its veterans. But that comes with bureaucratic overhead, which is going to exact its toll in the form of things like wait times. Speeding up those times, however, may very well lead to lower-quality care and/or higher costs. So while the VA has horrible problems with the speed of its care, the public — whether they realize it or not — may not want it any other way.
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