In response to the editorial article written by Thomas Mitchell, “Past Time to Abolish VA Health Care System and give Vets Vouchers for Treatment,” (MLN, Dec. 29, 2016) let me present my opinions on the subject.
Mr. Mitchell points out all the past and perhaps in some cases, the current faults of the VA health care system, especially regarding the scheduling of medical appointments and the delays that come with the scheduling. Mr. Mitchell blames the above by calling the VA health system socialized medicine and then refers to the self-preservation of the bureaucracy. He feels the objective of the VA is just that, self-preservation, not providing quality service. Mr. Mitchell sees no way towards improvement or success, just continued failure of the system.
Yes, the North Las Vegas VA hospital had large overruns in cost and time to build. Yes, it opened with too small an emergency room and missing ambulance drop-off ramp. These problems have been corrected. The hospital is running well considering the lack of staffing.
Mr. Mitchell fails to address the real issues that hamper the VA and provides us with solutions that cannot work, at least until many of the underlying issues are solved. First let me state some of the issues that can be corrected that would assist the VA in solving some of these problems.
The VA is the largest training center in the world for training new medical professionals. The problem is most of them move into private or other group practice. The reason why is simple. Medical doctors in private practice are paid considerably higher than VA professionals. Of course, VA doctors do not have the overhead that private practice doctors have such as medical malpractice insurance and office expenses. Private practice doctors can increase the size of their practices to overcome these costs; VA doctors have fixed pay ranges. In the case of specialists, the pay differential can be major. No wonder they can’t staff key positions.
Let’s look at Mesquite and the VA choice program and why it’s not working well. Because we are further than 40 miles from the nearest Nevada VA medical facility, the VA offers a program, that with a referral, a veteran can go to a doctor nearby for some services. On the surface that sounds fine. However, you need a doctor that is willing and able to see you and then willing to wait months for reimbursement. With many of our doctors, they are so busy with their current client load; they just can’t accept new patients.
In many cases, the VA would be quicker. In addition, rural medical facilities rarely have specialists. Additional issues can and will arise such as over-billing and other related errors that have made it difficult to monitor the program which is running out of money.
The problem gets worse for several other reasons. Mr. Mitchell says for rural vets it is too long a drive to the major facilities in Reno or Las Vegas. This might be the case in some places, but Mesquite, as an example, provides DAV funded vans to transport our Veterans directly to either the main VA hospital or a clinic for an appointment. Our vans go three times a week and do not charge for transportation.
If the VA medical system is eliminated, 20,000,000 currently served veterans, many of them needing very specialized treatment, would be directed to local facilities, that is, if they exist. Current wait times would only increase. Of course, the current VA medical personnel would have to be absorbed into mainstream medicine. Easier said than done. VA doctors, in many cases, do not have to have local state licenses to practice as they are employed by the Federal government. This would have to change on the state level. Ask any out-of-state doctor how long and difficult it is to get a license in Nevada to practice.
So, is there a better solution than Mr. Mitchell suggests? I believe so. We need to have our VA doctors and support personnel paid considerably more in our VA facilities. The VA is and has always been underfunded by our government. In addition, as the veteran population increases and ages, because of the lack of funding, the VA has reduced its workforce considerably. This must stop.
Until this country gets its priorities together to take care of our veterans properly and make them the number one priority, we have and will continue to set up the VA for failure. It’s a far from perfect system, but it works. Make it better, don’t advocate scrapping it.
Allan. S. Litman