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Abu Muqawama Goes Jihad on the VA (UPDATED)
I have a lot of love for the hard-working people at the Dept. of Veterans Affairs, but when Foreign Policy asked me what parts of the government should shut down and stay shut down, I offered the following:
[As] veterans from World War II, Korea, and Vietnam depart this Earth, we are likely to be left with a much smaller group of veterans who, thanks to the life-saving technologies developed prior to and during the wars in Iraq and Afghanistan, might need less care in terms of quantity but more specialized care. So it might make sense to get rid of the old brick-and-mortar VA of the 20th century and replace it with something more akin to an HMO that allows veterans of this generation to make use of the best care available to them in our nation's private health care system.
I owe a big intellectual debt of gratitude here to my friend Phil Carter, I should add, as it was in conversations with him that I came around to thinking this way. Feel free to tell me why I am wrong in the comments.
Update: There are some great and feisty comments below, so be sure to check them out. I should clarify that I do not think the entire Dept. of Veterans Affairs should go away but that it should look a lot different in 2051 than it does in 2011. I actually think the Dept. of Veterans Affairs is a great organization filled with dedicated public servants. But as the demographics of our veterans population changes, so too should the VA.
Update II: I've been going back and forth with Alex "Army of Dude" Horton over Twitter, and he provides some good statistics (.pdf) showing the way in which the number of living veterans are expected to decline from now until 2036. I see this data as confirming my belief that the VA of 2051 has to look different than it does today. But I am hardly a hard-liner on this. I suspect you can make a good argument for why some specialized care should remain in place.
Update III: Again, some really great comments. Here are two I largely agreed with, but read them all. The fact that this post has generated so many great comments -- both criticizing me for being a bourgeois to understand the condition of most veterans and lending supporting fire to my contention that the VA needs to adapt and evolve -- offers the best counterargument to those who would argue this blog should not tackle these issues!
Look, today's VA provides *fantastic* care to the ~23m veterans in the U.S.
But tomorrow's population of veterans will look different from today's population of veterans. The future veterans population will be smaller, more diverse, more diffuse, and more likely to place increased demands on the VA. How does tomorrow's VA meet the needs of this population?
So the question is how the VA should adapt its 20th Century infrastructure for the 21st Century -- and beyond. One way is to continue embracing Community-Based Outpatient Clinics. Another is to revamp its hospitals, mirroring innovation in the private healthcare sector, to embrace outpatient and specialty care, and push primary care out to centers like the CBOCs. A third is to continue innovating in the benefits and records areas, including the new joint DoD-VA medical record. A fourth is to streamline and improve the ways VA allows care in the private sector, especially to help veterans who don't live near a VA facility. And there are many other ways the VA can and should continue to innovate.
The end state should be a VA that serves the needs of veterans (and their families). But to do that successfully, tomorrow's VA can't rest on the laurels of today. It needs to aggressively question its assumptions, structure, and model, and figure out the best way to continue caring for those who have borne the nation's battles.
And another:
A 21st century VA needs to take into acct the nature of the modern day force. An all-volunteer force means that a disproportionate number are Reserve and Guard who come home to civilian communities and families, not to bases or installations, certainly not to federal agencies. For this reason and many others, a 21st century VA needs to meet veterans "where they're at" (to parapharase an old community-organizing adage) and recognize, uphold and invest in the best, most efficacious, most accountable community-based providers out there. I'm not calling for the abolishment of the VA; I'm suggesting a new model that recognizes the shortcomings of federal bureacracies, and capitalizes on the competencies of smaller community-based providers, through implementation of a public-private partnership approach. Think small-scale HMO in which a veteran can make choices (one of which is to get services where and when they're needed, and not wait three weeks for an appt).
A start wold be vetting critiera: VA should recognize veteran serving orgs NOT because Congress chartered them 40 years ago but because they meet rigorous and robust criteria for meeting the real needs of veterans today. Second, enage those providers in bona fide contracts that hold them to standards of service and accountabilty. Third, provide funding so that services can be delivered swiftly and adequately. Fourth, evaluate and revisit steps 1-3 regualry, so that a new standard for excellence in the provision of care and services to veterans is consisently upheld.
Is there any subject on which
Is there any subject on which you would refuse to comment? You are way out of your lane on this one.
Paging Phillip Longman:
Paging Phillip Longman: http://www.washingtonmonthly.com/features/2005/0501.longman.html
I think you are directionally
I think you are directionally correct but I think the VA should continue to offer something like ombudsman / concierge support. The one benefit the VA has is it's one set of swinging doors to walk through. It might be complex when you walk through them, but at least you know you are in the right place get help. If someone serves a career with service-provided health care and then the day after they retire they are dealing with our private health care system, the sheer lack of understanding of how it works can stand in the way of appropriate care.
I'm dealing with this now trying to help my uncle - a 20 year veteran of the USAF - navigate the complexities of the health care system. His care has definitely suffered over the years because the service taught him to be very accepting of what care was offered / provided. He's been slow to (and I've been too slow helping him) realize that in the public sector you must be much more aggressively responsible for your own care.
I generally agree. But there
I generally agree. But there are regions of this country where the VA is either the closest or the best care for the community, such as the Carl Hayden complex in central Phoenix.
What would you propose to do about cases such as these?
Nick beat me to the Longman
Nick beat me to the Longman piece.
But that raises the question of keeping it on the basis of having it serve as an example of what the entire health care system should look like. Sadly, that actually makes sense. Such is the state of this mixed-up, muddled-up, shook-up country.
I find your commentary on
I find your commentary on this topic to be nothing short of breathtaking. Have you ever even utilized VHA healthcare services yourself? In an era of 9% unemployment overall and much higher unemployment among young Veterans, VA is a lifeline for many folks your age who don't have the benefit of an elite education or cushy gig at a big think tank.
You are so out of your depth here it isn't even funny.
For starters, while the population of the nation's veterans is indeed declining, VHA enrollment is actually holding steady. Enrollment and utilization of VHA medical services is much higher in the cohort of younger veterans. Unlike the WWII and Korea vets who were able to enjoy the benefits of defined benefit pensions and generous, employer sponsored healthcare, VA is the only game in town for most working class vets. As private sector benefits and income security have been savaged in our national race to the bottom, VA care remains the "Rock of Gibralter" that many have to rely on. Others, like myself, choose to utilize VA care and eschew private sector health insurance even though our employers provide it.
VA Care is oustanding when compared to the private sector on quality and outcomes. It is integrated care where primary care and specialty care are coordinated within a single infrastructure and network of providers - connected by a portable, electronic health record. If you have a CT scan at Louis Stokes in Cleveland, it can be viewed by a VA physician in Phoenix. In this regard, VA is light years ahead of the private sector.
Regarding costs. It is far more cost effective to provide services within the VHA system than to contract it out (what VA calls "fee basis" care). Fee care costs, like most healthcare costs in the private sector, are growing at an uncontrollable rate.
The VHA is remarkably lean. You owe it to yourself to enjoy this great DC weather and come over to 810 Vermont Ave. NW and take a stroll around to see just how few central office "bureaucrats" oversee this enormous system. It is truly amazing how "lean" the overhead is in comparison to the provate sector.
Academic affiliations. One of the hallmarks of VA care is its academic affiliations. These allow VA to leverage these relationships to provide quality care and serve as a training ground for a significant portion of our nation's medical residents. Our academic affiliates are top notch schools. VA's Philiadelphia affiliate is PENN. If you are a VA beneficiary in Philadelphia and need neurosurgery, a surgeon with a PENN appointment will be doing your procedure. Good luck getting that in an "HMO type" system.
I could go on and on here. If this was an attempt to impress the Very Serious beltway pundits who are also advancing the notion of slashing Medicare benefits and "fixing Social security", it is an epic failure.
How about showing some "true faith and allegiance" to those you served with and who rely on VA benefits and healh care. As someone who sure loves to talk about your "East Tennessee" roots, you evince an utter cluelessness about what is going on right now in much of the US.
I simply cannot believe that you would espouse the dismantling of a national resource that works, to divvy it up to a failed private sector model with runaway costs.
To control skyrocketing healthcare costs and expand access, we, as a nation, should be embracing the VA model rather than dismantling it for the benefit of the power elite and those who contribute to keeping them in power.
Here we make haste slowly say
Here we make haste slowly say I, we don't need to make sudden moves- like get rid of it. The VA health care system is not what's killing the budget. The War wounded vets do need specialized care - and in the case of TBI fast.
The VA is more than a bit overwhelmed from what I've garnered so it needs more resources. If the fastest way to do that is outsourcing - absolutely just like any other modern well run enterprise public or private.
I'm so glad you are seeing the virtues of the Private Sector, in particular with regard to Health Care.
Now where is Exum, and what have you done with him?
OIF and OEF produced close to
OIF and OEF produced close to 90,000 cases of PTSD and 180,000 of Traumatic Brain Injury in the 10 years to September 2010 and, whilst these conditions are not unique to the military, they are far more common amongst service personnel than amongst civilians.
Experience from other countries suggests ordinary health systems are not that good at dealing with the specific needs of current and former service personnel. The VA has a unique combination of experience and expertise in dealing with veterans and the U.S. would be wise to give very serious thought as to the consequences of its loss.
OIF and OEF produced close to
OIF and OEF produced close to 90,000 cases of PTSD and 180,000 of Traumatic Brain Injury in the 10 years to September 2010 and, whilst these conditions are not unique to the military, they are far more common amongst service personnel than amongst civilians.
Experience from other countries suggests ordinary health systems are not that good at dealing with the specific needs of current and former service personnel. The VA has a unique combination of experience and expertise in dealing with veterans and the U.S. would be wise to give very serious thought as to the consequences of its loss.
I would say its heading that
I would say its heading that way with the passage of PL 111-137 & PL111-148 signed into law by President Obama in Feburary 2011. Reflecting on the old VSO's an the legacy drivers of past generations with the wisdoms and fore-sight into your writing they advocated hard. Is it the perfect solution? no, yet a step into the right direction I would think. Vr jw-Pittsburgh.
A 21st century VA needs to
A 21st century VA needs to take into acct the nature of the modern day force. An all-volunteer force means that a disproportionate number are Reserve and Guard who come home to civilian communities and families, not to bases or installations, certainly not to federal agencies. For this reason and many others, a 21st century VA needs to meet veterans "where they're at" (to parapharase an old community-organizing adage) and recognize, uphold and invest in the best, most efficacious, most accountable community-based providers out there. I'm not calling for the abolishment of the VA; I'm suggesting a new model that recognizes the shortcomings of federal bureacracies, and capitalizes on the competencies of smaller community-based providers, through implementation of a public-private partnership approach. Think small-scale HMO in which a veteran can make choices (one of which is to get services where and when they're needed, and not wait three weeks for an appt).
A start wold be vetting critiera: VA should recognize veteran serving orgs NOT because Congress chartered them 40 years ago but because they meet rigorous and robust criteria for meeting the real needs of veterans today. Second, enage those providers in bona fide contracts that hold them to standards of service and accountabilty. Third, provide funding so that services can be delivered swiftly and adequately. Fourth, evaluate and revisit steps 1-3 regualry, so that a new standard for excellence in the provision of care and services to veterans is consisently upheld.
After getting out of the
After getting out of the military and while attending college, I used VA Health Care Services regularly for 4 years and while in Graduate School.
I made less than 15,000 dollars a year, for a majority of my 4 years active duty and couldn't afford health insurance after my honorable discharge. I working 3 part time jobs during the summers while in college / grad school.
Besides the health care provided to me by the VA, I'm thankful the VA completed my physical for my current job. Being a Disable Veteran, I also received additional points for my current employment. Being a member of the VA helped in more ways than one, besides the health care and job placement services they provided me during the hard times.
Mr. Exum, being a former commissioned officer, I don't believe you've dealt with or may understand the financial difficulties those in the enlisted ranks deal with after leaving active duty service.
My first two semesters in college, I received Pell Grants because I was so poor. I was making below the poverty level, before, during and after my Active Duty Service.
You're probably scratching your head, asking.... what about the GI Bill? Unfortunately, I didn't sign up for the G.I. Bill at Boot Camp, (I tried later to sign up, after Boot Camp), but I wasn't allowed get my name on the list / pay a lump sum of $1,200.00. It was an unfortunate situation, one that I deeply regret and it contributed to harsher financial difficulties for me than what most Veterans deal with attending college and grad school after Active Duty Service. It could have been avoided, but in the end, I made it. I pay my taxes, I have a great job and now BCBS takes care of any health care issues.
I realized I'm a very small percentage of members of disabled veterans who have had these financial and medical issues. If you feel one person's 14 years of faithful Federal / Military service aren't worth the hassle, then by all means... shut it down AM. I'm sure you're not the only person who feels this way, but really what are the benefits of scraping the entire VA? I'm not really sure what to make of this posting AM. I'm actually baffled. I deeply respect your intellect, knowledge and your experiences. You're a hard working and smart guy, who I thought was about troop welfare and taking care of his own. Are you showing a different side of yourself, that we haven't seen before?
Elf...as always..... you are the voice of reason. "we don't need to make sudden moves- like get rid of it." Props up to ya. Thx.
There should be alternatives. Perhaps you should find them AM and if you feel like it, write about those alternatives. The Hill and House are listening and it could help a disabled veteran who's dealing with financial hardships / medical problems.
Just to add on to the
Just to add on to the ridiculousness of this post, but I guess you're assuming that there will be no more war for the next fifty years.
When I'm the voice of
When I'm the voice of reason.....
Meanwhile in Transoxnia....
Pakistan wants us to call off our "covert" drone strikes...
http://online.wsj.com/article/SB1000142405274870466260457625727369613641...
I think the lowly private is more covert than the CIA. Good Grief.
"The CIA's covert drone program has operated under an arrangement in which Pakistani officials deny involvement in the strikes and criticize them publicly, even as Pakistan's intelligence agency secretly relays targeting information to the CIA and allowed the agency to operate from its territory."
Look, today's VA provides
Look, today's VA provides *fantastic* care to the ~23m veterans in the U.S.
But tomorrow's population of veterans will look different from today's population of veterans. The future veterans population will be smaller, more diverse, more diffuse, and more likely to place increased demands on the VA. How does tomorrow's VA meet the needs of this population?
So the question is how the VA should adapt its 20th Century infrastructure for the 21st Century -- and beyond. One way is to continue embracing Community-Based Outpatient Clinics. Another is to revamp its hospitals, mirroring innovation in the private healthcare sector, to embrace outpatient and specialty care, and push primary care out to centers like the CBOCs. A third is to continue innovating in the benefits and records areas, including the new joint DoD-VA medical record. A fourth is to streamline and improve the ways VA allows care in the private sector, especially to help veterans who don't live near a VA facility. And there are many other ways the VA can and should continue to innovate.
The end state should be a VA that serves the needs of veterans (and their families). But to do that successfully, tomorrow's VA can't rest on the laurels of today. It needs to aggressively question its assumptions, structure, and model, and figure out the best way to continue caring for those who have borne the nation's battles.
Great. I resign my associate
Great.
I resign my associate professorship to focus on the VA and now you guys recommend closing the the whole thing?
Just kidding. I'm pretty sure my skills will transfer. And I only want what is best for our system and our veterans. I've got multiple sclerosis so I deal with the private health care system as a patient too, and while our system is annoying, irritating, and certainly not the best it could be, it is far, far, far better than its critics realize. Far better than even some health care professionals realize.
Is this some sort of intellectual trial balloon for cost savings on military entitlements? A way to roll veterans into so-called "Obamacare" and present budget cuts to a public worried about our fiscal health?
Anyway, I'm sort of over this particular Ezra-Klein-ish "which centralized system is better" discussion. That is because I believe that our increasingly regulated system will cause real, serious medical innovation to flee to Asia. Technology will change our health care habits, and doctors and regulators in the States will be undercut in the way manufacturing was previously.
Or not. One of my pet theories. I presented an abstract at a recent meeting in which I looked into YouTube and health care information education. Intriguing possibilities.
Take for example, the Khan Academy and online education. Imagine a system where a physician with my level of experience (excellent teaching hospitals and the VA) presents a series of online videos identical to the classes I have given in medical school. I could virtually teach students to look at biopsies over the net in the way that I teach residents around the microscope.
Why do we need so many years of medical school? Maybe I take someone with a really good undergrad degree in biology, a year of old-fashioned core medical school classes and then they come right to someone with a lot of experience like me. Spend a couple years of apprenticeship, take rigorous exams, and then go out into the system.
Or, you take a picture of your funny mole with your smart phone and send it to a dermatologist in another state or overseas.
I'm rambling, but basically, what I am saying is that we are only limited by our imagination and, sadly, bureaucrats. This is my worry about the system that we have set up. We don't really have a private system. We have a mix of public-private. Everything is regulated. I can spend an hour on a case, or ten minutes, and I charge an 88305 either way. How many doctors are trained, how many years they are trained, what they may charge, all of this is regulated. And yet, a lot of medical innovation comes from the States, we train a fair amount of doctors in other countries in our taxpayer-funded fellowships, and so on.
But the status quo thinking keeps us in a box. Even single payer, which progressives favor and I certainly do not, is still a box when it comes to innovation. Those systems are by definition rigid. They cannot be flexible. You may be covered on paper, but you get what you get, and the system is driven not by millions of users, but at the behest of centralized managers. It is not the radical vision of technology driven health care that I envision.
There are many ways to deliver health care but a system that doesn't prize freedom, and innovation will lose out in the long run to those that do. We could have a health system that provided more care, more cheaply, for a wider range of patients, if we were not so rigid in they way we have designed things.
But doctors, nurses, favored hospital constituencies and politicians that cater to those constituencies, and bureaucrats don't like challenges to their state-sanctioned positions. Again, we don't have private health care in the states. We have a patchwork system of regulation that is being codified into a new, centralized system that, in my prediction, will be as unwieldy in practice as our current system.
Despite this, both the public-private sector and the VA can provide very good care and I've seen it in both systems. That is because the professionals in both systems try to do their best even when they may disagree with the system.
But there is so much more that we can do if we do not limit ourselves. This is the future and it's sad that the country of innovation, the United States, so limits itself when thinking of health care. Flexibility and technology and creativity are needed. Instead, we are freeze-drying the status quo.
(A little secret: organizations measure such metrics as make their own system look best. They all do it. So, really, the question is what does the individual think? But large systems are by definition about standardization and the individual will always be fighting a bureacracy. Medical tourism will become digital. Mark my words.... :) )
Mr. Exum, This is not an
Mr. Exum,
This is not an uninteresting area for CNAS to study. Being a think tank, go wide. Really, really, really challenge assumptions.
Think up pilot studies that the VA could do. That would be interesting.
I made use of the VA back in
I made use of the VA back in 2008 after snapping my collarbone in a snowboarding incident. At the time, I was too old to be covered under my parents' insurance so the VA was my only option for medical care. The state of New Jersey actually covers the full cost of medical care for veterans for five years (I think, might be three) at VA hospitals.
At that time, sitting in the car with my arm in crude sling, I was pretty happy to know there were physical hospitals I could go to RIGHT at that moment, because trying to navigate a labyrinth of private providers who might have been covered by the VA would be problematic at best. If I had to go to a network of providers covered unde a VA HMO, I could hope I found one that worked. But I didn't have time to do research right then. What if I went in the wrong place? Yes, I'd be treated, I'd also be stuck with a hefty bill.
Branching out into supporting community outpatient care and making use of private providers is probably the best plan for the future. However, I think that physical brick and mortar facilities run by the VA would still hold an important place, at the very least for the purpose of emergency care that a vet would KNOW he's covered at. There's already enough stress with traumatic injury.
In a future with perfectly secure networked information sharing, and easy access to reliable and up-to-date lists of providers, then that would be a non-issue. But I'm not optimistic enough to believe that will happen (even by 2051!). I believe it'd be worth it to have the slight inefficiency and redundancy of physical VA hospitals for that peace of mind. They can be smaller, and post emergency care can be... outsourced, but I'd still want them to exist.
There is no way you can base
There is no way you can base what the numbers of veterans will be in 2051 and use that projection to determine the feasibility of retaining the VA. Eleven to twenty years ago, the same type of argument happened; no one foresaw the huge influx in veterans from OIF and IEF, the numbers of PTSD, the numbers of TBI, the increases in presumptive herbicide claims, etc, etc. Given the recent history of foolish wars, about the only thing one could predict is that the numbers of future veterans in need of Federal government medical, financial, educational assistance is only going to grow, not diminish.
Fix what you have, streamline it, make it more efficient and caring. Don't trash it.
Appreciate the dialog. I am
Appreciate the dialog.
I am an OIF veteran and work for a small national nonprofit helping my fellow comrades transition into employment and education opportunities.
The VA system is not just about healthcare, but it is also a centralized point to receive information and resources on every effected area of a veterans life.
In is a hub of education, housing, employment, and other life services.
A hybrid model might be best used to provide remote care for veterans that live in areas away from the VA facilities and for special healthcare procedures that are not frequent enough to house on a constant basis at the VA hospitals.
Also a warning for a slippery slope on privatization. I recently spoke to the Nurses Union, who were upset on some of the privatization already ongoing. Certain hospitals have hired contractors to provide nursing services and they complete rounds for bedside care. Many of these employees have no degree and have a few days training before they are given a clip board and authority to hand out meds to patients. When companies more concerned about the bottom line are caring for our veterans we will have a decline in professional care offered. The VA staff are not only employees, but see themselves as a part of serving those who served.
When I read your comments
When I read your comments about eviscerating the VA on Foreign Policy's website, I wrote you off as a pinheaded academic who had little experience with the military, its members, or the human toll of OIF, OEF, and GWOT. Still, I did my research; I was shocked to see your affiliation with CNS and dumbfounded to learn you served in combat as a Ranger. I'm a Marine infantry officer and combat tour vet of OIF so I laid down the "benefit of the doubt" card and figured I either misinterpreted what you said or you were privileged to information that I am not. However, with continued comments like "I suspect you can make a good argument for why some specialized care should remain in place" I am sorely tempted to return to my first position.
I don't have an issue with your call to overhaul the VA. My post-deployment experiences were not generally positive and I believe that the disproportionate numbers of Guard and Reserve veterans (who IMMEDIATELY become dependent on a VA system set up to service veterans of last century's very different wars) neccessitate a new paradigm for VA operations. Dismantling the VA and replacing it with private HMOs is NOT it!
These are links for the DoD numbers for TBI and some comments from the Army Chief of Staff on future rates of PTSD and TBI:
http://www.dvbic.org/TBI-Numbers.aspx
http://www.army.mil/-news/2011/02/02/51178-chiarelli-expects-increase-in...
While the number of veterans is declining and older veterans are coming to the end of their lives (No news there...people get old and die) the number of our generation who will require specialized VA care will continue to rise. It's worth noting that the DoD numbers are substantially lower than other estimates of tbI and PTSD, including the VA's. Foisting our injured comrades on a system that is designed to maximize profit and not care is a horrible idea!
Exactly how are already injured veterans going to "make use of the best care available" under an HMO? Perhaps you haven't heard about rescission so here is a link:
http://www.npr.org/templates/story/story.php?storyId=105680875
In addition to the prospect of rescission, what HMO do you think is going to enroll servicemembers who have or are likely to have a pre-existing condition? If a veteran manages to get enrolled and develops PTSD or exhibits delayed onset of TBI, do you really think that an HMO customer service rep is the right person to decide what treatment is appropriate? I've focused on TBI and PTSD, but I know (personally) dozens of Marines and soldiers who received extensive burns or lost limbs...more pre-existing conditions. Without a system of nationalized health care that covers all citizens and is not concerned with shareholder profit, your idea is, to be polite, a non-starter.
Check out these 2 heroes:
http://www.dallasnews.com/sharedcontent/dws/photography/2011/wounded/
Which one of these great Americans "might need less care in terms of quantity"? I find myself amazed that I have to tell you this, but these guys probably would have died during Desert Storm, Just Cause, Urgent Fury, Vietnam or Korea. Maybe that hits home to me because I've been around since the mid 1990s...long enough to remember when we didn't have good body armor and great trauma medicine.
I'm not unique in being able to relate stories of a normal kid who returns from a deployment and cries uncontrollably for no apparent reason or of a model Marine who returns and begins abusing alcohol or drugs. I'm also not unique in being able to rattle off a long list of friends who never returned or who returned very differently from how they left, physically and emotionally. I suspect that you have plenty of anecdotal evidence of your own. What shocks the hell out of me is that you don't seem to care.
The primary goal of the VA is the delivery of healthcare services...period. Trying to alter this goal and polish it in the foolishness of "free market efficiency" is naive and ignores the lessons of the last 10 years. As the financial toll of ill-conceived and poorly planned wars and foolish foreign policy mounts, we should not look to cut costs by reneging on the covenants made with the few who stood up and and have already sacrificed.
I think the V.A. Hospitals
I think the V.A. Hospitals should be discontinued all together. They are not the best quality places for veterans to get help care as politicians and government officlals would like everyone to think. Most V.A. facilities are death traps-or bordering on being death traps! And, the best doctors do not work at the V.A., but mostly doctors who have graduated at the bottom of their classes, and couldn't make it on a civilian job as a doctor in the first place.
There's also a lot of B.S. at the V.A. hospitals, where veterans have to beg for the care that they rightfully earned while serving this country. We sign a contract to fulfill our obligations while serving our country, and in return, the lying government of America falsely promises us excellent healthcare, and benefits if we are injured or psychologically harmed while serving our country. However, after we have fulfilled our obligations for America and our government, the government has betrayed us, and doesn't fulfill their end of the contract. Instead, we get poor quality healthcare at B.S. V.A. hospitals where civilian employees, and bottom of the barrel doctors don't even know how to relate to us in the first place, and f*ck up patients on a daily basis, while being protected by the civilian hospital administrators, and patient representatives. The veterans are the victims and the ones being used and abuses by all concerned-to include congressman/woman and politicians who exploite all of us every time elections roll around, or if they can politically benefit from us in any other way. But, none of these people really give a good sh*t about any of us. We are just tools for them all to get elected with, or benefit from-veterans be damned!
Michelle Backmann wants to decrease veterans benefits, and social security that compensates the already low payments that veterans get for severe service connected injuries, and psychological disorders that are permanent, and need life long treatment to manage them. Even 100 percent connected veterans are struggling to make ends meet each month because the money just isn't enough. Yet, our politicians and government just smile at us, make false promises, and then turn around and screw us all economically, and in every other fashion that they can. However, veterans benefits should not be cut, but increased according to how bad the economy gets, and other factors pertaining to the veterans health problems and care.
I do think the V.A. hospitals should all be dismantled and every veteran given a government medical card to go to the civilian doctor of their choice. The government could also contract soldiers who have been severely wounded in war out to a civilian hospital at a lower negotiated cost than at the wasteful spending V.A. hospitals, where civilian doctors administer care anyway. And, a lot of these soldiers go from the V.A. to civilian hospitals anyway-which is just more money the government has to spend for their treatment at a civilian hospital. And, because the docors at most V.A.s are not the best, most of the time a veteran has to go back two or three times for the same outpatient medical condition because of all the B.S. and mess that exists at all V.A. hospitals, and because a lot of the doctors don't know what they are doing, or just are not very good.
The government would save billions if they just dismantled the V.A. hospitials, because they should not be models for private healthcare reform, because private healthcare is a whole lot better. Obamacare is not the way to go right now as far as using the V.A. hospital as a model, and this would be devastating to America's health care system if this were to come about. Get rid of the V.A. hospitals in America!
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