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How much should VA rely on private-sector care?

 

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Bob95490

June 12, 2014 - 11:23am

As a 100% SC vet that lives in a rural area I know first hand of the need for "Last Resort" options to alleviate the delays in treatment caused by long-distance travel to VAMC facilities and the unavailability of the various specialty clinics in rural area VA outpatient clinics or the total lack of a VA outpatient clinic in the rural area.

I have travelled to the San Francisco VA Medical Center, a distance of over 200 miles, to receive treatment for various debilitating illnesses. Appointments are over-booked and because anyone travelling long distances must make afternoon appointments these people are often left waiting until long past their appointment time or told to return the next morning. This means they will miss the VA bus they took to get to the hospital and will have to find overnight accommodations. This means an out of pocket expense for the veteran that will not be reimbursed due to the veteran having travelled to the appointment on the VA bus; thus making him or her ineligible for travel money. The availability for alternate treatment sources in rural areas is a real and ongoing need to augment the available / unavailable rural VA sources.

Robert I Finkel MD (USNR,MC)

June 12, 2014 - 6:33pm

As a medical student at the West Haven VAH in Connecticut, an internal medicine resident at the Ann Arbor VAH in Michigan, and as a fellow occasionally working at the VA Research Hospital in downtown Chicago, my experience is from years ago.

Having said that, many of the issues I noted years ago are still relevant. The medical care at the West Haven VAH and the Ann Arbor VAH was excellent. As a matter of fact, these two hospitals are among the five or six currently rated 5 star. Getting anything done was another matter. These issues obviously have only worsened over the years. This is function of government controlled medicine at it's worst and will not be remedied by anything that Congress is now proposing. As a matter of public record, moneys allocated to the VA system are increasing percentage-wise four or five faster than the population the VA serves. The system is marred by a government-civil service-union mentality that is toxic for efficiency.

Throwing more money at it hasn't and won't help. Money doesn't cure the everything stops at 3 PM mentality nor that which causes people to fudge reports and statistics to make thing look good or to earn bonuses.

Having vouchers for private care might be helpful. Being a very conservative and very cynical doctor I'm not sure that even that will help the system, but it might help some vets desperately in need for care now or soon.

By the way, my VA experience is vastly different than my active duty Navy Medical Corps experience between my internal medicine residency and my fellowship.. At Portsmout NH, New Hampshire. The docs, nurses, administration, and corpsmen were all active duty. Even in an outdated facility, with outdated equipment, and budgetary constrains. caring made all the difference in the world.

John Fowler

June 12, 2014 - 7:30pm

I totally agree with Dr Finkel. I also agree that throwing more money at a broke system is just a way for congress to get votes (few exemptions however from those who put vets first).

JimE

June 12, 2014 - 8:28pm

I can only speak for myself and my opinion as an Air Force and Vietnam veteran. The questions above doesn't address the real problems.
Every Honorably discharged veteran should be able to be treated at a reasonably close medical facility. There should be no additional cost as we already paid with our service.
My local VA Clinic only does minor exams and follow-ups. Anything additional or more complex and I have to go to a facility in another state. I have Medicare and a Medicare supplement to cover my medical expenses but the VA can't bill another government agency so I have to pay out of pocket for any and every service performed. My medications I found out can be purchased at a lower price at outside pharmacies than thru the VA system. Both of my sons who are now grown men have been diagnosed with neurological problems since birth, that I will always believe were caused by Agent Orange exposure to me in Vietnam, but the VA has never done anything to help me except to tell me that I was in the 2 most heavily sprayed locations during my AO screening.
So as far as I'm concerned, the VA can shut down all medical services and turn all treatment over to the private sector and allow them to bill accordingly or have veteran's treatment centers in all major hospitals and medical centers. I no longer use the VA for medical services.

FRANK ITZOE

June 12, 2014 - 8:35pm

They should also add group 8 Veterans to private sector care or at the least allow Group 8 Veterans access to to VA prescription drugs thru prescriptions written by private sector Doctors.

David Feagles

June 13, 2014 - 12:01am

I'm another with the option to use Medicare and Supplement. The supplement is not inexpensive. I've also left the VA behind essentially.I show up for yearlies so I won't have to re-enroll,should the sytem improve. I thought I was being a hero by bearing the financial burden personally, so other vets could have better access to the system, but when I went two years without a cardiac recall and an emergency pacemaker implantation in the middle. I rethought my "heroism". It was more a matter of survival. The reason I was given for my extended gap in surveillance was "Your doctor left". Finding that much out involved three hours of uncompensated driving and two and half hours on site.

LLOYD HUGHES

June 13, 2014 - 8:28am

VETERANS SHOULD HAVE A CHOICE---PRIVATE OR VA CARE!!!!!!!!!!!

Old Grunt

June 13, 2014 - 12:27pm

I don't have much to do with the VA, mostly because the people at our "LOCAL" clinic( about two and a half hours away) were the rudest, most uncaring pieces of S&)@!! I have ever encountered in my life. Ask a question and you were either ignored or made to feel like a total ass for interrupting a non-health related conversation! Excuse me all to hell!! I understand the current outrage over VA actions;however, the abuse of vet's at the hands of VA is not a new thing, it's been a constant since the 50's!! Did it really take the public/Congress this long to notice that the VA is broken goat?? I wish we could get Congress to take a good hand look at the Comp. side of VA just to see if they can figure out how the hell it works ( more like how it doesn't work) How in God's name can it take 8/9/10 years to make a decision on a Comp. claim??? Especially one that is a "presumed condition"!!! Who sit's on these boards?? and how can being in a different state make so much difference in a final rating?? I'm just an old grunt waiting to die: if someone can explain it to me, Please Do So!! I'll shut up now,

David Dean

June 19, 2014 - 7:59am

After 30 years of using private doctors, I have found the VA to be the best medical care I have ever received. private doctors in America are a for-profit racket simply to increase claims with patient well-being a secondary concern. Although my first appointment was delayed, I have since received timely and thorough care whenever I request it. I have aslso been treated with the utmost respect on every visit. I am very concerned that this latest accounting scandal by some will be used as am excuse to privatize the VA into some HMO cost-cutting scheme. Some in Congress don't want the government doing anything, and they see veterans' care costs will continue to rise as more vets trun to it for their care. Don't fall for their trap! They just want to get out from under our country's public obligation to care for our wounded. Don't forget that all the republicans in the Senate killed the increaSED VA benefits bill just a few months ago and the respublican House bill to address the delays doesn't include any addtional funding for more clinics or doctors.

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