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VA Privatization News

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  • Content Curator/HadIt.com Elder
17 hours ago, seminoles said:

If I had other health insurance I would gladly pay copays and not use the Va for much of my care, the fight just simply isn't worth it.  I am currently waiting on 4 community care authorizations to get through the system and they were put in on October 22 or 24th, still haven't received them, takes them forever to process anything. Of course when I do receive them the dates of authorization will be October 24-whatever months of care they give me even though it takes them 4-6 months to process them........insane. 

I completely understand. Community care is currently a joke because it takes forever due to the amount of red tape. I had to get my Congressman involved twice to get the treatment I needed. Like the Choice program, it seems that Congress authorized funds for use, but the VA has gone out of their way to make it extremely difficult and inconvenient to use the program within realistic timeframes.

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  • HadIt.com Elder

I think there is ample proof that lifers at the VA don't want us to get private care.  I bet if the VA Choice were transformed to a program as good as Medicare with no copays there would be a mass exit from the VA by all but the most deathly ill.  At least let service-connected vets get decent care close to home.  Due to political expediency medical care for non-service connected vets has become a welfare program.  The whole idea of care and benefits for vets being "needs tested" is just taking a welfare view to those who have sacrificed years of their lives to serve the nation.  Many of those who do pension exams believe that vets are deadbeats and scammers.  I have experienced this first hand with C&P doctor telling me that Vietnam vets get fat on purpose just to get DMII and get benefits.  What kind of attitude is that for a doctor to have?

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  • HadIt.com Elder

Vetquest

 

                     I was injured by a private doctor.  I sued him but lost the case.  People who think a malpractice lawsuit is easy should think again.  The doctor was a podiatrist who injected my foot with a dirty needle.  My foot got badly infected and I had to have a serious operation on my foot to save it.  Not one podiatrist in my city would agree to testify against my dangerous doctor so I lost.  Yes,  docs on the outside are not always good either.

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  • 3 months later...
On 1/14/2019 at 9:41 AM, john999 said:

I have a suspicion that if the government supports private care there must be a considerable cost savings. 

It is not really cost savings it is shifting expenditures.

The short version of the below is if you want/expect/prefer the VA hospital system to remain intact then privatization is a bad idea.

The one thing about privatization of any government program that constantly gets overlooked is that private companies are For Profit. The practical and known effects of For Profit business include that labor costs (docs, nurses, etc) are the easiest and quickest way to improve Profit. Lower your costs and your bottom line grows which makes shareholders happy.

The service and services suffer which means, in the case of the VA, patients suffer.

A further complication is that year over year For Profit entities "must" increase profits to keep shareholders happy. That means raising the rates they charge the VA. Since Wilkie moved VA hospital costs from Mandatory Spending to Discretionary Spending to accommodate Choice programs the practical effect is that as those private For Profit vendors raise their rates that money has to come from some other obligation in the same category....Discretionary......and that means VA hospitals will be stripped of funding and either Congress will cough up more money or the Hospitals will close.

https://federalnewsnetwork.com/veterans-affairs/2019/02/va-mission-act-funding-to-take-center-stage-in-upcoming-2020-budget-battles/

The only way Choice works is if VA Hospital spending is Mandatory spending and Choice is funded as a separate pot of money. That is unlikely to happen.

VA spends  a little over 8K per veteran for care when averaged over all veterans of all health conditions.

The For Profits want that 8K because they know in two years it will be 10K in 4 it will be 12K and most veterans will only visit their clinics 3 to 4 times a year max. The few, percentage wise, that need constant expensive care will likely be concentrated at the remaining VA hospitals.

 

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I will explain "why" private care is superior to VA care.  Its economics..dollars and cents.   

First, to address Geeking squid's "for profit" issue.  Do you really think that "money" is not a factor in VA care decisions??  Think again.  The VA is required to stay "in a budget" and decision makers make choices to make that happen, similar to the way doctors, and others (in public and private care) "make choices" to ensure their profitability.  The "profit motive" (greed) does not "go away" simply because one works for the government.  This profit motive often manifests itself in government by corruption in government where some officials take advantage of their positions to enrich themselves and friends.  

I asked my VA PCP for a special chair that raises my knee above my head to releive pain from my knees.  No.  Those chairs cost too much.  (I think they are less expensive than pain meds and surgery, but I got the later instead).  That's making choices based on money and it happens in VA everyday just like private care.  

Now, there is an economic principle called "economies of scale" and  "optimal interceptor allocation" and it goes like this:

     In a small company, (ma and pa) they dont run efficiently.  Ma and pa are not accounting professionals and they dont buy large quantities to get the best prices.  GSA has published prices for stuff the government buys, and its almost always far less than what we pay.  Why?  Because the government buys buy the car load and companies compete to earn these contracts.  

    As the company grows, it gets more efficient.  (The company "scales up" to become more efficient).   They hire specialists, such as accountants, maintenance, building committees, purchasing agents, etc., to keep costs down.  It works, and, a company as it grows becomes more efficient.  

    However, at "optimal interceptor allocation" the graph of efficiency levels off and goes down.  (Economies of scale becomes negative).   A massive company often wastes lots of money.  Lawsuits, for example, that can not be controlled when you have half a million employees.  Some of those lawsuits are from employees.  Unions move in and seek to maximize workers profits.  The unions are either successful, sometimes by threatening strikes, or the threat of lawsuits, forces very large companies to increase the workers wages and benefits.  Then, workers who need to be fired, cant be fired do to union rules.  They remain on the payroll as often happens with VA.  Massive companies can not operate efficiently as do their smaller competitors.  

     The US Government is massively efficient at squandering money.  When a manager is able to be "under budget" at the end of the year, his boss often tells him to "spend the money" or, if you return it, we will lose it next year.   There are multiple multiple lawsuits.  The VA employes about 500 lawyers to do nothing but oppose Veterans in obtaining additional benefits through appeals.   The VA pays out millions in lawsuits.  Waste is rampant.  Medical care is rationed. 

     How does VA "ration" Vets care?  Its simple.  When a Vet calls to make an appointment, they lie to the Veteran.  "We cant make an appointment past 30 days, so you have to call back when an appointment opens up, next month".  

     Guess what?  Many Vets dont call back.  They are denied care.  They get tired of waiting and some try to get private care or just do without and suffer.  The VA "rations veterans care".  Another way:  They DONT HIRE DOCTORS.  How do they do this?  

     I have a friend who is a Psychiatrist and applied at VA.  VA interviewed him, needed psych docs, and he was a good one.  Hire him, right?  Wrong.  Delay, delay delay.  (Just like they do to us).  After three years, this psytriatist "gave up" on VA, as much as he wanted to work there and help Vets.  They ration doctors in the same way.  Not hiring doctors saves em money..lots of it.  Not only do they not have to pay the doc salary and benefits, they dont have to have office space for him, they dont have to have nurses and medical assistants, and, of course medical supplies are not needed for a doc that does not work there.  End result?  Vets care runs inefficiently, costs more per visit, and Veterans get inferior care.  That is because of the economic principal of economies of scale and optimal interceptor allocation.  

     This is why Va needs private care:    Its too large to run efficiently and squanders way too much money that should go to Veterans care.  

Edited by broncovet
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