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VA Privatization News

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4 hours ago, broncovet said:

 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.  

You application of Economies of Scale to Health Care is wrong. The public health care system, not including VA and Medicare/Medicade, has exploded costs and those increases are funneled to Profits and Shareholders instead of being put back into serving the patients.

The VA and medicare/medicade do have many bad spending habits no argument on that basic point but if you take funding from the VA and shift it to private organizations costs will skyrocket there too which means the other VA in that same bucket, discretionary spending bucket, will have to cover the costs. The taxpayers will have to pay that cost. Fix the bad habits don't throw the baby out with the bath water.

To keep the VA hospitals and doctors available and do private care at scale (as you improperly use that concept) you need to first look at another salient issue.

The dearth of Medicare / Medicade accepting doctors. The reason there are shortages in available Medicare doctors is that they are not willing to have the government limit the amounts they can charge.

This is a trickle down effect of managed health operations like PPO's and HMO's. Everyone jumped at the "sizzle" of saving money and running more efficiently in health care operations. What they failed to understand was the "steak" in that analogy. It meant that bean counters and shareholders demanded doctors see more patients per day, charge for more tests and unnecessary things, be accessible to drug sales reps even though they personally did not want that drug, have limited authority as to what insurances and rates they set.

With Medicare doctors just don't sign up like they used to since HMO's and PPO's came on line. The Government sets low rates. The HMO's and PPO's won't accept those rates.This situation is why there is a special Immigration Visa for foreign doctors if they agree to live and work in rural areas and accept Medicare/Medicade. We as a nation just cannot get enough doctors who are willing to accept Medicare rates.

This is what Privatization of VA will closely mirror particularly when you close VA hospitals that provide services to Rural areas. 

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To make the Prioritization work The very first thing that has to be done is for Congress to establish a separate funding stream for Veterans to go the Private market. The VA funding mechanism uses a figure of about 8K per veteran when averaged across all eligible users of the system. The existing Tricare system could be altered to allow certain veterans to be covered under that funding stream and pulled out of the VA Hospital funding stream. The same with the Medicare stream. The current Medicar-for-All push would actually alleviate this issue completely for most Veterans. These actions take political will focused on helping real live Americans instead of fictitious persons which is how the law defines corporations. 

The second thing you need to do is apply that funding stream to an Insurance Plan available to Veterans who use the VA but do not need specialized ongoing care like TBI suffers and other areas that the VA has the broadest and deepest bench of experience. This is could be Tricare or Medicare for All, or even the ACA insurance pools. CHAMPVA would have to be addressed in any of those concepts.

Those vets would use that insurance to pay for local care at Insurance compensable rates and may or may not need to have a co-pay. They would have the VA Hospital system as their Catastrophic Care backup but could not use the VA for day to day things like shots, broken arms, etc.

Veterans with specialized care needs would be funneled primarily to VA facilities along with things like C&P exams and aggressive care needs.

There is a subset who have stabilized care needs that can be funneled into a third group that is a hybrid. I am one of those. My conditions are basically stable and I am at 100%. My care is essentially treatable with the experience of Doctors in the public provider space. If I make a claim for another condition to get SMC ratings then the VA would be the source, but for normal care, say that broken arm or counseling then public care of that subset would work.

This group would likely be the largest. Funding mechanisms and allowing systems like Tricare to cover Vets would be key. This can be done this way without Killing VA Hospitals and services and shifted expenditures into Insurance pools would accomplish that without the death of VA Hospitals.

There are other concerns about private care beyond direct expenditures:

The doctors serving the Insured groups would need to learn to "speak VA" and how submit the forms and records that the Government says need to be submitted which would give them access to the VBMS and other systems that have our personal records and that is both dangerous and would require those doctors to take off from their practice to take training in those systems. The private doctors would only be able to use the meds approved by the VA and would have to use their supply channels to deliver those meds.

If those docs don't document things the way VA needs them, then support for future claims will not likely conform to the legally set standards in 38 USC. Making getting rated even more difficult.

The further issue is scheduling which is even more complicated because the private doctors would need to meet VA standards as they sit today, meaning being seen in 30 days and that failed miserably under the Choice program.

Privatizing VA Health Care is about shifting expenditures and being prepared for the skyrocketing health care costs in the public sector. Privatization  would simply shift Federal Money (tax payer money) to the Public sector which treats Health Care as a Profit making income stream despite the use of the non-profit entity formation for tax purposes. It should not be done. Veterans will be harmed and the tax payers will foot the bill.

What kills me is that all of this information is Econ 101. Treating Health Care as a profit stream is what has driven up Health Care Costs.

Stop trying to apply the concept of Economies of Scale to Health Care, you are doing so inappropriately and misapply the concept as it exists in our Private Health Care and Insurance industries.

Countries with what we call Socialized Medicine, a.k.a. Single Payer systems can achieve savings at scale only because they are closed systems and set the prices that all providers need to accept. Since the U.S. has an issue with that term and the idea of the government setting prices it is not a functional or appropriate concept applicable to our National Health Care structure.

If you want that type system get behind Medicare-for-All which would include veterans.

 

 

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  • HadIt.com Elder

You know reimbursement rates for doctors who accept the VA payment for services is so low that most docs I know won't accept it.  Medicare reimbursement is so low that the hospital system depends on private payers and insurance to survive.  Medicade is the real joke.  Reimbursement is so low for nursing home doctors like psychiatrists that where I live no doctor will make rounds except quacks.  The Choice system will never work well because they need to make the VA a better payer than Medicare and you know they won't.  I have Medicare and private health insurance so my doctors don't mind treating me.  I do look at the difference between what the doctors charge and what they actually get paid.

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