At last night’s debate in Miami, the Republican candidates – as they have all primary season – attacked the VA health care system and demanded its radical restructuring. Few viewers were aware, however, that the candidates were following a script written by the Koch brothers.
In the next issue of the Washington Monthly, investigative journalist Alicia Mundy reveals how the Kochs and their network have executed, with meticulous detail, a plan to get Washington to outsource the health care of millions of our nation’s veterans to corporate sector providers. Among other revelations, Mundy shows:
- that stories about veterans dying while waiting for VA care in 2014 (the “scandal” that sparked the current call for privatization) turned out to be baseless.
- that these claims were cooked up by the Koch-funded group Concerned Veterans for America (CVA) and key Republicans precisely to stampede Washington into passing legislation to outsource VA care.
- that the first round of outsourcing has been a fiasco.
- that independent research mandated by that legislation shows that the VA continues to provide the same or better quality care than do private sector providers.
- that the commission now making the outsourcing decisions is stacked with members and allies of CVA and representatives of private sector providers.
To read the full story, click here. And check back Monday to see our whole new exciting March/April/May issue.
Additional recommended link: Phillip Longman VA Care: Still the Best Care Anywhere? This and other articles are building on or borrowing heavily from Longman’s highly regarded book — Best Care Anywhere: Why VA Health Care Is Better Than Yours . Because socialism works.
If it were not impermissible to use that word, I would say classic execution after use of “shock”. Who says it has to be a “real” event?
Do we need the VA? What does it do that other health care systems do not do?
Could we add additional capacity to existing non-VA providers to perform the functions that the VA can uniquely provide? So, for instance, let’s say that amputee care is something that the VA can do that others cannot. Could we add 2-3 amputee specialists to an existing orthopedics group to add necessary functions.
In the medical system that I am part of, we have aggressively absorbed many regional players due to the extremely extensive IT capacity that our system has. You will find that every growing health care system has that advantage – they use IT to leverage a competitive advantage, which other systems require due to Obamacare. That is a lacking of the VA.
In addition, we have a serious problem in the US today – rural health care systems. The out-sourcing of the VA could be done to support small rural players by making them absorb more and more VA functionality. The VA does a lot of plain old physician stuff, and very little which is military-related.
I think that a solid case can be made that the VA is not necessary as a separate entity today. It’s not ideology, it’s modern health care that is lacking.
It’s also important to occasionally ask “Am I shooting the messenger because of who the messenger is?” That’s the nature of this argument: Kochs are bad. Everything they promote is bad. That is a false statement. They do a lot of good things, as anyone who has ever gone to the American Museum in NYC or the Smithsonian Natural History Museum in DC can attest.
The VA does things better than the other current healthcare systems in the US (Medicare, employer insurance, and Obamacare). Why would we want to replace the best part of current healthcare? We should be looking at replace the other things with something more VA-ish.
Maybe read the article. I’d be really happy if you did.
Thanks for that suggestion. I just read 3 of the 11 pages. We come to this:
OK, so what? What proportion missed BEFORE? You cannot present an argument with 1/2 the information. The information about the VA performance is omitted. How good was that treatment? What are the outcomes there?
I do these studies all the time. This is a quasi-experiment. You guys should hire me to critique your articles on stuff like this. You do not present a coherent complete argument. You need 1) performance before 2) performance after 3) comparison of the two cohorts. Has anyone written this up?
Again, how much was wasted on VA treatment?
You need an epidemiologist to help you design your comparisons. The ones in the article are incomplete, and there is an “outcome-driven” reporting bias.
This is what I do in life – I design, run, critique, and manage medical comparisons. Sometimes they are designed experiments (clinical trials). Sometimes they are examinations of information in the medical record (quasi-experiments).
If you want to make a complete argument, examine “Quasi-experiments: design and analysis issues for field settings” by Cook and Campbell. It’s 30 years old, and so you can get one for cheap. It is no longer accurate in the description of the analysis methods (they use inappropriate ANOVA quasi-F ratios rather than mixed models) but the notions of design are still appropriate. A related text was used in an undergrad course I took in 1973.
If your malpractice rate is 80% with private outsourcing, they need to be fired. Whether VA was that bad or worse. If that is industry standard, maybe you need to shitcan that procedure altogether.
Again, that is a comparison with a standard. What proportion met the standard in-house? What proportion out-of-unit?
Next, we might wish to consider cost-benefit. Is the VA more costly? If we spent the same amount out of VA, would we get as much, more, or less. This requires a good experimental design. I am not 100% clear that a good comparison was used.
The whole point of the VA best quality argument is that it is less costly and has been for some time. That is exactly why the private health care providers want to kill it — and why it is ideological philosophy that government cannot perform better than the private sector that is looking to maximize the next quarter’s bottom line and pad the CEO’s salary. All of the MBA performance tracking does add overhead to delivery of care that often is not observed itself. All of the billing and collections IT adds overhead that the VA does not have at all, unless Congress adds deductibles and co-pays to VA benefits in order to hobble the system by increasing its complexity, accounting cost, and IT cost.
I’m getting a little tired of Democrats making Republican arguments, especially when it comes to the parts of government (the Postal Service and VA are two excellent examples) that have been placed in the gunsights of rightwing members of Congress.
The most efficient system is a practicioner whose practice does not depend upon the accounting of money. Who does get the reward of seeing healing occur. Too bad that the bean-counters don’t want to see that kind of medicine that ignores the necessity of bean-counters.
You don’t know much about the health care system of today, it’s clear. There are many requirements put in by Obamacare that make it very difficult for the independent doc to function. You need the IT stuff, and this mandates association with a large health care entity.
And enough of the bullcrap about “republican” arguments. As I have noted elsewhere, the VA was built to provide health care for the WWII generation. We have 1/2 that many vets now. The system is overly large for the number. If the money was given to vets, it would subsidize the private system, which is in many places not doing well.
Two things would happen;
First because of the repugnant LIE the for profit private sector does everything for less money than the non-profit government does, they would autocratically underfund the vets.
Just like how privatising the DOD was supposed to save money but the number of personnel assigned to DOD keeps falling while the money allotted keeps rising, much passing through to private military contractors who reap the money. The cost of defence never went down, just a small number of private contractors underpaying employees made off like kings.
Private contracting in education is going the very same route, costs to the tax payer don’t go down, just pay for teachers and GOOD education for students do.
The privatization of the VA would have the same result, not enough money for the individual veteran to pay their medical bills while a small number of health care millionaires and billionaires make off with the tax payers money.
Two the health care the veteran actually receives would suffer, because they would no-longer have a dedicated system to treat they problems that military service has given them which NO civilian occupation can do;
Case in point, ME;
I lived in a raw petroleum oil smoke environment for over 4 months breathing what ever levels of smoke that blew my direction that day in Kuwait while the oil fires burned day after day until we could be redeployed. NO one in the USA could be subjected to such an environment. My lungs are screwed up, I have a diagnosis of small airway reactive disease, breathing SUCKS, but there is no alternative. There is no non VA system for both researching the problems I face, and treating them. BTW I am also diagnosed with Gulf War Syndrome. There is no cure but they do treat the symptoms.
Also no civilian can be exposed to the levels of toxic chemicals most uniformed members face daily in a combat scenario. Agent Orange ring a bell?
Sorry, but the last 30 years of watching the moneyed backers of the various privatisation scams the GOP fronts for, leaves me saying:
Keep your filthy greedy privatisation paws off MY VA care.
The point is that the VA is a system designed to help millions of vets. Today, we do not have millions of vets, but 1/2 of what we had following WWII. No one is arguing with you. The vets must receive the care that they were promised.
The question lies with WHERE they receive the care.
When I worked at the Cleveland VA in 1997 (6 months), the entire facility was antiquated. Equipment was old. Physicians were underpaid. The IT system was an amazing unusable hodge-podge that few understood.
Today, the local VA is like that. I work in a modern hospital. The equipment is first-rate, and new. The VA does not have new equipment. It doesn’t have the money. It can’t hire physicians, because med grads rightly regard it as a dead end.
BULLSHIT
There are 22,676,149 living veterans which the VA has the duty to provide care for.
Want a break down by war??????
Gulf War Era 5,954,523
Vietnam Era 7,574,032
Korean Conflict 2,433,372
And that is JUST the war time vets there are 5,825,286 peacetime veterans, who did service who never were deployed to a combat theater. They are entitled to receive care for service connected disabilities.
I had a right shoulder injury from my time in Germany in the 1970’s that wasn’t from combat but peace time service. I received service connection determination for that, for because I was injured in the line of duty.
Quite pulling yer factoids from Uranus, while shrilling fer the greedy bastards who want to privatize the entire government so a few wanna be aristocrats can buy it for their benefit, and to detriment of the rest us.
PS: just to show how little you actually know about the veterans situation;
There are still 1,630,848 World War II LIVING veterans, kinda destroys your talking point by itself doesn’t it?
As for the rest of your wingnut propaganda rant, You must live in Uranus if you believe that, because I USE the VA, and I don’t see the third world medical care your trying to claim exists.
20 years ago??
Do you;
Still use that windows 95 computer????
Have a brick for a cell phone???
Use a 56K modem????
Neither does the VA
Damn do you out yer self from Uranus with that one.
Googling reveals that this was a giant mess with multiple news articles associated with the investigation, and that both sides (VA and UPenn) bore some of the blame.
I think this link is the actual VA report; conclusions are on page 74:
http://www.va.gov/oig/54/reports/VAOIG-09-02815-143.pdf
Let me be very clear about evidence requirements.
Here is a very simple example:
Miss Hit
VA # #
Non-VA # #
From this, you calculate proportions in each. You compare the proportions using a statistical test. I won’t bore you with that part.
However, we do want to also know: Did the same kind of physician see the patients in both settings? Were the patients equivalent? There are other factors that should be considered.
If you wish me to give you some professional evaluation of this kind of thing, let me know.
Between my first and second posts, I had a discussion about a medical study that I have helped set up. We have the data now. I will not describe the very specific information, but will sketch the project.
It is a comparison of practice BEFORE and AFTER a change in the approach to solving a problem. The student gathered the before data on 24 cases broken into 4 groups by an important variable. We have a number (26 or 27) after the intervention.
We will compare a specific variable. But we need the BEFORE and AFTER. If you don’t have the BEFORE, you have no idea how things were. Just presenting the AFTER is incomplete.
Thanks for documenting what is likely to be the biggest fraud on people who depended on government services and programs since 401(k).
I suspect every 401(k) salesperson still opens his presentation by telling the new marks that “Social Security will not be there for you.” That is in fact the lobbying position in Congress for these same companies, like Black Rock Securities, whose Pete Peterson was behind the “grand bargain” that Kent Conrad tried to shove down our throats.
Making VA services more geographically available and convenient looks a lot like implementing single payer healthcare that if it is not VA-for-all has regulations that compel private providers to operate like the VA does.
Note that the Walter Reed scandals were in a military hospital. And that VA scandals have dealt with scheduling for people who really want service by the VA.
No Democrat should be advocating anything about the Koch brothers’ wishes but “Hell No”.
This is the 3rd article from WaMo that has come across my radar this morning, great pieces at the Washington Monthly…good job!
hey, Booman. I accidentally rated the comment below “3” – was going to troll rate it thinking it was spam, then decided to cancel the rating because not sure. anyway, now I can’t change it; tried on a couple logins to change it.
sorry, mainsailset, this is OT for your comment, but not sure what to do. also too, anyone else getting a spam site trying to direct you to their site after you make a comment? I’ve had a couple different ip addresses they try to take me to [to which they try to take me]
The Koch brothers lurk behind most of these privatizing schemes, don’t they? No surprises. And it’s always about how privatizing will be “better.”
The GOP voters have gone off the farm to support Trump bc they claim they’re sick and tired of the same old. Yet should Trump win (horror of horrors) how much different will he be from the Kochs?
Well that remains to be seen but my speculation is that it’ll be just more of the same, except Trump will ensure that HE is the one getting his pockets lined with filthy lucre. HE’ll strike deals to privatize stuff just in the same way the Kochs attempt to do, but Trump will be behind the art of the deal, aka, all that sweet sweet filthy lucre goes into Trump’s offshore accounts. You betcha!
GOP voters want something different, but Trump is just more of the same…. albeit, from the perspective of a GOP voter, Trump is, I guess, uh, entertaining. That’s the only difference I see between Trump and the Kochs, who tend to keep a lower profile and support the arts sometimes.
Er, public/private is the modus for many Dems these days, too. Look at what they have done to public schools. All those government jobs that got evaporated are now in the private sector, even in the most sensitive areas of national security. As a bonus, they can more easily circumvent FOI requests and state sunshine laws. “Trade secret” protections are even being enhanced and broadened in new trade treaties.
Mr Koch recently resigned from the board of the Smithsonian. The public took his climate denial propaganda as being amiss in someone associated with an actual scientific organization. They effectively forced him out.
Great
__________
Beauty
There is another reason the VA is having difficulties, and why the wait times are so long. Salaries.
Physicians want to help people. However, they come out of med school with a lot of debt. Did you know that applying for residency can cost up to $40,000? I spoke to a med student who is going into dermitology. $35,000-40,000 to APPLY FOR RESIDENCY. $500/application for fees. Every one required an in-person visit ($2000-3000 per visit, with plane fares, hotels, etc). If you don’t get a residency, you don’t become a board-certified doc.
The VA pays a salary. The salary is high (starting at $230K for some areas). As a private physician, you can make a lot more money. Thus, it is hard for the VA to get the best. That probably means that they do not get the “best” (although the best is usually a foolish desire; there are many people who do a very good job).
I have just been referred to a urologist for a prostate thing – number has gone up, slowly, but a little higher than my GP is comfortable with. I saw the GP 10 days ago. We got the new prostate number that afternoon. I had the referral for Monday. I saw my urologist and … Well, I will spare the details. Exam suggests that the situation is not hugely concerning at this time. Suffice it to say that this probably would NOT have happened so quickly at the VA. That’s because they don’t have the specialists.
The VA has many advantages. It has many challenges. It was a system built to handle the millions of men who were in the services during WWII. We do not have the millions of men/women today. The numbers are far lower. I think that there is a reasonable argument to be made about alternatives.
While I don’t argue any of your numbers, I think it’s worth pointing out that dermatology is one of the most (if not the most?) competitive specialty to get into, and that derm applicants typically need more interviews.
Pretty sure that all grads had the same process.
The issue is slots. I work in a small, rural-based med environment. We have a med school. It has classes of 70-80. We get 800-900 applicants. We rightly prioritize in-state residents for admission. That means that 700 do not get in to the med school.
We need more slots. We do not need Indian physicians to come here. We need to be able to give US kids who do well in school the opportunity to become physicians.
According to
https:/www.aamc.org/data/facts/applicantmatriculant
41% of applicants to med school for 2015-2016 were accepted (21,643 of 52,536).
I’m sure we need more physicians, especially in primary care and lower-paying specialties. It’s a long pipeline.
There’s also an ethical problem with importing lots of specialists is that their governments have paid for their education to provide for their own countries.
And yes, the residency application process is similar in concept for all the specialties, but derm is really out there in terms of competition, and therefore how many residency applications are needed and how many interviews you need to travel to. And how fancy you need to look when you get there. :/
On your point of the ethics of importing specialists, this is absolutely correct. During the Ebola crisis, many noted the paucity of physicians. That is because many physicians from that area are in the US. They often cannot work as physicians here, so they work as aides or nurses. They get more money, but their home countries lose the training often provided at government expense. E. Fuller Torrey, once Pres Am Psychiatric Association, noted this. Ralph Nader has also made this point. We do not have right to take the best in the world. It’s intellectual imperialism. It’s wrong on many levels.
The med student who I referred to is pretty fancy looking. She is a very attractive young lady. I wish her well – she was in a special program that I partially work with to encourage additional research by med students. Not at the level of the MD/PhD, but a little lower.
Why are doctors a protected profession? Gatekeepers hold the numbers artificially down and costs high. We can’t poach enough foreign educated ones, either, it seems.
We do not need foreign practitioners, who steal the positions that should go to US kids. Many US kids want to become physicians.
The difficulty is first training slots in med schools, and second is residency positions. These are both very tight.
Congress can deal with that issue in a heartbeat–subsidize medical education overall or medical education whose practicioners choose to serve in the VA. And pay comparable salaries to local situations. Typically in the past, “comparable” meant median with a minor amount of variation for annual cost-of-living raises and changes of grade for experience. The cost-cutting frenzy of the past three decades have impacted public employees severely. Publicly-funded health care personnel are one especially hard-hit group even as education costs have skyrocketed.
I don’t want them to subsidize it. What I would like to see is a doubling of the training slots, so that all US kids who want to be doctors can become so.
The doc most likely to print money is not necessarily “the best”. There is an argument that the VA might actually be getting the best as in those who are more committed to care than cash.
I am a veteran and I get my care at the VA where I live. All that I am saying is based upon my personal experience. Yes in the beginning it took a long time to see a doctor. That time has steadily improved. I am now scheduled to see the doctor every 6 months. In between that time I may contact the office with any and all concerns by two ways.The phone and the secure email system on VA site. I have used both. I prefer the email and each and every time PCT Personal Care Team have contacted me and provided me with quick information.
I go to the lab for testing as requested by doctor. I go in the early am and am in and out from blood draws in 15 minutes.I have glaucoma and see the vision specialists every 3 months. Every 6 months they test my eyes for vision loss via computer. I receive my glasses for free and one time I had a fall and they replaced my glasses with ones that would not break if I had another one.
I am a diabetic and my doctor sent me to get new diabetic shoes. I have been for hearing tests and done PT Physical Therapy as well. In every case listed I received the best of care, been treated with the utmost respect and care. They all take their time and LISTEN to what I have to say. I am not a number to shove through see and get out quick. They ALL are the best. To destroy the VA is to destroy all Veterans highest quality of health care and to disrespect out service to this country.
Rachel Maddow has been the only person on tv covering this.