Veterans Sustain Two Serious Defeats From Trump And The House To VA Health Care

[ehrnst]

On Wednesday, Trump signed a law with a provision to establish a commission charged with conducting a nationwide “asset review” of VA infrastructure. If the commission is stacked with advocates of dismantling the VA and privatizing most care, the results could be disastrous. Congress remembers the great power of the base-closing commissions in shutting down military facilities, but at least they were able to vote the recommendations up or down. Not so with this commission; it will be empowered to make final decisions. There are likely to be regional winners and losers, and some decisions may be made to accommodate real estate developers, not veterans

.

https://www.forbes.com/sites/charlestiefer/2018/06/08/veterans-sustain-two-serious-defeats-from-trump-and-the-house-to-va-health-care/#222ffceb2c5a

I gotta $20 says that they start by targeting the facilities in highly populated (Blue) areas with the most valuable real estate, and sell it at sweetheart deals to GOP donors.

[Zambero]

1. More replacing with something "really terrific"

What Trump has done to savage health care was just the start. The VA and Postal Service are prime targets for privatization. It didn't end with for-profit prisons.

[saidsimplesimon]

29. Rural rumpie voters

are at risk of losing "free" deliveries to areas that don't fit the profit motive. So be it, gives me confirmation that dummies are willing to cut off their noses.....Same is true of rural hospitals, enjoy your rumpublican care model. We tried to save you, but, we must not allow a drowning victim to drown our lifeguards.

[The River]

2. This Cannot Stand

These rotten F*ckers need to be arrested,
run out of office and jailed ASAP.
Screwing with combat veterans is not a good idea.

[braddy]

3. After almost 50 years of only using the VA, twice in the last 18 months I was sent to civilian

doctors. A civilian treated me several times for an eye injury and I just went to a civilian emergency room, in both cases the experience was vastly better and more effective than the VA.

Would someone explain why the VA system which seems terrible to me is better than civilian doctors?

[ehrnst]

4. This is about selling off facilities for profit, instead of addressing the problems.

Privatizing, and contracting out some services is one thing. Wholesale gutting of the infrastructure is another.

And they are doing this targeting with NO input from the VA, as is required by statute.

The make-up of the commission had been a sticking point with veterans groups and lawmakers concerned about the facilities-closing review. In the statute written by Congress, it was required that several members come from traditional veterans service organizations, as well as a private-sector health care administrator, a senior government official with medical management experience, and an asset management expert. No representative of the VA’s own workforce will be included.

This is like addressing problems with a school system by having a bunch of developers get together and decide that the solution is to just close some of the schools sitting on the most valuable land, and sell them off to their business partners. The kids will be pushed to the remaining school, and some will get vouchers for parochial school.

No child would benefit - just like no Veteran will benefit from this.

[braddy]

8. How do I lose if I no longer go to the inferior VA system and get to start getting the same medical

care that civilians get? I was amazed at how much better the civilian emergency room and treatment was.

[ehrnst]

10. I think that there are many people who feel that about public schools

There may be private schools that are better, but closing the public system that guarantees everyone a baseline secondary education and giving vouchers for schools who are not accountable to the public will hurt the quality of education for our public in the long run.

People's situations vary, and I don't know what yours is. But you may also be swarmed by some people here who are fighting for the private health care system to be shut down in favor of a system very much like the VA.

[braddy]

15. This is the reverse of that situation, instead of an inferior ghetto situation they get the same

high quality medical care that everyone else does.

[Phoenix61]

31. What makes you think they will

fund that care? Do you seriously believe they are doing this to improve care for veterans? If that was their goal they would fund the VA so it is fully staffed with well-qualified providers who have access to current technology, medical and otherwise. I won't even get into what happens to the community's health care when 100's of people previously cared for at the VA are now seeking care in the community. There are only so many providers to go around. Everybody loses except whoever gets the property the VA was sitting on.

[braddy]

32. Yes, if you need an eye doctor the VA pays for the visit, if you need an emergency room the VA pays

for that visit rather than you having to drive a 100 miles or to a different state to get to a VA emergency room.

They are not going to build 4000 more VA hospitals and 100s of thousands of VA clinics and doctor's offices to duplicate the civilian medical care that is everywhere.

[The River]

7. Better Outcomes

A New England Journal of Med did a study and
VA outcomes are 25% better than civilian hospitals.

I've used several "world class" civilian hospitals and
they don't measure up to the care I've gotten from
the VA.

[braddy]

9. I've been using the VA for almost 50 years, and it sucks.

[ehrnst]

11. Do you have access to facilities that take Medicare/Medicaid? Are you on Medicare/Medicaid?

I have some knowledge about these systems, so I'm curious as to your experience with them.

[braddy]

17. I use VA only, no Medicare/Medicaid.

[ehrnst]

18. How were your trips to the private ER paid? Did you also go for a follow up to a private physican?

Or was the ER your only experience with the private system?

Did Tri-care reimburse?

I have a friend who is a vet who was put on Medicare and Medicaid prior to turning 63. She uses Tri-care only for vision exams, so she's not dependent on it.

My grandfather used the VA hospital an hour away for some care, but had Medicaid/Medicare for other care. The paperwork was complicated, and payment was not made if the paperwork was submitted to the wrong payer.

[braddy]

21. I was bad pain and couldn't drive myself to another state to go to a VA emergency room so

I told them that I was going to one locally and the VA could authorize that or not, they authorized it. The civilians did give me a prescription for pain and IMMEDIATE follow-up visits to specialists to drain my knee etc, the VA called me and told me that they wanted to handle the follow up themselves, so, no painkillers, nor reducing the swelling and pain, and no specialists yet, but I am now scheduled to get some labs in a month.

The VA did nothing for me, so I'm sitting at home in pain and wishing that I could see a doctor.

[ehrnst]

23. So that's somewhat like my grandfather's situation

An hour away in another state to a VA hospital.

He was able to get Medicare, and eventually Medicaid - and that gave him access to private care.

Have you looked into that at all?

[braddy]

25. So your granddad went civilian, I want to also.

[ehrnst]

27. He still got most non-urgent care done at the VA hospital.

Is there someone that can guide you through the process of getting on Medicare?

[braddy]

30. Where would he prefer to go if the VA paid for all the civilian care that he wanted?

[ehrnst]

33. He's no longer with us.

And no insurance pays for "all the care you want," anywhere. That's determined by many different factors.

Believe me - once you have fought with a private insurance company over paying the bill for the anesthesiologist that wasn't "in network" for an emergency procedure for your kid, you learn this. Seriously - it can take months, and even then, it's not guaranteed that they will pay.

As for Papaw, he had no teeth left (due to his time in a German prison camp) so there were no dental providers needed. He got shingles, and that was taken care of by Medicare, because of the urgency of it. He had to have someone to ensure that he didn't tell the provider to bill the wrong entity, or it would take months and many frustrating phone calls to get that straightened out. My stepmother had the list of who paid for what.

His ulcer treatments, his check ups, his prescriptions were all done at the VA. He had vet friends with long term health issues that moved to be nearer to a VA hospital, because they didn't want to spend the money on Medicare premiums.

My friend who is on disability - bipolar disorder (which took forever to get approved) went on Medicaid and Medicare. She uses Tri-care for vision, because she isn't near a facility but a couple times a year.

Closing down more of them won't solve the issue.

[braddy]

35. Merely ceasing (closing) VA medical wouldn't help, but allowing you to go to the non-VA doctor

you choose and live close to in your own communities would.

My own elderly father had to move to a different state away from his wife and young child, and his older children so that he could use the VA, if he could have he would have preferred to get local care.

[ehrnst]

37. I'm thinking that because it's more expensive at a private doctor, less would be covered

or you would have contribute more in the form of co-pays. Especially in this administration, who is hostile to any government assistance, even for vets.

One way or another, you pay for what you get. If it provides you more, then it will cost more.

Every year private health care coverage goes up, or the benefits shrink. There are physicians who refuse to submit bills to Medicare or Medicaid, and they could refuse those who are on the VA system as well. This doesn't apply to ERs, where they have to treat you for urgent conditions no matter your ability to pay, but if you walk into a doctor's office that doesn't accept medicare, they will tell you that they want payment in full, and that you will need to apply for a reimbursement from the VA.

I'm going to bet that they will only reimburse from select medical providers with whom they have an agreement with on prices for services - like Medicare or any private insurance policy. Otherwise they will be no different than "out of network" providers, and will only reimburse their own limit on a service, no matter if that provider charges more.

You will be responsible for it.

Whoever is paying the physician has a great deal of say over what is going to be covered. I think you may have a very limited view of civilian health care if you have never had to pay a bill that refused.

[The River]

41. We're Wasting Our Time

arguing with such well reasoned logic
and insightful arguments.

[Phoenix61]

34. It sounds like your complaint isn't about

the care you receive but about the difficulty in accessing care. I can't imagine how frustrating it would be to have to drive an hour each way just to see a doctor. Everyone where you live is in that same predicament. However, your assumption that if they privitize the VA that will give you access to all the care you want, IMO, is a reach. It will be pre-authorization for all but the most routine care. It is also assuming that private providers will be willing to deal with the VA to get paid. Thay being said, I helped a friend years ago access care through the VA. The squeaky wheel really does get the grease. Have you talked to the Patient Advocate?

[braddy]

38. LOL, no, my main complaint is about the low quality care and since I have moved, now the difficulty

of reaching a hospital and emergency room is an issue as well,

The civilians got to work on me instantly, gave me pain killers, prescribed more and scheduled me for a specialist to end the pain and swelling with an appointment in 2 days. The VA canceled all that and I will see a doctor (or lab tech) within a month, but it will be for a general look at me, it won't be a specialist to fix my problem.

[ehrnst]

39. That care you got cost much, much more than at a VA hospital.

If you have private insurance, you pay $100 - $500 per visit to the ER out of your own pocket.

A single visit can run over $20,000, because private ERs can charge those fees. They do, because they say it makes up for those who come in - that they have to treat - and have no way to pay. Your ER visit to the civilian hospital likely cost the VA twice what they would have incurred in one of their own ERs.

On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son Park Jeong-whan fell off the bed in the family’s hotel room and hit his head.

There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital.

The doctors at the hospital quickly determined that baby Jeong-whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula, and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.

Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labeled “trauma activation,” which sometimes is known as “a trauma response fee.”

“It’s a huge amount of money for my family,” said Jang, whose family had travel insurance that would cover only $5,000. “If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”

American hospital bills today are littered with multiplying fees, many of which don’t even exist in other countries: fees for blood draws, fees for checking the blood oxygen level with a skin probe, fees for putting on a cast, minute-by-minute fees for lying in the recovery room.

A trauma fee is the price a trauma center charges when it activates and assembles a team of medical professionals that can meet a patient with potentially serious injuries in the ER. It is billed on top of the hospital’s emergency room physician charge and procedures, equipment, and facility fees.

https://www.vox.com/2018/6/28/17506232/emergency-room-bill-fees-health-insurance-baby

In otherwords, a private ER in the US considers itself to be a Limousine, whereas managed care, like the kind that one gets in a VA views itself as a hatchback with some miles on it. There is a reason that the the ER wants you to feel very pampered. They are charging you limousine prices. They look way more like a Tesla dealership than a Used Car dealer - fountains, artwork, atriums... that is about client expectations...

[braddy]

40. So it costs too much to let the VA send me to a local doctor or the emergency room, like nonvets

get to, I understand that position.

[mythology]

12. And yet as cited, the VA has better outcomes.

Your experience is your own, but it's an anecdote not a long term study covering many people.

[ehrnst]

13. That has been shown in studies.

https://www.sciencedaily.com/releases/2016/02/160209121532.htm

Among older men with heart attack, heart failure or pneumonia, hospitalization at Veterans Affairs (VA) hospitals, compared with hospitalization at non-VA hospitals, was associated with lower 30-day all-cause mortality rates for heart attack and heart failure, and higher 30-day all-cause readmission rates for all 3 conditions, both nationally and within similar geographic areas, although absolute differences between these outcomes were small, according to a study in the February 9 issue of JAMA.

[braddy]

19. I wouldn't think that routine medical care involves being in hospitals and your study was of over

4000 civilian hospitals vs 129 VA hospitals, where I live now I have to travel to a different state for a VA hospital.

[braddy]

22. Every time you see a doctor for something it involves signing up for a hospital stay at

one of the few VA hospitals?

[The River]

16. Can You List

the reasons why or is this just an opinion?

I do volunteer work with other Vets and except for very few
malcontents, they all love the VA.

[braddy]

20. LOL, I know a lot of vets too, most but not all agree with me, I don't know any with money who

prefer to depend on the VA for their health care.

[ehrnst]

24. If they don't use Tri-care for everything, I imagine they are on Medicare. (nt)

[braddy]

26. We keep getting back to getting away from the VA and to civilian care.

[CountAllVotes]

36. Correct!

I worked for the VA Medical Center back in the 1980s.

They did everything they could to get rid of those that needed care. This is right around the time that many of the Agent Orange Vietnam era vets began showing up. It was all in their heads, those lazy bums was the way it was viewed at that time.

The only vets I knew of that used the VA Medical Center for care were those that had no other viable options for care. Many were indigent and had very few if any assets.

It was a cruel place to work and they sure had their share of incompetent doctors and interns, I can vouch for that!

As for this thank you for your service sh*t, it angers me hotly to this day.

What have they really done for vets? As little as possible best I can tell.

[ehrnst]

43. So you don't think that reforming and adequately funding them is better than shutting facilities

down, and paying much more to private physicians?

[CountAllVotes]

44. That would be nice

However, the way the VA works is that INTERNS are the ones that are in the OR doing the operations on people with a credentialed physician looking on.


Many at that time were men in their 60s+. They called them "cabbages" which was code for a coronary artery bypass surgery. Nice huh?

If something went wrong who do they blame, an intern?

I doubt it has changed as the VA system works like this.

The best doctors have jobs at hospitals with excellent credentials, not some hell hole which is what the VA I worked at was like.

They deserve a hell of a lot more!

[ehrnst]

47. So you don't think that the system can be salvaged?

What lessons do you think that Medicare for All proponents can learn from this?

[CountAllVotes]

48. It is difficult for me to know

I haven't worked for the VA nor the medical profession since 1991.

I quit after working through the AIDS crisis, etc.

The VA was just the beginning of a HELL I'd never care to relive.

Fixed?

The whole thing needs to be overhauled but that will take some major effort best I can tell. Is the need to fix it there for all parties involved, including physicians?

Lots of questions with too few answers.

[CountAllVotes]

49. That is where many vets are at

The VA is a last ditch place to go.

My husband is a vet and he won't go near them, not that I blame him! I saw it with my own two eyes so how could I ever tell him to go there? I couldn't.

Luckily for him, he is covered by my insurance which is pretty good. He needs good care as he has to have eye surgery every 3 mos. for the rest of his life (this has been going on for 10 years now, TEN years!). No VA around here for a need like this.

[smirkymonkey]

5. This is just evil!

Whatever happened to making things better for vets and all his bullshit about supporting the troops and patriotism? He is such a lying bastard. He is actively making things worse for the average american - and especially those who struggle - in every way. He needs to go asap. I don't care how, but he needs to go.

[ehrnst]

6. It has to be timed correctly, or it will come back on us.

Right now there is renewed calls for Clarence Thomas to be impeached.

We know exactly what would happen if he was impeached with Trump in office. He'd be replaced with a younger, more conservative justice.

I'm even betting that there are right wing bots and trolls pushing it.

Trump needs to be taken out in such a way that the least damage is done - preferably where there is enough dirt on Pence to impeach him, and we have a blue congress.

[ooky]

28. To him, vets are a prop. Much the same way he seeks out victims of immigrant murder

to use as a prop. Those two groups are his favorite props and he doesn't care a damn about either, but they make great photo shoots. Third on his prop list are the police, unless they are FBI.

[in2herbs]

14. I don't understand. According to polls, veterans do not want to privatize the VA yet

they overwhelmingly vote Republican and privatization of the VA has been the agenda of Republicans in Congress for decades.

[Docreed2003]

42. This move has exactly jack Crap to do with healthcare

These sick fucking leeches want to raid the budget of the VA that covers much more than just healthcare at VA facilities, it covers for tons of other benefits and programs as well. They are capitalizing on the recent controversies in regard to delays at VA Medical Centers in order to hide their true motivation. The problems the VA Medical centers were caused by lack of funding from these same leeches, for such a time as this.

Veterans are convenient props for photo ops for them, nothing more and nothing less.

[CountAllVotes]

45. Fix it!

The VA needs to be FIXED not eliminated!

[Docreed2003]

46. Exactly!