The problems at the VA

There’s a reporting problem about the scandal at the VA, which Republicans (this is a letter to President Obama) take advantage of:

“Are you willing to do whatever it takes, pending the results of the investigations that are underway, to ensure our veterans get the care we owe them, even if it means shaking up the current bureaucracy and rethinking the entire system?” the lawmakers asked in the letter.

The letter concluded, “The V.A. scandal is a national disgrace, and Americans are eager to know the extent of your willingness to personally take action in order to make things right for those who have served.”

Phillip Longman (at Washington Monthly) talks about how two issues have been conflated. His first post talks about the problems in the reporting:

I’m also talking about the work of hard-working and earnest reporters, who due to a combination insufficient background knowledge and the conventions of Washington scandal coverage, wind up giving the public a fundamentally false idea of how well the VA is performing as an institution.

There is, to be sure, a systemic backlog of vets of all ages trying to establish eligibility for VA health care. This is due to absurd laws passed by Congress, which reflect on all us, that make veterans essentially prove that they are “worthy” of VA treatment (about which more later). But this backlog often gets confused with the entirely separate issue of whether those who get into system face wait times that are longer than what Americans enrolled in non-VA health care plans generally must endure.

and then talks about one of the reasons why veterans have to wait for care (bold added):

For all the wars we’ve been fighting, the veterans population has been falling sharply (pdf). Nationwide, their number fell by 17 percent between 2000 and 2014, primarily due to the passing of the huge cohorts of World War II- and Korea War-era vets. The decline has been particularly steep in California and throughout much of New England, the Mid-Atlantic and industrial Midwest, where the fall off has ranged between 21 percent and 36.7 percent.

Reflecting this decline, as well a general trend toward more outpatient services, many VA hospitals in these areas, including flagship facilities, want for nothing except sufficient numbers of patients to maintain their long-term viability. I have visited VA hospitals around the county and often been unnerved by how empty they are. When I visited two of the VA’s four state-of-the-art, breathtakingly advanced polytrauma units, in Palo Alto and Minneapolis, there was hardly a patient to be found.

But at the same time there is a comparatively small countertrend that results from large migrations of aging veterans from the Rust Belt and California to lower-cost retirement centers in the Sun Belt. And this flow, combined with more liberal eligibility standards that allow more Vietnam vets to receive VA treatment for such chronic conditions as ischemic heart disease and Parkinson’s, means that in some of these areas, such as, Phoenix, VA capacity is indeed under significant strain.

This regional imbalance in capacity relatively to demand makes it very difficult to manage the VA with system-wide performance metrics. Setting a benchmark of 14 days to see a new primary care doc at a VA hospital or clinic in Boston or Northern California may be completely reasonable. But trying to do the same in Phoenix and in a handful of other sunbelt retirement meccas is not workable without Congress ponying up for building more capacity there.

By the way, back in February Republicans in the Senate filibustered a bill to help with the funding.

In Longman’s second post, he looks at the delay to get into the VA system:

Now let’s consider another, more serious, and often conflated wait time issue surrounding the VA—one that also been bringing forth all kinds of claims and accusations that are in desperate need of being put into context. I’m talking about the huge backlog of vets caught in the often protracted process of just trying to establish their eligibility for VA care.

This issue is confusing to most people, including many in the military, because they assume that vets are legally entitled to VA care, just like most seniors are entitled to Medicare or Social Security. But VA care is not an entitlement. Rather, reflecting the public’s deeply conflicted and often changing views about veterans, access to VA care is limited to vets who can establish that are “deserving” according to convoluted, arcane, and often impossible-to-prove sets of ever evolving metrics and standards.

In general and on paper, combat vets returning from Afghanistan and Iraq have access at least some VA health care for five years, few questions asked. But after that, they join most vets in having to demonstrate their worthiness for treatment by the VA. In general, to get or keep access to VA care most vets must either meet a strict means test or prove that they suffer from specific disabilities directly resulting from their military service.

The fundamental reason for the still huge backlog of cases does not lie with inefficiencies of the VA’s bureaucrats, most of whom are vets themselves. Nor does it come from an increase in the numbers of vets because, as explained in my last post, the number of veterans is actually shrinking dramatically. Rather, it fundamentally lies with the American people and their representatives in Congress, who despite all their fine talk about honoring those who have served their country, have tasked the VA with administering laws and regulations that presume most vets don’t deserve VA care unless they can prove otherwise.

It wasn’t always so. As I describe in my book, the Clinton Administration opened the doors to the VA in 1996 to anyone with an honorable discharge, and many folks who got in then remain grandfathered. But the Bush Administration slammed that door shut again in 2003, and while it has reopened a bit under Obama, we are still spending enormous resources enforcing policies designed to exclude most vets from VA care.

Hmm, so the problem of getting into the VA system is also due to Republicans. So, the two main problems about the VA are due to Republicans which means it’s Obama’s fault. See Kevin Drum for some bullet points.

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