Low hanging fruit fell into the picnic baskets of the House and Senate in the form of easy legislative fixes to the Veterans Administration. It isn’t that changing the culture, systems and management at the VA will be easy, but the legislative part of the solution is woefully long in coming. But, fruit fell into the hands of Congressional leadership to make them feel good about taking a summer vacation that is most undeserved. The President will have some new resources to fuel his newly appointed VA chief and all of that should result in improvements for Vets that include their getting more timely healthcare that will save their lives from premature death.
The obvious part of the solution includes allowing Veterans to used private care when the VA is overloaded. In a story published earlier on this subject, the question was raised about the justification for a special veterans agency instead of just mainstreaming Vets for healthcare to which all Americans have access?
With the Affordable Healthcare Law and national standards for healthcare, why not have everyone who needs it use the same system that is run by private healthcare providers and administered under one system.
Congress has had a hard time understanding that approach. Maybe, it is because the fruit was too green and high in the trees, or something.
There are necessary fixes to the Affordable Care Law that are visibly low hanging fruit.
Stuart Butler at JAMA proposed a State-Led Strategy to fixing the Affordable Care Act. Since healthcare in America remains a distributed system that is dependent upon dispersed healthcare operations, his approach makes common sense. It brings the solution branches closer to earth and by the time Congress gets settled again, maybe the fruit will ripen for easier picking.
“A State-Led Strategy
This state-led strategy involves 3 basic steps.
First, there would need to be a default baseline for total federal, state, and private spending within each state against which future spending could be compared, much as welfare reform (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996) was established to calculate savings from state action. With modest improvements and additional resources, the Centers for Medicare and Medicaid Services’ state level estimates would be sufficient as a baseline.
Second, a state-led commission of stakeholders would negotiate with Washington for federal administrative and possibly statutory changes that would apply within the state to achieve the stakeholder proposal developed at the state level.
Third, the state-federal negotiation would also focus on how savings would be shared between each sector within the state, including the federal government. The agreement would establish procedures for identifying and calculating savings.
States already seem willing to take the initiative in advancing cost control. For instance, just this January, Nebraskalaunched a Medicaid medical home pilot that grew out of a state-sponsored council of private and public stakeholders. Virginia also has a vibrant public-private stakeholder center to promote innovation and efficiency. Maryland has for for many years used a state commission, with several private stakeholders, to negotiate state-wide regulations and initiatives in an effort to slow costs and boost efficiency. And the first recommendation of the State Health Care Cost Containment Commission calls on states to create alliances of stakeholders to lead change.
The Hill provides the story.
“Senate passes VA overhaul in 91-3 vote
By Martin Matishak and Ramsey Cox
The Senate on Thursday easily adopted a $17 billion bill meant to revamp the troubled Veterans Affairs (VA) Department.
Senators voted 91-3 in favor of a conference agreement that provides $10 billion in funding to pay for veterans to get healthcare at private facilities and another $5 billion to allow the VA to hire more doctors, nurses and other medical staff.
The House backed the proposal in a 420-5 vote on Wednesday. The bill now goes to President Obama for his signature.