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Prescription for Veterans Hospitals: Real solutions to address patient influx

Veterans march in the 90th Annual Great Neck, Long Island, New York,  Memorial Day Parade.
Veterans march in the 90th Annual Great Neck, Long Island, New York, Memorial Day Parade.© 2014 Karen Rubin/news-photos-features.com

What happened at the Phoenix VA is a tragedy, it deserves an investigation, and an appropriate response.

Unfortunately, it has become a political football, with the loudest voices often the same people who voted against better funding for the Department of Veterans Affairs just three short months ago.

This is grave situation that requires an investigation, and action ... not a partisan witch-hunt.

These aren't my words. These were the words of Jon Soltz of Iraq War Veteran and Chairman of VoteVets.org. He ought to know.

Soltz adds, "In the days and weeks ahead, the Department and Congress will look into what happened in Phoenix and VA facilities around the country. Both have a role to play, but for the sake of our veterans at home, and those who will soon return, the goal should be to determine what happened, who is responsible, and how to fix it - not the easiest way to score political points in an election year."

Earlier this week, VoteVets polled veterans and military family members and out of 3,000 responses, 83% "said Secretary Shinseki should not resign before an investigation determines how these mistakes happened and who is to blame -- it was an even higher percentage for our members who receive VA care.

"The President said directly that anyone found who manipulated or falsified records will be held accountable, and that any additional misconduct will be punished."

He concludes, "Tell Congress a real investigation - not a witch-hunt - is the only way to make those determinations and improve care for future veterans." (http://action.votevets.org/va-investigation)

Republicans, of course, are ecstatic at the state of affairs - I am sure it will be the new "Benghazi" which was the new-old "IRS" and the new old-old "Fast and furious" - and provide fuel for their impeachment effort, while skewering Democrats in the midterms.

But this also gives Republicans a new opportunity to take revenge on General Shinseki for speaking up in 2003 that "hundreds of thousands" of American troops would be needed to secure Iraq, which would not be the "cakewalk", with Americans being treated as "Liberators" festooned with flowers and sweets, and the entire military action paid for out of $8 billion in Iraq oil revenues.

Because what is clear is that Republicans don't actually want to find out the source or nature of the problem because if they did, they may well have been found to be culpable. Because despite a significant increase in funding for Veterans Affairs (begrudgingly by Republicans who wanted to slash funding), it may well be insufficient to meet the needs of a ballooning population of newly minted veterans, fresh home from Afghanistan and Iraq - many of them who never would have survived, but will need treatment for lifelong injuries - along with aging populations of Korean and Vietnam War veterans. Each day, 10,000 Baby Boomers reach retirement age.

Preliminary reports from the Inspector General suggest that the Phoenix hospital fudged the numbers - didn't start the 14-day clock until the patient was entered into the system for an appointment - and the real wait time was around 154 days. What is more, this practice was used in other hospitals as well. That is despicable - people should not just be fired, but prosecuted, especially since it seems that being able to collect bonus pay may have been part of the motivation.

"It is critical to make sure that we have good information in order to make good decisions," President Obama said during a press conference. "I want people on the front lines, if there's a problem, to tell me or tell Ric Shinseki or tell whoever's their superior, that this is a problem. Don't cover up a problem. Do not pretend the problem doesn't exist. If you can't get wait times down to 14 days right now, I want you to let folks up the chain know so that we can solve the problem. Do we need more doctors? Do we need a new system in order to make sure that scheduling and coordination is more effective and more smooth? Is there more follow- up?

"That's the thing that right now most disturbs me about the report: the possibility that folks intentionally withheld information that would have helped us fix a problem. Because there's not a problem out there that's not fixable. It can't always be fixed as quickly as everybody would like, but typically we can chip away at these problems. We've seen this with the backlog. We've seen it with veterans' homelessness. We've seen it with the Post-9/11 GI Bill. Initially there were problems with it."

I have no reason to believe that this administration, which has done more for veterans and military family than any administration since Eisenhower, would intentionally harm veterans. In fact, Obama secured record funding for Veterans Affairs, including a New GI Bill (already helping 1 million veterans get a college education), at a time when Republicans have made it clear they want to eviscerate the social safety net, taking no prisoners, including veterans - 170,000 of whom lost food stamps; 258,000 of them have lost out on Medicaid in the 21 states where Republicans have refused to accept expanded Medicaid.

The question that should be asked is whether the funding was ever adequate to meet the ballooning challenges facing the Veterans health system in face of the onslaught of soldiers returning from America's longest wars, and aging of veterans of prior wars requiring more assistance.

Indeed, these problems seem to stretch back for decades and over many administrations. The central problem here seems to be that the Obama Administration instituted a mandate that appointments be made within 14 days. that sounds almost impossible, and apparently incentivized administrators to fudge results (just like No Child Left Behind turned principals and teachers into criminals, fudging test results).

The Veterans health care system - the only truly socialized medicine this country offers - serves nearly 9 million veterans - that works out to 85 million appointments scheduled among veterans during the course of a year.

"That's a lot of appointments," Obama said. And that means that we've got to have a system that is build in order to be able to take those folks in in a smooth fashion, that they know what to expect, that it's reliable, and it means that the VA has got to set standards that it can meet. And if it can't meet them right now, then it's going to have to set realistic goals about how they improve the system overall."

Unlike prior Administrations who claimed to love the troops until they returned as veterans wanting to claim their benefits, the Obama Administration has been aggressive in helping veterans and military families overcome the real challenges they face.

You only have to look at the Joining Forces campaign and other efforts to facilitate hiring for returning veterans and for military families; the crusade to reduce homelessness and suicide rates among veterans, all that has been done to improve the transition to civilian life, including bringing together all the federal agencies which have potential to touch veterans' lives (the Department of Agriculture even created a program to help veterans who want to do farming); to incentivize private enterprise to give veterans preference in hiring, to get a New GI Bill.

And yes, Obama came into office with a priority to address the unconscionable backlog that kept veterans from receiving their proper benefits for years. By all accounts, that issue has been cut significantly - averaging 154 days - though still too long.

Does it make sense that this Administration would deliberately withhold medical care?

Let's consider what is more logical: the fact that the system is overwhelmed with a vast increase in veterans using the system, or that there is some deliberate conspiracy to deny medical care.

One million men and women have served Afghanistan and Iraq, two of America's longest wars which are now winding down.

The fact that so many more troops wounded on the battlefields of Afghanistan and Iraq actually live through their injuries - coming home with amputated limbs that require a lifetime of prosthetics and physical therapy; burns; and brain trauma.

And one in five is estimated to suffer from PTSD - I can fully understand why - these were wars like no other, and the atrocities seen, perhaps committed, perhaps suffered, take their toll. The percentage of VA patients with a mental illness was 15 percent in 2007 and has trended up. The VHA allocated an extra $1.4 billion per year to mental health program between 2005 and 2008. Was that enough?

America is looking at a $1 trillion medical bill, at least, just to take care of these veterans for the rest of their lives.

Veterans hospitals only used to provide care for service-related medical issues, but when Clinton failed to get universal health care, his administration opened up VA facilities to primary care, as well. As a result, the percentage of patients receiving primary care at the VA increased from 38 percent in 1993 to 45 percent in 1996 to 95 percent by 1999.

Opening eligibility to those who suffered impacts of Agent Orange expanded use by 2 million veterans.

The VA scores well as a health provider based on multiple studies including a RAND Corporation study in 2004; a 2009 Congressional Budget Office report, and a Harvard Medical School-led study.

Indeed, the Veterans health system is as good, or better than the "civilian" (privatized) health care system.

And if Republicans use this opportunity (as is likely) to rail against Big Government and call for privatization of the Veterans health system (the only truly socialized medicine this country has), that would be a grotesque mistake, on par with voucherizing Medicare and giving Social Security funds to Wall Street.

You want to talk about wait times? Try getting a doctor's appointment in Boynton Beach, Florida, if you haven't purchased a VIP program with a doctor (at $1500 a year), just to have your phone call returned. As for fraud perpetrated by private-sector medical doctors and clinics, you only have to open up the newspapers. This is more an issue of "human nature" than "Big Government."

I have no doubt that the Obama Administration will seize on whatever problems are exposed at the Veterans hospitals.

"First, anybody found to have manipulated or falsified records at VA facilities has to be held accountable," Obama said. "The inspector general at the VA has launched investigations into the Phoenix VA and other facilities, and some individuals have already been put on administrative leave. I know that people are angry and want swift reckoning. I sympathize with that. But we have to let the investigators do their job and get to the bottom of what happened. Our veterans deserve to know the facts. Their families deserve to know the facts. Once we know the facts, I assure you if there is misconduct it will be punished."

He emphasized that he needs to understand the full scope of the problem, so is reviewing the Veterans Health Administration.

"Keep in mind, though, even if we had not heard reports out of this Phoenix facility or other facilities, we all know that it often takes too long for veterans to get the care that they need.

"That's not a new development. It's been a problem for decades, and it's been compounded by more than a decade of war. That's why when I came into office, I said we would systematically work to fix these problems, and we have been working really hard to address them."

"I want to know what's working, I want to know what is not working, and I want specific recommendations on how VA can up their game...

As for Congress, he said, "I expect everyone involved to work with Congress, which has an important oversight role to play. And I welcome Congress as a partner in our efforts, not just to address the current controversies, but to make sure we're doing right by our veterans across the board. I served on the Veterans Affairs Committee when I was in the Senate, and it was one of the proudest pieces of business that I did in the legislature. And I know the folks over there care deeply about our veterans.

"It is important that our veterans don't become another political football, especially when so many of them are receiving care right now. This is an area where Democrats and Republicans should always be working together, which brings me to my final point. Even as we get to the bottom of what happened at Phoenix and other facilities, all of us, whether here in Washington or all across the country, have to stay focused on the larger mission, which is upholding our sacred trust to all of our veterans, bringing the VA system into the 21st century, which is not an easy task."

And like the crocodile tears over the people who were dumped by their insurance companies, me thinks the Republicans protest too much over people dying for lack of access to health care. Otherwise, they would not be so cavalier about 5.7 million people being cut off from Medicaid, including 258,000 veterans.

It is estimated that out of these 5.7 million people, 17,000 of them will die each year for lack of access to medical care.

That strikes me as more than the 40 or so who are claimed by their loved ones to have died because they did not get an appointment early enough.

And where was the Congressional oversight, when you know that Darrell Issa is just itching for anything to investigate? Too obsessed about fast and Furious, IRS and Benghazi to delve into this? Is it believable that constituents did not complain to their Congressmen, especially in Arizona? Maybe they should subpoena requests for help from Senator McCain to see who knew what, when?

The difference between the Obama Administration and all the rest is that Obama, now that he is aware of the problem, will in fact address the problems and come up with a solution.

And that solution may mean hiring more doctors, perhaps physicians assistants and registered nurses - various health care professionals, perhaps opening up new facilities, or obtaining new technology and equipment. Which costs money.

But when if it comes down to money, I wonder where the Republicans will be, since they have been missing in action on every other proposal aimed at making lives better for veterans, from jobs creation to social services.

It is very much like Benghazi, where Republicans had as much culpability as anyone for not providing adequate funding for security at US missions around the world, forcing the State Department to scrimp.

The problems that veterans are experiencing in getting adequate health care must be resolved, but so should the problems of accessing health care for everyone.

There is a shortfall of medical personnel throughout our medical system - people are living longer (largely because of the availability of Medicare and now, with wider access to medical insurance), the demographics are bubbling with Baby Boomers who are reaching retirement age at the rate of 10,000 each day.

Why is the death of an 80-year old veteran who did not have proper access to medical care more tragic than the death of Charlene Dill, a struggling, 32-year-old mother of three who collapsed and died for lack of access to medical care, because Florida Governor Rick Scott has refused to expand Medicaid?

This is a crisis not just for veterans, but everyone, and needs to be addressed in a meaningful way.

Karen Rubin, Long Island Populist Examiner
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