What is the long term solution to the Problem with the VA Medical Care System?
Before I begin to give you my answer – in case you don’t know me personally – let me give you my qualifications to have an opinion. I served in the US Army from 1968 to 1970 and spent one year of that in the Infantry in Vietnam as a Platoon Sergeant – did a classified long range patrol in Cambodia observing the Ho Chi Min Trail and was on one of the first birds in the Cambodia Invasion. I was awarded the Bronze Star, Bronze Star with Oak Leaf Cluster, Air Medal, ARCOM, RVN Service, Campaign & Civil Action Medals, CIB and Purple Heart. By definition I am a “Combat Wounded Veteran” and have Partial Disability status with the VA and receive the grand sum of $101 per month. I am a Card Carrying Member of the Department of Veterans Affairs.
When my wife Marty and I lived in Chicago I regularly visited the Quadriplegic Ward at West Side VA with my local VFW Troop. As a retiree in Florida we serve as volunteers for Christ Fellowship Church calling on people in the local hospitals and in particular the Riviera Beach VA Hospital and Nursing Home – which is among the VA Hospitals mentioned in the press coverage of this issue.
Over the years we have known some of the very best and caring VA Medical Professionals you will meet anywhere. We have a very close friend who was Chief of Oncological Surgery at West Side VA in Chicago and a life long friend who is an Internist in a Regional Outpatient Clinic in New Jersey.
All that said is there a problem in the VA Medical System? Of course there is! Should the Head Man have been fired? Absolutely! When a company fails to serve its customers and its systems are broken the leadership has to be changed. If an investigation by the Administration or Congress or any legitimate body turns up specific departments and or individuals who falsified documents to cover up the failure to serve our Vets – should those Department Heads and the individuals named be fired? You bet your Purple Hearts on it!
Will The President and or Congress’s preening and strutting in front of any available camera – giving “face” and talking in serious tones about what we owe our Veterans really make any long term difference? I doubt it very much.
Do I favor the Bills I have read about being served up in Congress to increase eligibility and services which will add Billions of Dollars to our annual budget? NO I do not!
WHAT? How could a Veteran be against increasing care for Veterans?
This is my thesis. Supply and Demand – almost all of life comes down to supply and demand.
If we have learned nothing in the past decades surely we know that our “supply” is not unending.
First – Supply. There are limitations as to what our Nation can spend – though the Special Interest Groups and Liberals among us seem to have missed this message.
Second – Demand. My perception, therefore my reality is there is too much demand for VA Medical Services! Have I completely lost my mind? Do we not owe a debt of gratitude to our Veterans? Yes, of course we do. However, it’s also my perception that we have offered full medical services to too many men and women who have served in the U.S. Military Services – safely at home stateside who do not fit the profile of the Combat Wounded Veteran that we see on the news and know from our personal encounters has physical and emotional and mental scars from COMBAT that really, really needs our help.
Yet when a WWII, Korean War, Vietnam, Iraq or Afghanistan Combat Veteran goes to his local VA for medical or psychological services he stands in line behind men and women who served two years training and possibly training others here in the good old USA five, twenty five or fifty years ago. Please hear this: 90% of the services provided by the VA are to men and women (mostly men) who never served in a combat zone and whose medical needs have absolutely nothing – nothing at all to do with their military service.
Please allow me to repeat what I feel is a key point we need to at least think about and discuss publicly. Fully ninety percent of the “demand” for VA Medical Services is not related in any way, what so ever to service related issues.
Like it or not, the VA Medical System that we have today has become another poorly run social transfer payments system.
What do I propose?
First and foremost – anyone who “qualifies” at present from prior Military Service will continue to receive the VA Medical Benefits they were promised. I am not suggesting that we break our promises to the men and women who served state side and or just off the shore line of America of the benefits we promised them. Benefits that 90% of the time are not at all related to their Military Service.
However, going forward I propose that we begin a National Dialogue about creating various classes of “Veterans” and prioritizing who will be guaranteed full VA Medical services and scale it back from there.
What is my starting point or Class I Veterans? Members of all our Military organizations who were deployed to an active combat theater. They would be Class I.
Classes II and III and however many there are and what services they receive could be a part of the Public Debate and Administration/Congressional negotiations.
If you take the time to open the site below – and there are many others like it on Google – it can be seen that:
1. From 1950 to 2,000 there were 118,800,000 active duty military personnel
2. Only 22% of them were stationed “overseas.” Please note this does not mean they were assigned to a combat zone such as Vietnam, Iraq or Afghanistan – just overseas.
If foreign duty assignments that were not in a combat zone were defined as Class II Veterans and they were not given full medical benefits but something less – prescription drugs, emergency care, etc. – the demand for full VA Medical Services would be cut significantly – at least by 78% or approximately 92,600,000 persons going forward.
Think of how much money and demand for full medical services would be saved. This kind of reduction on the demand side would make it more likely for the current “private” medical services industry to absorb the remaining patients with vouchers and or what ever form of payment is decided on – thus lessening the need for an entrenched bureaucratic monstrosity like the VA Medical System we have today.
Finally, please allow me to address an issue that may be raised by some critics of this multi-level system for full VA Medical Care. I do not believe that the loss of full medical benefits would be that great a deterrent to the recruitment of young men and women so long as they are still promised and given things they can more readily relate to now like: training in a specific area of expertise that will assure them of a civilian job when their service is complete – college education assistance – technical school training – etc. What percentage of 18 to 20 year olds are thinking about long term medical care when they get old?
If you are still with me I look forward to hearing your thoughts and comments and especially your ideas on how we can improve the balance between a reasonable amount of supply and seriously needed demand.
Larry
Uncle Larry's Blog 
Larry, this is scary! Your last half is almost a precise duplicate of a memo I prepared at request of Sen. Roberts. So many facts have been totally glossed over. Some things to ponder:
(1) Many veterans are applying for VA cards in order to get a discount from Home Depot, and that’s their ONLY purpose. What “waiting lists” are they found on?
(2) When I see my private enterprise dermatologist, dentist, or primary care doc, I make the next appointment 6 or 12 months hence. If I were getting services from VA, I would show up as being on their list over 90 days waiting for service.
(3) I know of a national guard unit that has been encouraged to apply for VA medical services, so they can be ready, if they ever choose to “actively seek such services.” What lists are they on?
It is so hugely complex and it is being so distorted………….
At end of WW II, we decided returning vets needed education and health assistance. We did not set up a “Veteran University” system. We integrated them into the existing system, and it worked wonderfully. It is a tragedy we did not do the same thing with medical, in my view.
Harold – not only are you better looking than me you attention to detail is unparalleled. Larry
PS: Hi Larry, I sent this to a number of my colleagues, and one would like to know if you have a source citation you could give us for your 90% figure….ie: Please hear this: 90% of the services provided by the VA are to men and women (mostly men) who never served in a combat zone and whose medical needs have absolutely nothing – nothing at all to do with their military service.
http://www.va.gov/healthbenefits/apply/veterans.asp Some more details here.
The metamorphosis of the VA is the same that occurred in Social Security.
I would close 90% of the full service hospitals. Open clinics in some areas. Only those vets who saw active combat service can be seen at a full service VA hospital. Issue vouchers to the non combat vets which would be redeemable in private sector. Change the law to eliminate this abuse.
Of course, this is not going to happen. With base line budgeting all Government agencies grow like malignant cancers which they are. In the private sector bankruptcy cleans up the mess. Not so
for the public sector…….even in Detroit.
I forgot to mention my admiration for Uncle Larry AND his service to this great country.
Harold,
There were three methods I used to come up with the 90%.
The first relates to the number of military personnel that were assigned to combat zones from 1950 to 2000. I assumed the 22% that served overseas were broken into approximately halves: combat and non combat. If 78% were stateside and 11% were non combat that would leave 89% that were non combat – or approximately 90%. For most of that fifty years there was “peace” and the greater portion of the non stateside assignments were NOT in combat zones. Only during Korea, Vietnam and to a lesser statistical sense Iraq and Afghanistan would there have been a significant assignment in combat zones. When I say to a lessor statistical sense I do not mean to denigrate in any way those who served in Iraq and Afghanistan. Its simply a matter of math. The amount of soldiers in the Middle East wars is significantly less than Korea and Vietnam and of course peace time. Thus I logically conclude my 90% number is conservative and could be higher.
Another approach I took was to ask my friend who was the Chief of Oncology at West Side VA about the % of cases that he treated over the years. He was seeing people with cancer which were more than 90% non service related. Please bear in mind when I make the second statement that 90% of all medical services are not service related it may seem high but the amount of years that these ex-military people live far surpasses the amount of time they served in the Military. Hence – logically most of their sicknesses, cancers, accidents, general surgeries, etc. are going to be AFTER they are out of the military.
If I had to bet by own money I would wager that far more than 90% are not combat related just based on the increasing health issues as people age.
Finally, in my experience in hospital calling – other than the quadriplegic ward – 100% of the people I call on are in the VA system based on a medical need that arose long after they were discharged and had nothing at all to do with their service exposures.
This brings us to another point of discussion. Should guaranteed VA Medical benefits be for life for any form of medical need or only for needs that can be linked to their Military service.
It seems to me that our present commitment to eligible veterans under the current guidelines FOR LIFE AND IRREGARDLESS WHETHER OR NOT IT IS SERVICE RELATED almost guarantees that the VA system is going to serve as how I defined it earlier – another Government Agency giving out transfer payments.
If you doubt that all you have to do is visit any VA hospital and look for yourself to see that only the poorer Veterans are using the VA system.
People like me who were blessed to return alive and do reasonably well in life have medical coverage, Medicare and Supplement policies and given the opportunity to chose private medical care – most would not dare submit themselves to the long lines and waits at the VA Hospital. Finally, as bad and judgmental as it sounds nor would they want to be waiting with the people who are willing to subject themselves to the system because they have no other option.
I hope this answers your question. If someone has the time and inclination there are countless numbers of sights on Google that give more specific numbers of where Military people were assigned.
Thanks for your interest in moving this conversation forward.
Larry
Richard,
As always we see that you are a wise and discerning individual and I honor myself by being in agreement with you.
Larry