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" V.A. has a systemic, totally unacceptable lack of integrity"
May 30, 2014 11:02 AM   Subscribe

This morning, the Veterans Affairs Chief Eric Shinseki tendered his resignation, following the release of an independent review detailing corruption in the reporting of wait times and scheduling practices, along with alleged patient deaths in the Phoenix Health Care system.

Vox: Eric Shinseki deserved to be fired for the VA scandal and The VA scandal, explained

Wonkette: Eric Shinseki resigned this morning as Secretary of Veterans Affairs, so all the problems at the V.A. are probably fixed; expect his replacement to be unacceptable to Senate Republicans, or for wingnuts to call for Barack Hussein Obama himself to step down, or at the very least to tell the truth about Benghazi and repeal Obamacare.

Department of Veterans Affairs Fast Facts
posted by roomthreeseventeen (115 comments total) 22 users marked this as a favorite

 
On a related note, Jay Carney, White House Press Secretary announced his resignation this morning.
posted by zachlipton at 11:14 AM on May 30 [1 favorite]


. For those who died awaiting care
posted by angrycat at 11:17 AM on May 30 [8 favorites]


On a related note

Or not.
posted by zombieflanders at 11:17 AM on May 30 [2 favorites]


Stone Kettle Station has a must read about the VA situation.
posted by ocschwar at 11:19 AM on May 30 [12 favorites]


Paul Waldman: A Few Things to Keep In Mind About the V.A.
* This scandal isn't about the quality of care. While there are surely some veterans who have gotten poor care, just as there are plenty of patients at private hospitals who get poor care, the V.A. actually has an excellent record on this score. Surveys consistently show most veterans are extremely satisfied with the care they get at V.A. facilities, often more so than private insurance customers. And independent studies from places like the RAND Corporation have found that patients have outcomes as good or better at the V.A. as in private care. The problem around which this scandal revolves is how long vets have to wait to see a doctor, not what happens once they get there.

This is an important distinction to make, because there are going to be conservatives saying, "See? Socialized medicine doesn't work!" And it's true that the V.A. is indeed socialized medicine, much like what you have in Britain—veterans are insured by the government and get care at government-run facilities with medical professionals who are government employees. But what we're talking about now, in terms of the scandal, isn't so much socialized medicine, or really medicine at all, it's the agency's difficulties in moving vets through the system.

* The problems go back decades, but are particularly acute now. The Obama administration's task has been like trying to repair a leaky boat while simultaneously bailing out the water that keeps flooding in. They have made strides in updating an antiquated paper-based system for processing veterans' disability claims, but those claims keep pouring in at a rate of a million a year, driven by the large number of veterans of Afghanistan and Iraq, and by some policy changes the administration has made to make it possible for more vets to get benefits. So while backlogs and wait times have been reduced, they're still incredibly long.

* The V.A.'s budget has gone up significantly. Using the White House budget's historical tables (How do I love thee, historical tables? Let me count the ways…), I charted the V.A.'s budget. As you can see, the department's spending went up dramatically in the last few years:
posted by zombieflanders at 11:21 AM on May 30 [17 favorites]


Kevin Drum: The VA Scandal Is Bad, But Don't Make It Benghazi 2.0
I'd like to offer a few quick bullet points that anyone writing about the VHA should at least be aware of. Here they are:

* During the Clinton administration, the performance of the VHA was revolutionized under Kenneth Kizer. The old VHA of Born on the 4th of July fame was turned into a top-notch health care provider that garnered great reviews from vets and bipartisan praise on Capitol Hill. The best account of this is Phil Longman's 2005 article, "Best Care Anywhere."

* In 1999, Republicans decided to play dumb political games with Kizer's reappointment. Eventually, with the handwriting on the wall, he chose to leave the VHA.

* Under the Bush administration, some of the VHA's old problems started to re-emerge, most likely because it no longer had either presidential attention or a great administrator. As early as 2002—before the Afghanistan and Iraq wars made things even worse—claims-processing time skyrocketed from 166 days to 224 days.

* Under the Obama administration, the patient load of the VHA has increased by over a million. Partly this is because of the large number of combat vets returning from the Afghanistan and Iraq wars, and partly it's because Obama kept his promise to expand access to the VHA.

* It was inevitable that this would increase wait times, and the VHA's claims backlog did indeed increase during the first three years of Obama's presidency. Over the past couple of years, however, wait times have shrunk dramatically. A digital claims system has finally been put in place, and the claims backlog today is less than half what it was at the beginning of 2013.

* What's more, despite its backlog problems, the VHA still gets high marks from vets. Overall, satisfaction with VHA care is higher than satisfaction with civilian hospitals.

* The most sensational charge against the VHA is that 40 or more vets died while they were waiting for appointments at the VA facilities in Phoenix. But so far there's no evidence of that. The inspector general investigating the VHA testified last week that of the 17 cases they've looked at so far, they haven't found any incidents of a patient death caused by excessive wait times.

* In February, Republicans killed a bill that would have funded two dozen new medical centers. "I thought that maybe, just on this issue, this Senate could come together and do the right thing for our veterans," said Sen. Bernie Sanders. Nope.

Finally, it's important to distinguish between complaints about medical care and complaints about access to the VHA system. There are lots of complaints about the latter, partly because the rules about who's eligible for VA coverage are fairly complex. Both of these things are fair game, but they shouldn't be confused. They have different causes and different repercussions.

None of this is really meant to exonerate the Obama administration from whatever faults the VHA still has. He's been president for more than five years, after all. At the same time, the VHA has had a lot of problems for a long time, and their origins span parties, administrations and branches of government. Obama may deserve to get knocked around for not doing more to fix them, but he also deserves credit for finally making significant progress on issues that have festered for decades.
posted by zombieflanders at 11:24 AM on May 30 [45 favorites]


Two years ago the Center for Investigative Reporting was talking about this. They even had a map of the worst backlogs in the system. And Phoenix wasn't anywhere close to being at the top of that list.
posted by zarq at 11:27 AM on May 30 [2 favorites]


New Yorker: A Tough Report On The VA Waiting List Scandal
“Enlistment” is the word that we use for joining the military. You are entered onto a list; you put your name down. And much of the experience of the military is described by movement from one list to another—for a platoon, a deployment, or honors. When a soldier is killed, part of the memorial can be a final roll call—a last, ritual calling of the name of the dead along with those in the unit who survived. These are public lists: the most public of all are the monuments on which the names of the war dead are inscribed, for everyone to read.

That gets to the emotional heart of the Veterans Affairs scandal: at a V.A. hospital in Phoenix, veterans were not put on the lists for appointments where they belonged. They were shunted off to a secret waiting list, one that was a lie. The hospital did this to hide how long it was making patients wait for care. It blotted out their names and their needs; it struck them, dishonorably, from the rolls.
posted by the man of twists and turns at 11:32 AM on May 30 [3 favorites]


On a related note, Jay Carney, White House Press Secretary announced his resignation this morning.

Actually, Obama came in and interrupted Carney in the middle of a press conference and said, "I will continue to rely on him as a friend, an adviser after he leaves to spend as much of his summer as he can with his kids before he decides what's next for him." In other words, "Jay didn't plan on leaving beforehand." So I'm not really sure that the term "resignation" is the accurate one here.
posted by The 10th Regiment of Foot at 11:33 AM on May 30 [1 favorite]


This scandal isn't about the quality of care.

This is an unbelievably disingenuous statement. Please explain to me how the timeliness of the care given is not a factor in the quality of care, because I'd love to understand the mental gymnastics required to conclude that.
posted by tocts at 11:33 AM on May 30 [9 favorites]


Oh, man. My facebook feed has been literally blowing up over this. Suffice it to say that veterans have some really, really strong opinions on this subject, both pro and con.
posted by corb at 11:36 AM on May 30


Shitty or too-little-too-late care for our veterans seems like the natural consequence of short-sighted decisions to unnecessarily engage our nation in military conflict. The problem with our VA would surely be lesser in magnitude had we had fewer combat veterans.
posted by MoonOrb at 11:39 AM on May 30 [7 favorites]


IAVA's statement on the resignation.
posted by corb at 11:39 AM on May 30


Under the Obama administration, the patient load of the VHA has increased by over a million. Partly this is because of the large number of combat vets returning from the Afghanistan and Iraq wars, and partly it's because Obama kept his promise to expand access to the VHA.

And with the aging population of vets who are just now seeking services, more in part from old age than from service-related injuries.


Phoenix wasn't anywhere close to being at the top of that list.

From what I've heard, the outrage around Phoenix was because of the secret waiting list that was kept to the reported waitlist down closer to the 14 day timeframe in the VA guidelines, which resulted in employee bonuses. In short: people benefited financially from cooking the books.

The real problem is that the 14 day guideline is ridiculous, given the huge influx of veterans, and the limited size of the VA system.
posted by filthy light thief at 11:40 AM on May 30 [1 favorite]


That Wonkette article ended on one of the unexpected-but-awesome valedictions they do so well:
And so let’s pour out a 40 for Eric Shinseki, and acknowledge that he actually did get a lot of things fixed at the V.A. at a time when it was overwhelmed with new waves of veterans injured in our two off-budget wars. To Yr. Wonkette, Shinseki will always be a hero for speaking the truth about the number of troops that would be needed to keep postwar Iraq under control, for which realistic estimate he was mocked and quickly removed by the Bush-Cheney crowd. He was a straight shooter then, and he’s been a straight shooter at the V.A., where he faced a far larger mess, and was actually starting to make progress when the latest dysfunction erupted.
Too bad that'll all get ignored now that he's been "disgraced."
posted by psoas at 11:41 AM on May 30 [28 favorites]


Another really powerful post about this situation, which also notes how much of it pre-dates Shinseki:
Now after more than a decade of war, after many decades of endless lines and endless bean-counters and endless delays and endless waits and endless lost records and the endlessly misplaced paperwork and the endless institutionalized incompetence and the endless excuses and the endless unending VA shuffle, now you’re upset?

After five years of an intransigent, deadlocked, do-nothing Congress who’d rather chase hysterical manufactured conspiracies and beat their fleshy chests in faux-patriotic fever, who’ll enthusiastically fork over hundreds of billions for fancy new jets and ships and tanks so long as that hardware is manufactured in their own districts, who drive past homeless needy vets every single day, and gleefully refuse to pass a veterans jobs bill or to fully fund veterans services in their own districts or any other, after five years of this capering self-serving congressional bullshit, now you’re pissed off?

Now you want blood?

Now you want an accounting?

Now?
posted by corb at 11:43 AM on May 30 [34 favorites]


Because, as has been pointed out, the VA has improved immensely on care throughout the Obama administration. The issues that they are dealing with are:

*A massive influx of new patients, courtesy of Bush's follies in the Middle East; and
*A continual underfunding of the VA by Congress (read: the GOP), which then causes understaffing and lack of supplies.

So it's only about care in the broadest sense. The real issue is that we have a political party that sees soldiers as a disposable asset for the accrual of wealth to the elite - see the VFW response to Bob Barr when he tried to shame them into backing his push to have Shinseki removed.
posted by NoxAeternum at 11:43 AM on May 30


Shitty or too-little-too-late care for our veterans seems like the natural consequence of short-sighted decisions to unnecessarily engage our nation in military conflict.

I do see a lot of magnets on cars telling people to support the troops. Surely that profound and not-self-righteous action has resulted in improved medical care for people who are actually in the military!
posted by Mrs. Pterodactyl at 11:43 AM on May 30 [9 favorites]


Actually, Obama came in and interrupted Carney in the middle of a press conference

It's kind of amusing to watch, at 6:10 in the video here.
posted by kiltedtaco at 11:44 AM on May 30 [2 favorites]


I am a medical professional who regularly interacts with VA staff in VA facilities.

Quality of care is atrocious. Patients are left in their own filth. Medications are simply not administered. Nurses take "lunch breaks" in which they disappear for hours.

Let's not turn this into Republican vs. Democrat. This is not a referendum on Obama or government-run medicine.

The VA is awful, people knew it was awful, and nothing was done. Heads need to roll for that, regardless of who you vote for.
posted by Avenger at 11:45 AM on May 30 [15 favorites]


SUPPORT THE TROOPS JUST NOT WITH MY TAXES
posted by benzenedream at 11:46 AM on May 30 [23 favorites]


Bernie Sanders Terrifies Republicans By Pointing Out We Have a War, Not a VA Problem
Towards the end of the interview with Andrea Mitchell, Sen. Sanders said, “The bottom line here, I would hope that as a country, is that we fully understand the cost of war. And Andrea let me tell you, I think many people do not. We’re not just talking about the thousands of people who died in Iraq and Afghanistan. We’re talking about 200,000 men and women who came home with PTSD and TBI. We’re talking about people who came home without legs, without arms, without hearing, and without eyesight, and if this country stands for anything, what we have got to say is that we are going to provide adequate funding to make sure that every person who is entitled to those healthcare services gets the best healthcare they can and they get it in a timely manner.”
posted by audi alteram partem at 11:47 AM on May 30 [20 favorites]


I don't understand how we can't have both a war problem and a VA problem.
posted by roomthreeseventeen at 11:48 AM on May 30 [1 favorite]


Someone educate me...why the VA system at all ? Why not have veterans on something like Medicaid or Medicare? Isn't a separate system of hospitals kind of redundant?
posted by ian1977 at 11:50 AM on May 30 [1 favorite]


But what we're talking about now, in terms of the scandal, isn't so much socialized medicine, or really medicine at all, it's the agency's difficulties in moving vets through the system.

I think I get what this quote is trying to say, but it's disingenuous at best. One of the frequent allegations leveled at socialized medicine—which the VA is, only it's limited to a specific population—is wait times. I don't think that many wingnuts really think that the quality of care under socialized systems is that different (well, some surely do, but they're morons), the argument is always over the wait time to see a doctor or get something treated. So I'd expect the V.A. scandal to feed into that.

I don't think you can get around that, nor should anyone; the way out is through, in the sense of fixing the problem and proving that the V.A. system works and that the U.S. has in it an example of a functional, socialized single-payer healthcare system. Otherwise it's always going to be an example of "it can't work here."
posted by Kadin2048 at 11:50 AM on May 30


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.
posted by Renoroc at 11:50 AM on May 30


“The first time I heard it was actually at my desk. They said, ‘You gotta zero out the date. The wait time has to be zeroed out,’ ” Turner recalled in a phone interview. He said “zeroing out” was a trick to fool the VA’s own accountability system, which the bosses up in Washington used to monitor how long patients waited to see the doctor.
posted by roomthreeseventeen at 11:53 AM on May 30


Having the VA as a separate system is actually really useful for veterans - it allows providers to be specialized at the things that veterans most often face, and enables that providers are conversant with the population easily. It also provides a one-stop-shop for a lot of other services for veterans - the DAV has an office there, as does the Legion/VFW, the Dod/Tricare, and many others. It also tends to serve as a gathering place and place for individuals to find community. It's a really good idea, but it is certainly overtaxed by the amount of wounded warriors currently coming home right now, which were somehow never included in the war planning.
posted by corb at 11:53 AM on May 30 [12 favorites]


I spend about half of my working time at a VA hospital that is widely regarded to be one of the best in the country, mostly on the inpatient side. It's by no means a perfect system, but when I compare it to my two other hospitals, it is the best hospital that I work in. I don't have any sort of administrative authority that would make me privy to information about secret waiting lists and the like, so I can't comment on that in particular. I find this very troubling, but not at all surprising given the working conditions at even our very good VA.

We are problematically understaffed, all year round. The VA budget is based on how many vets are in the service network, which works better for places where the population is consistent year-round. Our population of veterans almost doubles during the winter months. It becomes miserably busy during this time, and it's very difficult to attract the best attending physicians to our facility because they can make more money as permanent staff almost anywhere else. So, we are constantly under an emergency hiring protocol, which allows us to hire temporary locus tenens physicians at much higher rates (but they all leave after 3-6 months). It took the better part of 18 months to get another gastroenterologist hired to relieve the backup of colonoscopies and endoscopies. Lately, we seem to end up with permanent staff who come because their spouse was hired at another hospital and this was where they could get hired.

It's not an efficient system. On the days when the ED is particularly busy, everybody gets admitted, whether there is an indication or not. Sometimes, it takes days to get your patient non-critical imaging. Lots of labs are send-outs and take days or weeks to result. But efficiency is not always a bad thing, when so often patients are admitted and barely treated before they are discharged to continue their recovery at home. In a system where a huge proportion of the population is homeless, has a substance abuse problem, or has another social need, those extra days are valuable in making sure that patients are adequately treated, and have access to the services that they need. And, because you don't have to worry about a payor source, you can get almost everyone a safe and appropriate discharge (unlike some other hospitals where I've worked, where uninsured patients get a cab voucher and a phone number of a place where they can get sliding scale medical care). With the help of our excellent case managers and social workers, I've been able to get homeless patients into shelters with safe places to store their medications. I was able to get another patient an air conditioner installed when he showed up because it was 112 degrees outside and he had no access to AC.

Something that people often don't realize is that not every VA hospital can perform every service. It doesn't make sense to run a transplant center out of a VA hospital when there is often a large teaching hospital nearby that has well-trained, well-paid experts. There are only two VA bone marrow transplant centers in the country. We actually take a fair number of transferred patients from Phoenix because they don't offer certain types of surgery. Even under the best conditions, though, non emergent care can take a long time to coordinate because those kinds of specialty services take beds at the other hospitals, which often need to be filled by their own acute care patients.

All that being said, it's a pleasure and an honor to take care of the veterans. They are typically very appreciative of the care that they get at the VA. The staff is typically very motivated to take excellent care of their patients, even though they are working in nursing ratios that are often much higher than they would be at any other facility. You can get medical records back from as far as 1998, from all over the country, at the touch of a button, without worrying about faxes back and forth. It's going to take a lot of work to restore faith in the system, but I really do think that when it works, it is capable of giving some of the best care available in this country.
posted by honeybee413 at 11:54 AM on May 30 [45 favorites]


Quality of care is atrocious.

Only inasmuch as health care in the US is atrocious in general. Multiple surveys of veterans and third party health outcome reports rank it among the best in the country, as low a bar as that may be. I'm sure you've seen some awful stuff, but that doesn't say anything about the system in general.

I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.

Except for the part where it almost always is? The VHA, along with Medicare and Medicaid, beat private healthcare in almost every metric, including fraud/waste/abuse. The problems with bureaucracy wouldn't necessarily be solved by privatization.
posted by zombieflanders at 11:55 AM on May 30 [27 favorites]


Oh, man. My facebook feed has been literally blowing up over this.

You may need to go to the Genius Bar.
posted by shakespeherian at 11:55 AM on May 30 [3 favorites]


There's also the fact that the VA deals with veterans from separation to grave, so they tend to be incentivized to look at the long term picture.
posted by NoxAeternum at 11:56 AM on May 30


To Yr. Wonkette, Shinseki will always be a hero for speaking the truth about the number of troops that would be needed to keep postwar Iraq under control, for which realistic estimate he was mocked and quickly removed by the Bush-Cheney crowd.

Mocked, yes. Marginalized, yes. But then-Gen. Shinseki was not removed because of his comments on troop levels. He served a full four years as Chief of Staff. Exactly two officers have served for longer than four years as Chief of Staff of the Army since the position was established in 1903: Douglas MacArthur (five years, 1930-1935) and George Marshall (six years, 1939-1945).
posted by Etrigan at 11:57 AM on May 30 [1 favorite]


It's a really good idea, but it is certainly overtaxed by the amount of wounded warriors currently coming home right now, which were somehow never included in the war planning.

They weren't included because they were ignored. It must be a particularly bitter sort of irony to Shinseki, who was one of the loudest voices to bring this up in said planning.
posted by zombieflanders at 11:59 AM on May 30 [10 favorites]


If you really believe in government-run healthcare, you should be arguing for more accountability, not less.

Also, "the VA ranks higher in surveys!" is not a defense against MRSA. People can be satisfied with atrocious care and still get atrocious care.
posted by Avenger at 12:00 PM on May 30 [2 favorites]


Someone educate me...why the VA system at all ? Why not have veterans on something like Medicaid or Medicare?

The VA was established in 1930, and it replaced/supplemented a system of veterans' homes that dated to 100 years before that. Medicare and Medicaid came along in the 1960s.
posted by Etrigan at 12:00 PM on May 30 [5 favorites]


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.

Well the veterans groups don't want it for one thing. While certain conditions can be treated easily in the private market, the VA has an enormous amount of specialized expertise in dealing with conditions common to veterans. The VA also provides care to a difficult population of homeless patients, who don't tend to get great care for chronic conditions at private facilities.
posted by zachlipton at 12:01 PM on May 30 [12 favorites]


Technically removed, no. But you can bet that Rummy windowseated him.
posted by NoxAeternum at 12:02 PM on May 30


If you really believe in government-run healthcare, you should be arguing for more accountability, not less.

Who here is arguing for less accountability?

Also, "the VA ranks higher in surveys!" is not a defense against MRSA. People can be satisfied with atrocious care and still get atrocious care.

Thus the qualifiers I included about US healthcare being atrocious.
posted by zombieflanders at 12:02 PM on May 30 [2 favorites]


Military folks are long since aware that the only time they are an actual asset is when the barbarians are at the gates. The rest of their service is mostly a wash. But after they retire, especially if they have "issues" or "problems", then it's directly into the credit column as a liability. And nobody likes to pay old debts if they can avoid it. Congress unfortunately can avoid it...
posted by jim in austin at 12:03 PM on May 30 [2 favorites]


Oh, fun fact: the now standard practice of nurses using barcode scanners to verify patient medicines (which has helped drastically cut down on mismedication rates) was developed at the VA, thanks to a recommendation by a VA nurse. Even after the VA adopted the process systemwide after the success of the pilot, it still took years for private hospitals to adopt it.
posted by NoxAeternum at 12:06 PM on May 30 [14 favorites]


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.


yeah just like prisons great idea
posted by entropone at 12:07 PM on May 30 [25 favorites]


FWIW, the VA's computer system is perhaps the best one around for patient care. I would suggest that a lot of our national issues could be resolved by mandating use of a single ehr platform.
posted by mikelieman at 12:08 PM on May 30 [3 favorites]


The VA took care of my father in his last illness. There were things that were deplorable, like the fact that we had to constantly monitor to make sure that his food was correct for his condition or that they would give him liquids when there was a huge sign above his bed saying LIMIT FLUIDS. But I have personally had similar issues with the dietitians sending up the wrong meals in a plush private hospital with all the fixings.

The VA doctors and staff worked tirelessly to fight the disease that was killing him, and thanks to their work I had my daddy for ten years longer than anyone could have expected. I know it's just an anecdote, but I will always, always be grateful that the VA system exists.
posted by winna at 12:09 PM on May 30 [10 favorites]


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.

yeah just like prisons great idea


Yeah, the private sector has been great for american healthcare, just great.
posted by The 10th Regiment of Foot at 12:10 PM on May 30 [14 favorites]


FWIW, the VA's computer system is perhaps the best one around for patient care. I would suggest that a lot of our national issues could be resolved by mandating use of a single ehr platform.

Are they still using MUMPS?
posted by jim in austin at 12:10 PM on May 30 [2 favorites]


Let's also keep in mind that the Electronic Health Records system for the DoD is not combined with the Electronic Health Records system for the VA. Medical data for service members is currently separate from medical data for veterans.

So there's also that infrastructure challenge, too.
posted by oceanjesse at 12:11 PM on May 30


The VA was one of the first groups to really get the power of healthcare IT, mainly because of their mandate. One of the reasons VistA beats the pants off everything else is because it's had a five year head start.
posted by NoxAeternum at 12:12 PM on May 30 [2 favorites]


(Both the DoD and the VA use MUMPS)
posted by oceanjesse at 12:13 PM on May 30


Sadly yes, Jim - the backend of VistA is still MUMPS.

From what I've heard, I'm not sure which is worse - the disease or the language.
posted by NoxAeternum at 12:14 PM on May 30 [2 favorites]


Let's also keep in mind that the Electronic Health Records system for the DoD is not combined with the Electronic Health Records system for the VA. Medical data for service members is currently separate from medical data for veterans.

That is sometimes a feature, not a bug, particularly given the different motivations re diagnosing for various conditions. The DoD is well known to underdiagnose for service-unbefitting conditions, while the VA has no such impetus.
posted by corb at 12:17 PM on May 30


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.

Yeah, the privatized system never fudges numbers, makes people wait, dumps patients they don't want and/or who can't pay, etc. and so on. This is a uselessly stupid "argument."
posted by rtha at 12:20 PM on May 30 [39 favorites]


From what I've heard, I'm not sure which is worse - the disease or the language.

I played around with it several decades ago. A very, very strange environment. Data and macro code stored in the same B+ tree and everything executable and addressable. Never could get my head wrapped fully around it. Fortunately I never had any use for it either...
posted by jim in austin at 12:22 PM on May 30


Shinseki got a raw deal here, but, naturally and as usual, he's done the honorable thing. This truly only increases my admiration for the man.

Here's my two step solution to this problem:
  1. Double the VA budget
  2. Give every veteran of Iraq and Afghanistan who needs it a war pension right now.
posted by ob1quixote at 12:27 PM on May 30 [8 favorites]


ob1quixote, President Barack Obama has increased the Department of Veterans Affairs’ budget each year since he took office, claiming the funds would give veterans the health care they deserve. However, an analysis of records show the agency has spent close to $500 million on office furniture under the Obama administration. Link.
posted by roomthreeseventeen at 12:30 PM on May 30


Eric Shinseki resigned this morning as Secretary of Veterans Affairs, so all the problems at the V.A. are probably fixed; expect his replacement to be unacceptable to Senate Republicans, or for wingnuts to call for Barack Hussein Obama himself to step down, or at the very least to tell the truth about Benghazi and repeal Obamacare.

and expect Democrats to say that congressional Republicans are actually at fault, a Republican President would have been just as bad, that President Obama bears no responsibility at all, that Republicans should be ashamed for starting wars in the first place, and that Republicans should just support socialized medicine for everyone so this doesn't happen again.
posted by Drinky Die at 12:33 PM on May 30


Yes, because the VA has a LOT of offices all over the US, including the facilities that they have been opening. $500M for office furniture over a four year period is actually understandable.
posted by NoxAeternum at 12:34 PM on May 30 [7 favorites]


...or in other words, expect Democrats to say true things.
posted by ROU_Xenophobe at 12:35 PM on May 30 [17 favorites]


Some truth, some obfuscation. Republicans AND Democrats share responsibility for the situations in question and will both deny most all of the responsibility to blame the other side instead. It's your basic partisanship. Not trying to bash Obama here, just thought the Wonkette snippet lacked balance.
posted by Drinky Die at 12:38 PM on May 30 [2 favorites]


However, an analysis of records show the agency has spent close to $500 million on office furniture under the Obama administration.

So should the office workers sit on the floor? The annual budget of the VA is north of $150 billion. ~$100 million per year represents less than 0.1%.

This is a massive, massive organization. And it has offices. That must be furnished.
posted by mr_roboto at 12:38 PM on May 30 [16 favorites]


Let's be clear. Neither Democrats or Republicans give enough of a damn about veterans to pass the funding and legislation they need to get their due. That's why MST survivors still have to prove their own rapes, and the VA thinks retraumatizing them by an invasive and offensive one-time exam with a stranger is a better idea than looking at its own doctors' records. That's why the VA now only counts veterans as homeless when they're actually sleeping on the streets, not when they don't have a place to go and are using friends' floors.
posted by corb at 12:39 PM on May 30 [4 favorites]


This is a massive, massive organization. And it has offices. That must be furnished.

Sure, but did they need NEW furniture? They probably had furniture.
posted by roomthreeseventeen at 12:40 PM on May 30


ob1quixote, President Barack Obama has increased the Department of Veterans Affairs’ budget each year since he took office, claiming the funds would give veterans the health care they deserve. However, an analysis of records show the agency has spent close to $500 million on office furniture under the Obama administration.
[...]
Sure, but did they need NEW furniture? They probably had furniture.


That's something like $300 per office, or one new chair per year.

$500M for office furniture over a five year period is actually understandable.

FTFY

and expect Democrats to say that congressional Republicans are actually at fault

They do consistently block increased funding for the VA.

a Republican President would have been just as bad

Worse, if the Dubya numbers are to be believed.

that President Obama bears no responsibility at all

Hasn't been said. The calls for investigations and Shinseki's resignation have been pretty bipartisan.

that Republicans should be ashamed for starting wars in the first place

They wouldn't exactly be wrong.

that Republicans should just support socialized medicine for everyone so this doesn't happen again

Considering the effectiveness of socialized medicine, this would be great. Sadly, few Democrats actually do say this on a regular basis.
posted by zombieflanders at 12:41 PM on May 30 [5 favorites]


Let's be clear. Neither Democrats or Republicans give enough of a damn about veterans to pass the funding and legislation they need to get their due.

So it was the Democrats who chased Kizer out, let the VHA decay during the aughts, and sabotaged the effort to expand capacity a couple of months ago? No?
posted by Pope Guilty at 12:42 PM on May 30 [8 favorites]


Neither Democrats or Republicans give enough of a damn about veterans to pass the funding and legislation they need to get their due.

This is demonstrably false.
posted by zombieflanders at 12:43 PM on May 30 [4 favorites]


I'll just link a few comments from the last time you tried spreading this particular flavor of fertilizer.
posted by Aizkolari at 12:53 PM on May 30 [8 favorites]


To answer your question, 317, yes for a few reasons:

1. The VA has been opening new facilities, such as telepresence clinics, to deal with both greater need and to apply new technologies to dealing with access issues due to distance. These new facilities need to be furnished.

2. Furniture wears out. It breaks. It becomes unusable. And thus, it needs to be replaced.

In short, to paraphrase a semi-wise lobster, your argument is bad, and you should feel bad.
posted by NoxAeternum at 12:55 PM on May 30 [11 favorites]


From what I've heard, I'm not sure which is worse - the disease or the language.

'M' ( the current incarnation of MUMPS ) isn't too bad. The backend databases used these days ( Cache IIRC ) have some nifty features.

The real showstopper turns out to be the proprietary modules with prohibitive licensing. Medical Imaging isn't trivial, and Intellectual Property is a thing....
posted by mikelieman at 12:55 PM on May 30


ian1977: "Someone educate me...why the VA system at all ? Why not have veterans on something like Medicaid or Medicare? Isn't a separate system of hospitals kind of redundant?"

As a VA-funded research scientist I can tell you the VA is there to specifically deal with the issues facing veterans. The VA also has a very strong research program (clinical and preclinical) dealing with issues of relevance to veteran's health. The benefit to former military personnel is obvious, but the side effect is things like massive funding for prostheses, brain injury, PTSD, obesity, COPD, etc. that directly benefit both Veterans and the general population. The normal hospital system is not set up to cater to these specific issues, in the numbers of patients that will be presenting them. If you look at vets, there are a large number of differences between them and civilians. Take, for instance, the fact that vets start out healthier and in better shape than most civilians, but in general are in worse health than the general population as they get older. Why? We're working on that.

mikelieman: "FWIW, the VA's computer system is perhaps the best one around for patient care."

Maybe. But for us non-clinical people, it's a 1980-something dinosaur, a telnet-based terminal driven program with no instruction manual. We're supposed to use it for everything from room scheduling to work requests to timekeeping, and as far as I can tell, no one (including the local IT help desk) actually knows how it works. (Really. Last time I needed help, the IT person said when they hit problems they just try everything and write down what works, because even they don't have the directions.) The GOOD thing about it is that anyone in any VA anywhere can look up the health history of the patient in front of them.

(Oh and lest I forget, as a VA-funded scientist, any and all opinions I have of the VA are my own, and I do not speak for the organization as a whole. Having said that, the people here work damn hard to help out the veterans, and from what I have seen, the veterans know this and appreciate it. My father in law finally came in to the VA system to deal with his longstanding service-related health issues, and he has been treated with an amazing amount of respect and care.)
posted by caution live frogs at 12:56 PM on May 30 [11 favorites]


P. J. O'Rourke is cited as the the source of the quote "Republicans are the party that says government doesn't work, and then get elected and prove it." But I think that a significant reality is elided there, and it should properly end with "... and then get elected with the specific aim of making certain of it."

Perhaps it crosses party lines to some extent, but of late whenever I see significant failings in some government program I generally look first to deliberate legislative and appointee sabotage for the purpose of privatization, and then try to connect the dots between legislators and campaign contributions and / or crony connections.
posted by George_Spiggott at 12:57 PM on May 30 [16 favorites]


But for us non-clinical people, it's a 1980-something dinosaur, a telnet-based terminal driven program with no instruction manual.

You say that like it's some sort of negative... ( the clinicians get a shiny GUI built in Delphi ( Object Pascal ) IIRC... )
posted by mikelieman at 12:59 PM on May 30


roomthreeseventeen: “However, an analysis of records show the agency has spent close to $500 million on office furniture under the Obama administration.”
You mean 0.37% of the FY13 budget? Over the course of the last six years? Sounds about right. Would you rather that our veterans have to visit dingy offices with decades old furniture so they feel bad about even going in?

I know $500M sounds like a lot of money. If you or I had $500M we'd not only never need to work again, but our families would be set for life for generations. When you're talking about an agency with a budget of $135B, $500M is a rounding error.
posted by ob1quixote at 1:01 PM on May 30 [12 favorites]


roomthreeseventeen: "Sure, but did they need NEW furniture? They probably had furniture."

Yes, we needed new furniture. The lab chairs, for example, were 20-odd-year old cloth-covered things with tears and holes in them when I started in the VA system in 2007. These have since been replaced with new impermeable lab bench chairs. Use of cloth chairs in a lab is a violation of proper lab hygiene standards, because cloth chairs can't be sanitized to stop MRSA and the like.

The VA is not buying Italian leather sofas for pete's sake. They are buying basic items that need to be replaced periodically. They are also furnishing new space for use by new hires.

If it makes you feel any better, my desk is likely older than I am. The chair though, that's new.
posted by caution live frogs at 1:01 PM on May 30 [55 favorites]


Can't we all at least agree we all want a couple of bonus-crazed mid-level bureaucrats to at least have the threat of a little time in the pokey, kind of like what happens for people who falsify their tax returns?
posted by RobotVoodooPower at 1:03 PM on May 30 [1 favorite]


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.

Actually, according to the reports about the "secret waitlist" in order to game the system to get higher bonuses, this is actually directly from the private sector playlist, and something that started in the 1980's due to the big push for privatization under Reagan (and Thatcher in the UK).

One of the theories behind it is to give employees a reward for finding ways to achieve certain pre-decided metrics, list shorter waitlist times, etc, etc. However, later studies of these types of systems has shown that people are more likely to fudge numbers, lie, cheat, and push off doing actual productive work in order to gain access to the rewards. This is especially prevalent when managers are not trained to follow up on the processes that the employees they are supervising are using to achieve these gains. Of course, the people who proposed these incentives based ideas all come back claiming that the managers should be doing more to make sure the workers are performing their jobs correctly, but that's the spherical cow argument all over again. Of course they "should" be doing that, but if they have the same incentives to reach certain unexamined metric goals, they have more of a relevant motivation to make sure those target numbers are reached, consequences be damned.

And of course, this always comes down to bean counters, and the Republican talking point of "everything should be run like a business, as cost effective as possible, blah blah blah".

No. No it should fucking not. That is completely contrary to effective health care, as well as education, research, and many many many other areas of society.

The other relevant thing to consider is that to effectively service several million patients, you need hundreds of thousands of doctors. And in the United States, the number of newly minted doctors is restricted. You want proof? Here's the AMA. Here's a Forbes (blog I think, but still) article about the lobbying by the AMA. Here's a USA Today article about the doctor shortage in the early aughts caused by the lobbying of the AMA to limit the number of doctors educated and certified.

And that's just the start of things to consider about the VA, and the state of health care in the U.S. to begin with. You then have to look at the bureaucratic systems and processes that are mandated by law, as well as the systems and processes created by technological limitations (M.U.M.P.S. being one of the primary ones), and the vested interests of the people who are tasked with the responsibility to deliver the care, but who are not doctors or nurses. And further than that, you have to account for the sunk cost fallacy that every right-wing fiscal conservative is going to blow a bunch of hot air about (like the $500 million spent on office furniture as linked above).

I swear, sometimes people really just want a pat answer to everything. Sadly, reality is not simple and there are not pat answers to solve complicated problems. Throw people into the mix, and it's a wonder anyone gets anything fucking done. And this is why the VA is still better than the private health care system. All of these stumbling blocks and problems, and they still have better outcomes for their patients than every private system in the United States. They also have a much better accountability record than any other system, as they are a part of the government, which is by it's very definition, a system that is accountable to the citizens (or at least that's the theory, anyway), and because of this, it can be much more responsive and held to uphold the tasks for which is was designed. Yes, things got really messed up. But also, under Shinseki, things got a whole hell of a lot better. And because of public inquiry and accountability, things can get even better.

Try getting a private company to do that. I'll be waiting for you at the heat death of the sun.
posted by daq at 1:05 PM on May 30 [31 favorites]


Yeah, look, I have a lot of issues with the VA, but I can tell you that every one I've been in, the furniture is utilitarian even in the higher-ups offices, with the possible exception of psychiatrists offices, which have very comfortable chairs for the already stressed person to sit in. The furniture flap is a non-starter.

I'll also note that the research by the VA is often phenomenal, and they do this by having ready access to large segments of the veteran population - like how they discovered that a routine blood pressure medication also happened to calm PTSD nightmares with their combat veteran patients. That's something that never would have been discovered without the existence of the VA. My problem is not its existence, my problem is the funding and lack of oversight.
posted by corb at 1:10 PM on May 30 [7 favorites]


OK, I apologize about the office furniture. I honestly did not know the situation.
posted by roomthreeseventeen at 1:12 PM on May 30 [17 favorites]


and expect Democrats to say that congressional Republicans are actually at fault

They do consistently block increased funding for the VA.


Decreased funding did not force the Obama executive branch to allow workers to lie about patient wait times to make the problems seem less severe. President Obama has been in office for for many years now, administrative failures belong to the administration. True information could only have helped pressure Republicans to increase funding.

that Republicans should be ashamed for starting wars in the first place

They wouldn't exactly be wrong.


The wars were started in the most bipartisan of ways, and Afghanistan was continued under Obama when it could have ended sooner. You are going to vote for Hillary Clinton very soon, I might too. She supported the wars, she helped craft America's foreign policy under Obama. We don't get to wash our hands of the wars because we want to blame Republicans for a bipartisan scandal in great part caused by the complications of those wars.

The calls for investigations and Shinseki's resignation have been pretty bipartisan

I do agree, that's a good hint we can't throw up our hands and complain about Republicans and Benghazi and how they hate Obamacare.
posted by Drinky Die at 1:12 PM on May 30 [1 favorite]


Having been poked and prodded by the military medical system for many years I'll add this - from my experience its awful. So awful I pay extra to ensure my family sees civilian providers. I live with multiple ailments and often wait until I'm on death's door to see a provider, knowing that what awaits me is blind folly or sometimes worse.

Y'all got it good - now that the ACA is in place. You don't even know.
posted by vonstadler at 1:14 PM on May 30 [2 favorites]


The wars were started in the most bipartisan of ways

Arguable, certainly
posted by mikelieman at 1:14 PM on May 30 [1 favorite]


And with the aging population of vets who are just now seeking services, more in part from old age than from service-related injuries.

Vox's interview with Hank Aaron talks about the double-prong here.
posted by phearlez at 1:17 PM on May 30


Arguable, certainly

We will have to agree to disagree on that, beyond the scope of the thread and I've said enough in regards to the Wonkette piece which is not the meat of the discussion.
posted by Drinky Die at 1:19 PM on May 30


As corb and caution live frogs mentioned, the VA addresses the unique needs of veterans - of which we have more and more, many with serious, lifelong medical issues that would have been fatal in earlier wars.
And as NoxAeternum mentioned, the VA is different than almost any private health system with its incentive to prevent the development or exacerbation of problems, vs. getting a profit from treating them once they occur.
And the VA does all this relying on funding from a less-than-smoothly-running federal budget process.

This scandal sheds some light on serious problems affecting the VA as a whole, and some problems unique to specific facilities.
Those facilities obviously should not have been gaming the system that monitors wait times. (However, it is nice that the VA does monitor wait times. I'm not sure if that is universal in the private sector. It does seem that long wait times are not unique to the VA)

No large healthcare system is without its critics. But independent evaluators seem to have good things to say about the VA.

Addressing this scandal in a ham-fisted manner will just damage the parts of the VA that are doing good. Instead, looking at the specific nature of the problems will lead to useful changes.
posted by neutralmojo at 1:23 PM on May 30 [7 favorites]


Republicans should be ashamed for starting wars in the first place

You're goddamn right I'm going to say that Republicans should be ashamed for starting the Iraq war! It was the single worst decision in American history. Bush, Cheney, Rumsfeld, and Rice are un-American war criminals and no one who was in Congress who voted for it should ever be allowed to hold public office again. And that includes Hillary Fucking Clinton. I will be damned if I ever pull a lever to vote for her.

But the Iraq War was a Republican idea, executed by Republicans who controlled the executive branch. Period. And this VA scandal is a direct result of that war. And I will never, as long I draw breath, let anyone forget it. I got called "traitor" by Republicans too many times in 2002-2005 to ever, ever, ever forgive and forget.
posted by vibrotronica at 1:36 PM on May 30 [17 favorites]


Charles Forbes was chosen to head the Veterans Bureau by his poker buddy, President Warren G. Harding, in 1921. He was a poor choice. Forbes took kickbacks. He sold off federal supplies. He wildly misspent taxpayer money — once buying a 100-year supply of floor wax, enough to polish a floor the size of Indiana, for 25 times the regular price (apparently as a favor to a floor wax company).

Eventually, Forbes was caught. The president was unhappy. In 1923, a White House visitor opened the wrong door and found Harding choking Forbes with his bare hands.


I miss the good old days, when Presidents could get away with direct action.
posted by pjern at 1:36 PM on May 30 [13 favorites]


Okay, here's a what I hope will be a pleasant sidebar about the VHA's highly touted EHR. It's a bit long for a comment, too self-linkish for an FPP and I doubt I'll ever find a truly appropriate thread for it. Sorry.
Run Your Own Private EHR System: Install VistA/CPRS on your own desktop PC

Just about all clinical activity at the VA involves the use of CPRS/VistA/BCMA. Security requirements severely restrict ordinary user access to a only small fraction of the system. Unfortunately, most never get a chance to see the true extent of VistA/CPRS nor are able to safely explore its capabilities and potential.

Fortunately, CPRS/VistA is open-source, public domain software freely available for download. You can create your own installation on an old, surplus PC. (I did this on a 6yo laptop, WinXP and about 5Gb of disk space.) Installation requires the ability to follow somewhat disjointed instructions and some familiarity/comfort with command line interfaces. You really don't need to know what you're doing, you just need to be able to muddle through instructions.

The resulting sandbox installation will give you super(duper!)-user-programmer access to your own, private VistA EHR system pre-seeded with a half dozen fake patients. You'll have greatest user privileges and you'll be able navigate through all the dirty, behind-the-scenes functionality of VistA/CPRS.

worldVistA (1 of several flavors of VistA available):
worldvista wiki
Server(VistA) and Client(CPRS) software download
Installation instructions for Windows
Installation instructions for linux

There's an active user community at a google group(listserv) called Hardhats (a lot of retired VA coders, CAC's, some private clinician-users. The guy who wrote Taskman is fairly active on the list.)

More on the Hardhats
Did you know VistA was created by renegades?

Vista University
Vista Software Document Library
posted by klarck at 1:40 PM on May 30 [24 favorites]


You then have to look at the bureaucratic systems and processes that are mandated by law, as well as the systems and processes created by technological limitations (M.U.M.P.S. being one of the primary ones), and the vested interests of the people who are tasked with the responsibility to deliver the care, but who are not doctors or nurses.

MUMPS is the same database back-end that's used in Epic, the market-leading clinical information system in the private sector. Implementing and using an EHR system is such an interlocking set of incredibly difficult problems that I don't think which database engine underlies the system is even in the top 50 most important considerations about how to go about it.

The problems in this scandal are not problems with MUMPS or VistA, they're problems with people intentionally circumventing the systems in place and feeding them bad data to game their metrics, which is not a problem that can be solved with more and shinier technology.
posted by strangely stunted trees at 1:42 PM on May 30 [2 favorites]


He wildly misspent taxpayer money — once buying a 100-year supply of floor wax, enough to polish a floor the size of Indiana, for 25 times the regular price (apparently as a favor to a floor wax company).

To be fair, it was also an excellent dessert topping.
posted by Daily Alice at 1:44 PM on May 30 [11 favorites]


* It was inevitable that this would increase wait times, and the VHA's claims backlog did indeed increase during the first three years of Obama's presidency. Over the past couple of years, however, wait times have shrunk dramatically. A digital claims system has finally been put in place, and the claims backlog today is less than half what it was at the beginning of 2013.

Which is total BS if you are cooking the books. A totally separate, off the books list was kept. Any system will look good if you don't enter the stuff that makes it look bad. Encentivizing the wait list was, I'm sure, well intended, but you have to monitor these types of incentives to make sure no one is playing the system.
posted by Gungho at 1:55 PM on May 30 [1 favorite]


To be fair, it was also an excellent dessert topping.

Tastes great, and look at that shine!
posted by prodigalsun at 1:56 PM on May 30 [1 favorite]


Other countries have, or had, systems similar to the VA system, which were often created after the huge number of casualties in WWI meant the existing care systems would be inadequate. In Canada, only Ste. Anne Hospital in the very West of the Island of Montreal is left out of the nine hospitals created by the Military Hospitals Commission, in part because Canada hasn't been involved in many wars since WWII, in part because all provinces have single-payer health care and mostly good systems.
posted by Monday, stony Monday at 1:58 PM on May 30


Also, "the VA ranks higher in surveys!" is not a defense against MRSA. People can be satisfied with atrocious care and still get atrocious care.
Avenge

True, but not really relevant.

The best MASH in Korea was arguably much, much worse than any hospital most of us have been to - but it was still the best available, and that says something good about it.

When US healthcare is atrocious (on a results/cost basis, at least), and everyone with two functioning brain cells knows it, yes indeed it is important that the VA system is better. Less atrocious is better. That clearly means they're doing many things right.
posted by IAmBroom at 1:59 PM on May 30


Congress is all outraged over the deaths of four Americans in a war zone (one of which was a liberal ambassador and personal friend of Obama. And now you know how to get the GOP to care about Americans, all you have to do is kill them first. It’s pretty much exactly the same as their stance on abortion). Meanwhile countless American Vets have died waiting for care in their own hospitals and not even a committee level review from Congress. Nothing.

from the stonekettle article link above
I like how it implies vets aren't considered Americans, I'm not sure if that was intended but that's how it reads. Not saying that's bad, just a very interesting take that clarifies the conservative position I've had trouble wrapping my head around.
posted by sio42 at 2:03 PM on May 30 [1 favorite]


roomthreeseventeen: I'm glad you asked about the furniture spending. Now I have a bunch of stuff I can say when someone tries to make it an issue!
posted by sio42 at 2:16 PM on May 30 [3 favorites]


Not everyone thinks there's even a problem here.
posted by NervousVarun at 2:17 PM on May 30


Vaguely tangential government procurement memoir: I am personally acquainted with someone who, in her first month on the job, thought she was ordering several gross of rolls of toilet paper, but actually ordered several gross pallets of toilet paper. As in dozens of tractor-trailers full of toilet paper. The trucks were backed up to the Interstate trying to come through the gate. She's going to retire in December after decades on the job. Legend has it that there is still TP from that original order in supply closets around the facility.


Meanwhile…

“The Problem isn't the V.A. or Eric Shinseki”, Charles P. Pierce, Esquire Politics Blog, 30 May 2014
posted by ob1quixote at 2:43 PM on May 30 [1 favorite]


If only there was a head we could lobby to have roll whenever civilian healthcare drops the ball.
posted by Thorzdad at 2:45 PM on May 30 [7 favorites]


First off, my father in law is alive because of the outstanding care he received from the VA. Their willingness to go above and beyond in his treatment is what helped him beat lymphoma.

That said, I think it's abhorrent that they were gaming the system to try and make appointment waits look better. I also understand that systematic underfunding for decades at the VA is part of the problem. You can't expect a system to function at high capacity and continue to reduce funding over and over again. I know the Obama administration has increased VA funding the last few years, but decades of withdrawals can't really balance the account.

And let's not even begin to examine the wait time for appointments in the private world. Before I was diagnosed with my lovely chronic immune disease, I was in sheer agony. It only took me a day or two to get into see my GP, but when he recommended me to a rheumatologist, I was politely told that the earliest appointment was 2 months away. When I mentioned how much pain I was in I was advised to "take some Advil and don't overdo it."

Our healthcare system is a freaking nightmare and as I private citizen it infuriates me. If I had served my country and was told over and over again how valuable my service was, only to face this nonsense when I sought medical care? I would straight up lose my shit.
posted by teleri025 at 2:59 PM on May 30 [2 favorites]


When US healthcare is atrocious (on a results/cost basis, at least), and everyone with two functioning brain cells knows it, yes indeed it is important that the VA system is better

Here's the problem. Everyone comparing wait times and care between VA and civilian facilities is fundamentally missing the boat. It's like apples and oranges, and it's certainly not what most veterans I know compare it to. If you're going to compare it to anything, you need to compare it to the active duty military health care system - which, like the VA, maintains its own clinics and hospitals, doesn't charge for access to doctors, etc.

The active duty military health care system, compared to the VA, is superb. Wait times are extremely low. Doctors are usually available for emergency appointments, and always available for emergency mental health appointments. There are more doctors per patient. Conditions in the facilities are generally good. Everyone, but everyone, is on the books if they so much as got a sick call slip. Dental care is free and comprehensive.

Then, when the soldier gets out and becomes a veteran, the exact same government, run by the exact same people, in nearly the exact same fashion, manages to treat them like utter shit. Long wait times abound. Mistakes abound. Care for women is abysmal. All sorts of problems are on display. It really exemplifies that they have value to the decisionmakers only so long as they are actively putting bullets into targets (or the equivalent). They can do better - the veterans remember them doing better. They just choose not to.
posted by corb at 3:06 PM on May 30 [9 favorites]


One of the other things that was noted on the Tell Me More interview about this is that Obama and Shinseki also eliminated a lot of the hoops for vets with PTSD, "Gulf War syndrome," and cancers that may or may not have been linked to Agent Orange. Where the previous administrations had treated those as things that needed to be proven as related to service, now the default is to treat them as service related, which opened up millions of other claims against the VA.
posted by klangklangston at 3:37 PM on May 30 [9 favorites]


How many of you guys posting here are actually veterans who are now in the VA healthcare system? Methinks not many. I have been in this pathetic system since 1998. Was a US Army Airborne Ranger for years before getting honorable discharge and then getting dumped into the VA system. Been fighting their lies, corruption, fabrication of evidence on tests and exam results for 16 years. Before anyone here starts in on how most veterans are pleased with this system, please STOP. Every single vet I've talked with in the past 16 years has nothing but NEGATIVE things to say about the VA. Period. Hit me up for details. Thanks for giving me your eyeballs.
posted by RioRamirez at 5:24 PM on May 30 [11 favorites]


Obama may deserve to get knocked around for not doing more to fix them, but he also deserves credit for finally making significant progress on issues that have festered for decades.

You know who else used to screw the V.A.?
Forbes.

Screwing soldiers or veterans out of money, playing a shell game with the government, it's a pretty time honored method of making money.
Simon Cameron during the Civil War sold bad blankets and tainted food (pork and beef - the more things change ... ) Pretty much every war the U.S. has had, returning troops have been exploited either coming or going.
(on preview - I see it's touched on above, tangential point here tho)

So this has pretty much nothing to do with Obama or the current administration (the nature of the department being under the executive branch aside). For good or ill really. It's always been on Congress. And Congress has always depended upon this partisan b.s. - the GOP started the wars, the Dems hate the troops, blah blah blah.
It's not a blue or red issue. It's just green.

War is how many people make money. Period. Ask anyone if they want war. G'head. Ask 'em. Nope. No one wants it. "BUT ... " they always say. It's how they avoid the reality. The
And there are plenty of ways to ignore the reality. You can 'support' the troops with bumper stickers (which, yeah, so, so great) or be a rebel and not support the troops. Typically with a contrary bumper sticker (again, really kick ass).

Plenty of people have strong feelings somewhere on the pacifism / hawk spectrum, but no one really challenges the people who make the dough (with laws, protest, etc).

So no one really gets bent out of shape on these kinds of things because hey, politics. But it's not. It's just part of the method of profiting from war. It's gotten more sophisticated since the Assyrians figured out you could sustain a standing army off of what you get from foreign soil (and the Romans who took that much further). But essentially it's still laying costs off on someone else.
The more modern element of course is doing that to your own standing army as well. Give them bits of ribbon and pot metal to distract them from that (thanks Napoleon!) or other empty praise ("support") so they don't go Praetorian on you. Keep everyone afraid.
Simple tricks really. Like scapegoating.

I like (legislative director for Disabled American Veterans) Joe Violante's characterization: "It's like driving around for two decades in a car that had the check-engine light on ... and now someone is trying to do something about it."

But y'know, they design the car that way at the factory.

From the Stonekettle link: The problem is an ineffective deadlocked Congress who’ve abdicated their actual constitutional responsibilities and oversight for conspiracy theories and witch hunts, hysteria mongering and political theater.

this

What I don't get is how an organization for former military personnel can't be, y'know, organized. Plenty of ways to run an organization. The incentive thing seems to have failed miserably. More oversight maybe? I don't know. But clearly you need a basic organizational format to begin with. A sort of benevolant dictatorship. Or at least orderly one involving a chain of command. The V.A. doesn't really have that. It's hybridized. It's subject to political whim. The VA operates by the laws Congress gives them and then manages them.
IIRC Obama asked for more money for the V.A. and Congress didn't fill that as much as asked ($2 billion a year short?). The budget has gone up, certainly, but nowhere near in proportion to what was required for a post-war recovery.

Naturally Bushco nickle and dimed the wars (heh, 'armor', heh,' fungible', heh) but more recently Bernie Sanders' bill got shot down which would have addressed exactly this issue.


and expect Democrats to say that congressional Republicans are actually at fault...
Well, but...they are.

The V.A. was a crippled outfit from its inception. But narrowing the issue down to specifically wait times - The Veterans' Affairs Committee Chairman (Sanders, whos an independant) sponsored a bill primarially to address the long wait times by expanding facilities (27 new ones), and repealing the cuts to military pensions which would have helped caregivers and wounded vets not, y'know, die.

Nah. The GOP fillibustered it. Cost too much.

I don't know of any veterans groups that opposed it.
Back in February the American Legion Commander said "I don’t know how anyone who voted ‘no’ today can look a veteran in the eye and justify that vote."

We borrow to go to war, but it's only the "heroes" who have to pay anything.

This rarely changes no matter who the President is.


But the point remains - I don't get how this can be a "scandal" when it's clearly a deliberate result of political choices and design.
I'd call them design "flaws" but it's subject to so much predation by politicians who are one minute CEOs and the next in office and 'round again that it's impossible to see such legal loopholes and "errors" as anything but deliberate intent for the sake of exploitation (politically or financially).

War is a racket. But post-war politics (reconstruction, production sharing agreements, GI Bill scams, pension poaching, health care billing), that's where the f'ing money is!
posted by Smedleyman at 5:38 PM on May 30 [16 favorites]


6 problems at the VA that Shinseki's successor faces
posted by the man of twists and turns at 6:03 PM on May 30 [1 favorite]


My grandfather was a WWI veteran who died in 1981. That's right. The first world war. As his health declined his standing order to the family was "don't let me wake up in a VA hospital". This shit has been going on for far, far too long.
posted by Ber at 8:53 PM on May 30 [3 favorites]


There are at least two of us in the VA system. It's... okay. My doctor's good, but too many people are lazy, indifferent and rude. I'm about as liberal as it gets, support public-sector workers earning good salaries. Too many VA people are getting them, not earning them.

What's extra-galling is that they have all these signs up, "You served us and it's our honor to serve you," and the facilities are about half-full of unprofessional assholes.
posted by ambient2 at 5:39 AM on May 31 [3 favorites]


I also cannot stress enough how shitty the VA treats women. Klangklangston talks about the better rules on PTSD, but neglects (or honestly may just not know) to mention the fact that none of those rules apply to women suffering PTSD from MST, which is also a casualty of service - even if it happened in a war zone while they were deployed.

My favorite #vahateswomen story is when my VA primary care doctor in the Women's Clinic saw my tattoo and said that I needed to be careful, because no good man would ever want to marry a girl with tattoos. TRUE STORY.
posted by corb at 5:49 AM on May 31 [5 favorites]


Also, "the VA ranks higher in surveys!" is not a defense against MRSA.

Since 2007, the VA has had one of the most comprehensive and effective MRSA-control programs in the nation, with declines in infection rates greater than non-VA facilities.
posted by Panjandrum at 9:07 AM on May 31 [5 favorites]


I've always wondered why the VA can't just be privatized. This is not something that the gov't should be expected to be good at.

Governments around the world are good at it. There is no reason whatsoever that the VA shouldn't be setting the gold standard of healthcare in the USA.

I'm a pacifist. I think war is terrible. I'm glad we stayed out of Iraq and Afghanistan.

But.

When you have someone who quite literally says "I will put my body in front of a bullet for my country," they deserve nothing but gold-plated medical care if and when they get injured doing so. Any politician who votes against that sort of thing (I mean for God's sake the 9/11 first responders bill took how damn long to pass?) should be voted out of office whenever the next election is.

If you're going to say Support The Troops, that doesn't end when they get back home.
posted by feckless fecal fear mongering at 5:37 PM on May 31 [3 favorites]


There are a lot of ways Congress could respond to this catastrophe.

They could (but probably won't):

* immediately introduce and pass an emergency funding increase for the VA to try to help cut down wait times for the veterans they say they care so much about

* acknowledge their own failures to improve the VA's situation, including:

- blocking Tammy Duckworth's nomination to serve at the VA.

- killing a bill to increase veterans healthcare funding with a filibuster and a poison pill about the unrelated issue of Iran sanctions.

- abdicating their own responsibility to serve as a check on the executive branch's increasingly-centralized war-making powers.

They could (and probably will):

* launch a series of investigations that will try to point the finger at specific individuals who either cooked the books themselves, looked the other way while books were cooked, or set the standards knowing that the books would have to be cooked in order to meet those standards.

* begin issuing reports detailing "WasteFraudAndAbuse" in the system -- the proverbial $500 toilet seats that can make everyone point and laugh at government bureaucracy as a way of excusing themselves for not increasing funding to adequately care for our veterans. (I see there's already talk about expensive furniture!)

* engage in Shock Doctrine policy-making by trying to use this crisis as a way to undermine the VA system and move it toward privatization. (Oh, whoops! They're already on top of that one!)

Here's my idea. I work with military and civilian agencies by day, so I have some window into what they look like, at least at the lower button-pusher levels. From that experience, I can guarantee you that there's an Excel spreadsheet somewhere at the VHA that can accurately forecast the amount that each veteran will cost the agency, including adjustments for the increased cost of healthcare services, medicines, etc., as well as the fact that more veterans who go to war now survive their injuries, and therefore cost more to care for. Someone at the VA has the job of making those calculations so they know how much money to ask for every year.

So, Congress, put your fucking money where your mouth is, and introduce legislation requiring that not a single troop deployment is paid for until that soldier's health-care is paid for in full before they put on a uniform. We required the U.S. Postal Service to pre-fund their pension obligations for 80 years or whatever, but we can't find it in our hearts to pre-pay for VA healthcare so that the agency doesn't have to go hat-in-hand when people are already dying?

Shinseki's resignation, though far too late, shows that cabinet secretaries are held accountable for their failures, regardless of how personally responsible they were. Now what we need is some accountability from the people who stood by while these wars were started, refused to fund the VA adequately, and now, as the Stonekettle Station post points out, are trying to invoke the Captain Renault defense. Funding for veterans benefits should be determined by an actuarial equation that takes into account the number of veterans, the cost of care, etc., not by a Congress that wants to blame everyone but themselves.
posted by tonycpsu at 7:55 AM on June 1 [11 favorites]


The Daily Show: World of WarriorShaft - Terrible Memory Lane
posted by tonycpsu at 5:54 PM on June 1 [2 favorites]


IAVA releases only partially self-serving list of 8 steps to fix the VA.
posted by corb at 1:34 PM on June 2


Shinseki Wasn't the Problem: "Taxpayers Get What They Fucking Pay For"
posted by homunculus at 5:17 PM on June 2


Here's The Simple Reason Congress Hasn't Fixed The VA
"The number one job is now fundraising, and everything gets distorted by this need to fundraise," said Harvard professor Lawrence Lessig, who studies congressional corruption. The silence of the Veterans' Affairs Committee, he said, is a "really interesting other dimension of this. You can't even get the ordinary work done because it doesn't pay."
posted by Golden Eternity at 9:20 AM on June 9 [1 favorite]


killing a bill to increase veterans healthcare funding with a filibuster and a poison pill about the unrelated issue of Iran sanctions

The only "fun" thing to come out this for me is rebutting the fulminations on my social media feeds about this being the fault of the socialists in government (led, of course, by the Kenyan Muslim Usurper) with the fact that the person leading the effort to make the VA better is, in fact, the only current actual socialist elected to the federal government.
posted by zombieflanders at 9:31 AM on June 9 [2 favorites]


Clearly the answer is to go after the whistleblowers: To defeat encryption, feds deploy the subpoena
posted by homunculus at 4:38 PM on June 12 [1 favorite]


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