Saturday, February 07, 2009

Time to Start Restructuring the DVA

Congress's hands are not clean over the Blue Water Navy issue. They have consistantly passed budgets over the years while the DVA takes appropriations away from Veterans to build new facilities. We refer mainly to costly 'Rural VA Health Centers'.


  • The DVA had to have money appropriated in its budget to acquire the land for these centers.

  • Then they had to have money appropriated to construct them.

  • Then they had to have money to staff them.

  • Now they have to have money to keep them running.

  • This is a very costly program.

    Consider the alternatives, however. Not having them forces the Veterans to travel very long distances to receive diagnosis and treatment for any conditions thay have or develop. They have to travel to VA Hospitals...


    ...Congress could authorize the issuance of a Veterans Health Care Card, with coverage levels based on DVA Categories of eligibility, and with a payment schedule identical to the one Social Security uses for Medicare. There would be no deductibles or copays for full coverage. The Veterans would use the card at any and all medical facilities they choose, and the medical provider would be barred by law from billing the Veteran for any difference in fees and costs. Prescription coverage would be the same as they have with the DVA, based on categories of eligibility.

    The DVA could then sell those costly Rural Health Centers, applying any moneys realized to the next year's infrastructure maintenance budget to repair and modernize any DVA Hospitals to begin to switch their primary role to that of long term care. Staff reductions will further reduce the budget.

    What could be the advantage of this system?

    Politically, the Democrats will embrace it because it is a step closer to universal health care. The Republicans will embrace it because it shrinks government [hundreds of administrative clerks are far cheaper to pay for than thousands of administrators, doctors, nurses, pharmacists and therapists].

    Medical professionals will embrace it because it does not force many of them to take any experience and training they garnered while serving in the Armed Forces and work within the DVA healthcare system. They can work where they want, and their expertise will be spread throughout the nation and be available to all, not just Veterans.

    Veterans should embrace this plan since it allows them to go to their family doctor for treatment, and their local hospital for emergency and long term services.

    This would reduce instances where Veterans go to DVA Hospitals in an emergency only to find they have no Emergency Room, or to be turned away because of a snafu, or by an undertrained staffer who just doesn't care, forcing the Veteran to seek emergency care at a local facility that is NOT DVA, and then be forced to pay the bill.

    Chances are, the Veterans contemplating suicide will receive better judgement on examination in Emergency Rooms of civililan facilities and not be turned away. They would likely receive better care after admission as well.

    Mostly, though, this would eliminate many of the "cracks" that Veterans fall though in their health care system. Quality of care varies greatly from DVA Medical Facility to Facility, making treatment a hit or miss reality for the Veteran. Many of the staff at DVA facilities are simply overburdened, and have become callous to their patients.

    Positive Results

    Let's get the DVA out of the business of being the ones who treat all of our Veterans and into long term care only, and whatever period of time a wounded warrior needs to transition from the active Military to Veteran status and be ready to go out into the civilian world.

    Finally, by freeing up money in the DVA Budget by stopping the acquisition, construction, staffing and running of DVA Rural Health Centers, and divesting itself of them using the above concept, perhaps the DVA could spend more money, time and effort in paying the benefits to Veterans that they fight so hard to deny. It is time to zero in on the DVA and force massive changes in its thinking, and operations. This is one step, and it starts with Congress.


    ”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

    "The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Bush Administration and his Department of Veterans Affairs?"--VNVets

    "With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

    "It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

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    1. Why not have mobile units that make the rounds in rural areas? After Katrina, we were shown the marvels of technology. Less staff, overhead, more accessibility.

      This way, daily, noncritical problems could be addressed and with a card allowing care anywhere, in patient or more extensive diagnostical/treatment could be done at existing nearby facilities.

      Also, arranging for effective transportation in those areas could be done cost effectively.

    2. Anonymous09:48

      I'm not in disagreement with what you say but I do question the statement:

      "Medical professionals will embrace it because it does not force many of them to take any experience and training they garnered while serving in the Armed Forces and work within the DVA healthcare system. They can work where they want,"

      What "forces" them to do so now?

    3. 3D,

      That is certainly something to think about for the most rural areas.

    4. Anon,

      Doctors tend to go where they are most comfortable and experienced, and Military Field Physicians and Nurses trained in Battle Trauma will have gained those specific skills, and only one other employer besides the Military offers patients with those conditions: the DVA. If the DVA reduced its medical workforce as described above, many of those medical personnel would be gaining new experience working in civilian facilities or private practice, and they would still be experienced in Battle Trauma. Thus, the experience is pread wider geographically, closer to the Veteran.

    5. Anonymous,

      I had to delete your latest comment because it was garbled with everything in this comment window.

      Please feel free to re-try your comment.


    6. Anonymous21:26

      Resubmitting.....I understand why it is easier and more advantageous for a military physician to go to work for the VA but still question the use of the word "forced".

    7. Where else would doctors go to work in order to treat combat injuries? The open market, ie. private practice, and work in private clinics has an extremely limited number of cusotmers with combat trauma injuries requiring treatment.

      If the doctors were able to spread out throughout the country because the combat injured had also spread out throughout the country, combat injured Veterans could often return home sooner from the Military Hospitals and get treatment by experienced combat trauma specialists in those private medical facilities.

      That saves money on the taxpayers' dime, provides a more comfortable environment for the Vet, and still affords him the experienced expert care he needs. Indeed, the overhead in maintaining such physicians withing the ranks of the DVA Medical system would be drastically reduced, while patient stays in VA facilities would be shortened.

    8. Anonymous11:05

      While the majority of VA doctors are ex-military, they make up a small minority of ex-military MD's in practice nationwide. Also, the great majority of doctors who work for the VA do NOT have experience in treating combat injuries. Most of those I know are people who were, themselves released from active duty for some disability of their own. Perhaps making such an experience a requirement would be a good idea.
      Of the three VA doctors I met in past weeks at the VA Clinic here, one was a retired USAF LCol who had been retired with Macular Degeneration (had to read the computer screen with a magnifing glass), and two who had never been in the military at all. Of the two, one had been unable to get a residency after Med School and now does VA physicals....what does THAT tell you?

      "Forced" may have been a poor choice of words but doubt if you will acknowledge it.

    9. You are speaking from the experience of a VA clinic. I am talking about VA Hospitals where the long term Battle Trauma Soldiers transition from Soldier to Veteran. That is not done at clinics.

    10. I am going to close the comments for this entry as of today.

      Anyone with further comments on this particular entry shouls use the "Email Me" link on the left sidebar.