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Veterans who depend on the VA for their health care and who hear the talking heads on television yammering about the “VA scandal” must be concerned. These include our many Vietnam veterans, most of whom are aged 60 and above now. Statistics tell us Vietnam vets are unusually susceptible to high blood pressure and cancer. Former Navy sailors and shipyard workers suffer high rates of mesothelioma. Gulf War veterans have an increased risk of fibromyalgia and chronic fatigue syndrome.
The good news is that the scandal is not about the quality of health care veterans are receiving, which by all accounts is excellent. That did not used to be true; in the mid-1990s the VA health care system was in a deep crisis, and VA hospitals had a reputation, possibly exaggerated, of being rat-infested warehouses where sick veterans were neglected. Reforms were put into place, and by 2007 many within the health care industry were rating VA health care as good as or better than the highest-rated non-VA hospitals.
The primary problem today is not quality of care, but access to care. The scandal came to light when it was learned that officials at the Phoenix, AZ veterans’ hospital were falsifying records to hide the fact that patients had to wait an average of 115 days to see a primary care doctor. CNN reported that at least 40 veterans died while waiting to receive care.
Then the American Legion got involved and began checking management in other VA hospitals. In their report, Epidemic of VA Mismanagement, the Legion shows a number of other hospitals hiding long wait times, although this is not true of all of them. A more widespread problem is the huge backlog of benefit claims. The Legion says there is a backlog of 271,740 disability benefit claims that have been waiting months for a decision. Kelly Kennedy of USA Today reported “At least 350,000 veterans of wars before those in Iraq and Afghanistan have outstanding appeals of benefits decisions, according to VA records.” Some veterans languish for years waiting for a decision.
How Did This Happen?
Regarding the wait times: The basic problem is that since the beginning of the Iraq War in 2003, demand for VA health services has far outgrown the VA’s capabilities to provide it. As much as Republicans in Congress may want to lay all the blame for the scandal on the Obama Administration, it began with the George W. Bush Administration. This of course does not excuse the Obama Administration, in office now for going on six years.
However, many of those same senators and congressmen who pointed fingers at the White House, and demanded the resignation of Gen. Eric Shinseki as Secretary of Veterans Affairs, are also part of the problem. For years, Congress has denied the VA the money it requested to improve. Although the VA budget has increased, it has not increased nearly enough to deal with the rise in health care costs plus the increased demand for health services created by the Iraq and Afghanistan wars.
Bottom line: Congress has been budgeting, on average, about $2 billion a year less on the VA than the Obama Administration has been requesting. And in February 2014 Senate Republicans blocked a $21 billion bill intended to provide improved health care, education and job benefits for veterans.
As wait times grew, why did hospital administrators hide the wait time problem instead of asking for help? Very simply, administrators receive pay bonuses for keeping wait times short. Exposing the problem so that it could be fixed would have cost administrators their pay bonuses. Obviously, more oversight is needed, but oversight costs money, too.
The VA has had problems with benefit claims backlogs going back to the John F. Kennedy Administration, and these problems were caused, or at least not addressed, by several congresses and presidential administrations. The current backlog is actually slightly smaller than it was five years ago, but it is still too high. There have been plenty of problems with VA management as well.
What Can Be Done?
Senator Bernie Sanders (Independent-Vermont), chair of the Senate Veterans Affairs Committee, introduced a bill that would allow veterans facing long wait times to seek care outside the VA without having to pay out of their own pockets. The bill also allocates money to hire new doctors and nurses, and it would provide scholarships or forgive college loans for doctors and nurses who go to work at the VA.
Others have suggested the VA audit its incentive policies, especially to be sure the goals it wants to reward are realistic. Many in Congress want to make it easier to dismiss underperforming managers and staff. And some are pushing to privatize the VA, such as by giving veterans health care vouchers to take to any health care provider.
More than anything else, politicians in Washington need to stop grandstanding to score political points and simply address the problem. There is plenty of blame to spread around in both political parties, but blame isn’t going to get help for veterans.
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