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  #61  
Old 25 April 2018, 13:08
Fu King Lawyer Fu King Lawyer is offline
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Originally Posted by 1RiserSlip View Post
..... Are we doomed to continue with the status quo of internal beaurracy?

Thoughts?
Recommendations?

I'm at the point where I think the VA needs to be privatized. It's a defunct as the USPS, which goes under every year by BILLIONS costing the taxpayer enormous amounts of money. Raising the cost of a stamp by .04 cents isn't going to fix it.

I don't mean to bring up 2 issues here but was using the USPS as an example. .....
.
WTF to do. Anybody?
1RS:
The current VA system is not sustainable. It is important to have the facts (see below). There is no way the costs of the bureaucracy can continue, especially with the declining number of Vets. We don't fight wars with bomber crews of 12 any more, we use drones. A brigade or regiment can do what used to take a division or two to accomplish. With these efficiencies, the number of combat wounded will continue to decline (thankfully). Congress critters will wait until the wounded Vet numbers get low enough that they can abandon them without political fall out.
Time to give disabled Vets a healthcare card that pays 100% of care and RX. Turn the VA clinics and hospitals over to local governments to take care of Medicaid/welfare patients. Let Dept of Defense maintain services for PTS and amputees and any other needed specialties. As far as gunshots, burns, and trauma injuries, any Chicago medical center has more experience than any VA facility.
v/r
fkl

The stats (from VA's own web site):

The total Veteran Population is predicted to decline from 20.0 million in 2017 to 13.6 million in 2037
https://www.va.gov/vetdata/docs/Demo...ic_Final31.pdf


There were an estimated 26.19 million Vets in 1995 (see table page 1) – so we lost an estimated 6.19 million Vets in last 22 years.

https://www.va.gov/vetdata/docs/Tren...70_to_1995.pdf


About 9.05 million Vets are enrolled in VA healthcare.
https://www.va.gov/vetdata/docs/pock...s/fy2018q1.pdf

Of special note on the pocket card – there are still over half a million living WWII Vets.
VA’s budget (in real terms) goes up every year. In other words, as the Veterans population continues to fall, VA keeps doing less and less, with more and more.
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  #62  
Old 25 April 2018, 16:41
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Thanks. Good post.

Makes perfect sense too. Less veterans. Throw more money at it for office furniture. Follow the EPA's lead.
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  #63  
Old 25 April 2018, 17:29
Fu King Lawyer Fu King Lawyer is offline
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Originally Posted by 1RiserSlip View Post
Thanks. Good post.

Makes perfect sense too. Less veterans. Throw more money at it for office furniture. Follow the EPA's lead.
Fact is, at the last VA link provided above - there are 4.55 M disabled Vets. Compare to the number enrolled......Simple math indicates that half the patients enrolled in VA health care system were neither wounded in combat, nor injured in service. I can see arguments to provide "free" VA healthcare to homeless Vets, but the numbers seem out of whack. I gather VA got a bunch of folks enrolled to keep their numbers up and justify positions, and enhanced GS grades, IMHO. The cost savings would be huge if they abolished VA healthcare. VA is the second largest Department in the federal govt.
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  #64  
Old 25 April 2018, 20:04
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Originally Posted by Fu King Lawyer View Post
Fact is, at the last VA link provided above - there are 4.55 M disabled Vets. Compare to the number enrolled......Simple math indicates that half the patients enrolled in VA health care system were neither wounded in combat, nor injured in service. I can see arguments to provide "free" VA healthcare to homeless Vets, but the numbers seem out of whack. I gather VA got a bunch of folks enrolled to keep their numbers up and justify positions, and enhanced GS grades, IMHO. The cost savings would be huge if they abolished VA healthcare. VA is the second largest Department in the federal govt.
Just because you are a Veteran does not qualify you for V.A. Medical treatment. These benefits are codified in Title 38 of the United States Code, www.va.gov
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  #65  
Old 25 April 2018, 20:32
Fu King Lawyer Fu King Lawyer is offline
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Just because you are a Veteran does not qualify you for V.A. Medical treatment. These benefits are codified in Title 38 of the United States Code, www.va.gov
https://www.va.gov/HEALTHBENEFITS/re...strictions.pdf


Sir, respectfully suggest you need to do a little reading. v/r fkl

SECVA Shinseki et al., waived the income restrictions previously associated with Category "8" vets, allowing virtually anyone with a DD-214 to enter the VA healthcare.

My understanding is that following the last administration, VA is now supposed to follow the income thresholds as a gateway once again. The ones who got in regardless of income, are still in the system. Hence the fact that 50% of those enrolled are not combat wounded nor injured in service. The VA pocket card previously cited, is correct.

It is just MHO, but VA wages an extensive "disinformation campaign" to maintain the status quo. VA is aided by Vet Svc Organizations, such as VFW (I am a member and have witnessed this). The facts are out there for those willing to dig for them.
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  #66  
Old 25 April 2018, 21:03
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Wow! It's even worse than the USPS.

2 things really stick out in that graphic.

The 1.22 trillion in face value of Life Ins Policies.
The number of employed VA personnel.

I guess it's going nowhere. But certainly there's gotta be a smart guy out there to manage this deal.
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  #67  
Old 25 April 2018, 21:06
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They've created a self licking ice cream cone. Budgets continue to go up, patient numbers go down and the care keeps getting shittier.

However, no politician on the planet will get in there and lop heads cause they'll be accused of being "against" vets.
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  #68  
Old 25 April 2018, 22:19
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I'm Cat 2 and have my VA ID card as a "just in case", but I refuse to use it as long as I have private insurance. There are those out there that who need it much more than I and I wouldn't feel right taking an appointment away from someone who had no other option.
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  #69  
Old 26 April 2018, 00:51
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Quote:
Originally Posted by firstshirt View Post
I'm Cat 2 and have my VA ID card as a "just in case", but I refuse to use it as long as I have private insurance. There are those out there that who need it much more than I and I wouldn't feel right taking an appointment away from someone who had no other option.
The more you use it the more money is allocated to the V.A. an more DR are hired. You are not taking away anything from a veteran. At least see your Dr once a year. this keeps your record up tp date, provide them with any records etc from your private DR. Group 2 will help with your service connected disability, if you have problems down the line.

I have received Calls from Hospitals, requesting information on a Veteran that was admitted to their Hospital, due to HIPPA we have to refer them to a different department. This causes a delay in care for the Veteran. Just have a checkup once a year
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  #70  
Old 26 April 2018, 05:15
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I studied healthcare law in the Netherlands. As an outsider I notice one of the biggest problems at the VA (or VHA) is the outdated bureaucracy. And in the American healthcare system as a whole it's to control the rising healthcare costs. That can be done by competition (in the insurance market) and regulation (by government). In the States that doesn't work very well yet. To regulate the pharmaceutical industry and insurance corporations. They have powerful lobbies. Privatizing the VA (or VHA) doesn't fix all that.

I would think... instead of full privatization, rather corporatize the VHA (take it out of the VA, and let the VA exist for all non-healthcare related support and benefits) and let that 'new VHA' be a nonprofit corporation. To be restructured, reorganized, and operate like a corporation, more independently from the government, but not for profit. Any profits made (in future) then should flow back into healthcare for veterans, and not into the pockets of shareholders.
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  #71  
Old 26 April 2018, 07:42
8654maine 8654maine is offline
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Originally Posted by dutchdevildog View Post
I studied healthcare law in the Netherlands. As an outsider I notice one of the biggest problems at the VA (or VHA) is the outdated bureaucracy. And in the American healthcare system as a whole it's to control the rising healthcare costs. That can be done by competition (in the insurance market) and regulation (by government). In the States that doesn't work very well yet. To regulate the pharmaceutical industry and insurance corporations. They have powerful lobbies. Privatizing the VA (or VHA) doesn't fix all that.

I would think... instead of full privatization, rather corporatize the VHA (take it out of the VA, and let the VA exist for all non-healthcare related support and benefits) and let that 'new VHA' be a nonprofit corporation. To be restructured, reorganized, and operate like a corporation, more independently from the government, but not for profit. Any profits made (in future) then should flow back into healthcare for veterans, and not into the pockets of shareholders.

You just added more bureaucracy.

Any person, regulation, rule, desk, phone number that one puts between the patient and the provider is more delay and paperwork.

Healthcare, like any other business, needs the least amount of distance between the decision maker and the consumer. That is efficiency.

So, who are the decision makers?
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  #72  
Old 26 April 2018, 07:57
Fu King Lawyer Fu King Lawyer is offline
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Originally Posted by firstshirt View Post
I'm Cat 2 and have my VA ID card as a "just in case", but I refuse to use it as long as I have private insurance. There are those out there that who need it much more than I and I wouldn't feel right taking an appointment away from someone who had no other option.
Spot on. But the problem with the VA mismanagement is that once you are in, you are in. For example, a current combat wounded Vet discharged because he is an amputee, once in the VA system and in need of prosthetic replacement, waits in line while a 70 year old non-combat vet who lost a leg because of the onset of adult diabetes due to life-style choices, who got the limited appointment because he called first.

The Veteran Service Organizations are processing a whole bunch of VA disability claims for Vets in their 60s, so they can squeeze into the system and drop their Medicare Part D prescription coverage. VA encourages this, as it keeps their numbers up.

Combat wounded Vets who have no other choice, are suffering because of VA mismanagement. But VA just points to Chpt 38 CFR (which VA itself wrote).

Last edited by Fu King Lawyer; 26 April 2018 at 08:06.
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  #73  
Old 26 April 2018, 18:35
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Originally Posted by 8654maine View Post
You just added more bureaucracy.

Any person, regulation, rule, desk, phone number that one puts between the patient and the provider is more delay and paperwork.

Healthcare, like any other business, needs the least amount of distance between the decision maker and the consumer. That is efficiency.

So, who are the decision makers?
Bureaucracy is a necessary evil. Both in government owned (or funded) and private insurance. I agree it should be efficient and people who need healthcare should have access to it without being put on a waiting list and without getting unpayable bills. Healthy people who don't (or hardly) use healthcare pay part of the bill through premiums or taxes. Have to be fair for everyone, that takes bureaucracy. Have to control costs, that takes regulation.
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  #74  
Old 26 April 2018, 21:20
8654maine 8654maine is offline
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Originally Posted by dutchdevildog View Post
Bureaucracy is a necessary evil. Both in government owned (or funded) and private insurance. I agree it should be efficient and people who need healthcare should have access to it without being put on a waiting list and without getting unpayable bills. Healthy people who don't (or hardly) use healthcare pay part of the bill through premiums or taxes. Have to be fair for everyone, that takes bureaucracy. Have to control costs, that takes regulation.
Your definition of fair is interesting. Plus, insurance does not mean health.

By your definition, it should be fair that the Dutch pay for US healthcare. One world and all.

But this thread is about VA healthcare, which has a very specific risk pool and requirement for eligibility. It is already funded by taxpayers.
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  #75  
Old 27 April 2018, 03:31
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Originally Posted by 8654maine View Post
Your definition of fair is interesting. Plus, insurance does not mean health.

By your definition, it should be fair that the Dutch pay for US healthcare. One world and all.

But this thread is about VA healthcare, which has a very specific risk pool and requirement for eligibility. It is already funded by taxpayers.
Yeah a large majority of American tax payers (around 75% in polls) support spending more tax money on modernizing the VA. People support veterans. They aren't the problem. I think political leadership is the problem (in combination with special interest, lobbies, etc). Because in return government has to spend the money well, don't waste it, provide quality, etc. (that's what I mean with "fair"). There work needs to be done.
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  #76  
Old 27 April 2018, 07:52
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...You are not taking away anything from a veteran....
No? Seems to me that every appointment that I make is one less appointment for someone who really needs it.
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  #77  
Old 27 April 2018, 09:23
Fu King Lawyer Fu King Lawyer is offline
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Originally Posted by dutchdevildog View Post
Yeah a large majority of American tax payers (around 75% in polls) support spending more tax money on modernizing the VA. People support veterans. They aren't the problem. I think political leadership is the problem (in combination with special interest, lobbies, etc). Because in return government has to spend the money well, don't waste it, provide quality, etc. (that's what I mean with "fair"). There work needs to be done.
I previously mentioned that VA (and their political allies) use "disinformation campaigns", the fact is that the VA has BILLIONS of dollars in unspent funds - they can't spend all that congress gives them. The unobligated funds issues for the VA have gone on for decades. Here's a sampling plus a very good statement from a US Senator who left office in frustration with it all.


https://www.gao.gov/products/HRD-78-77

https://www.gpo.gov/fdsys/pkg/CHRG-1...9shrg28247.htm

https://digital.library.okstate.edu/...-shinseki.html



“The American people and our nation’s veterans need reform at the VA, not just resignations. Further, more money is not the answer. Funding for the VA has grown at more than three times the rate of inflation since 2009. My office has also learned that at the end of Fiscal Year 2013, the VA held nearly $35 billion in unspent funds, which is more than the entire annual budget of the National Institutes of Health. It’s long past time we gave our veterans the freedom they fought for. I look forward to introducing legislation with Senators McCain and Burr that will accomplish that goal in the coming days,” Dr. Coburn said.

At the conclusion of Fiscal Year 2013, the VA held nearly $35 billion in unspent funds. To give this amount some perspective, the entire annual budget of the National Institutes of Health (NIH) is $30.1 billion[1] -- billions of dollars less than the excess amount the VA leaves unspent at the end of every year. The department is projected to end 2014 with another larger sum of unspent money, including nearly $5.9 billion in unobligated funds.[2]
The VA “expects to carry over $450 million in medical-care funding from fiscal year 2014 to fiscal year 2015.”[3] This is the fifth year in a row the VA has carried over funding for medical care.[4] VA carried over $1.449 billion in medical-care funding from fiscal year 2010 to 2011, $1.163 billion from fiscal year 2011 to fiscal year 2012, $637 million from fiscal year 2012 to 2013, and $543 million from fiscal year 2013 to 2014
.

http://coburn.library.okstate.edu/ri...taxpayers.html

Last edited by Fu King Lawyer; 27 April 2018 at 09:41.
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  #78  
Old 27 April 2018, 09:41
8654maine 8654maine is offline
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Originally Posted by dutchdevildog View Post
Yeah a large majority of American tax payers (around 75% in polls) support spending more tax money on modernizing the VA. People support veterans. They aren't the problem. I think political leadership is the problem (in combination with special interest, lobbies, etc). Because in return government has to spend the money well, don't waste it, provide quality, etc. (that's what I mean with "fair"). There work needs to be done.
Interesting.

I think you are referring to this Gallup survey for your 75% quote. This was a phone survey of about 500 people during Mar '16. We have no idea if they are taxpayers. This is a meaningless survey. It's like a survey asking whether people are for child welfare.

In regards to the leadership issue, that is only part of the problem. The VA has changed leadership in many facilities as well as the Directors. Has anything changed?

And what do you mean by "modernizing", "special interest" and "lobbies"?

My observation is that the bureaucracy and the folks behind the bureaucracy are to blame for the faults of the VA. You seem to want more bureaucracy. That is not efficient.

My observation comes from 20 years of being a physician trying to take care of VA patients and enduring no less than hours of calling, paperwork and days of delay.

Just to be clear, this is not a bashing of all the people in the VA system. There are good folks who work there. There are good folks who understand that the veteran is the mission priority. But, the VA also houses many folks who think they are the G-chief in Robin Sage (in deference to my Army friends).

And the only one who suffers is my veteran patients.

ps. I see my colleague Fu King Lawyer has posted some interesting facts regarding the VA money. It just illustrates that adding more money to a problem is not a solution.
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  #79  
Old 27 April 2018, 09:43
8654maine 8654maine is offline
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...double tap...
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  #80  
Old 27 April 2018, 16:05
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Originally Posted by 8654maine View Post
Interesting.

I think you are referring to this Gallup survey for your 75% quote. This was a phone survey of about 500 people during Mar '16. We have no idea if they are taxpayers. This is a meaningless survey. It's like a survey asking whether people are for child welfare.

In regards to the leadership issue, that is only part of the problem. The VA has changed leadership in many facilities as well as the Directors. Has anything changed?

And what do you mean by "modernizing", "special interest" and "lobbies"?

My observation is that the bureaucracy and the folks behind the bureaucracy are to blame for the faults of the VA. You seem to want more bureaucracy. That is not efficient.

My observation comes from 20 years of being a physician trying to take care of VA patients and enduring no less than hours of calling, paperwork and days of delay.

Just to be clear, this is not a bashing of all the people in the VA system. There are good folks who work there. There are good folks who understand that the veteran is the mission priority. But, the VA also houses many folks who think they are the G-chief in Robin Sage (in deference to my Army friends).

And the only one who suffers is my veteran patients.

ps. I see my colleague Fu King Lawyer has posted some interesting facts regarding the VA money. It just illustrates that adding more money to a problem is not a solution.
I could not agree with you more. Some of the Links Fu King post have dates

The unexpended balances in the VA Major Projects appropriation account have grown sharply between fiscal year 1973 and the end of fiscal year 1977. At the end of fiscal year 1973, actual unexpended balances totaled $112 million, whereas at the end of fiscal year 1977, actual unexpended balances reached $708.5 million, an increase of more than 530 percent. Unobligated balances in the Major Projects account have also been steadily increasing since fiscal year 1973. The rise in both unexpended balances and unobligated balances can be attributed to: an expanded construction program, full funding of projects, phased construction of large projects, congressional actions, and VA misestimates. VA has developed a consistent pattern of significantly overestimating obligations and yearend unliquidated obligations and significantly underestimating yearend unobligated balances. Without marked changes in VA estimating procedures, these patterns are likely to continue indefinitely.

The building of or adding on to buildings at different V.A's are being done.

Part of the problem is STATE Regulations, OSHA, Unions, so forth & so forth. If all the funds are not spent by the facial year end or not allocated then they are with drawn.

The BID always goes to the Lowest BID. A lot of times there are cost over runs. It could be the contractor or the V.A. add something to the contract.

Each project has to be inspected a lot of times. Again this is where the problem is STATE Regulations, OSHA, Unions.

I know where the V.A. Hospital has a Building being used, BUT only have is can be used because. Someone screw up.
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