"Obama has combined foreign and domestic disasters, scandals and failures in an entirely unique, unprecedentedly awful, comprehensive and kaleidoscopic fashion." JerryFox News: Obama Promises to Fix VA
"Apart from the VA, I don't see any scandals. There have been some political disputes, however. I will be looking forward into the Congressional investigations in Congress' failure to adequately fund the VA. I expect they will be really hard on themselves." Hiram
Kaiser: VA Controversy Showcases Problems With Government Health Care
LA Times VA Problems Systemic
WP: Obama Defends Veteran Policies
So what do you think?
Is this just what happens when you try to "socialize and cost control health care"?
Is it a good reason to avoid single payer and/or single provider?
Or is it something else?
my views are shaped by my favorite news interpreter, Kevin Drum who concludes his blog post with this:
ReplyDelete"...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."
Here's Why It's a Mistake to Foxify the VA Story
So Obama promised to fix the system and then I don't here him talking about it for 5 years until something bad happens. Maybe there weren't enough votes there.
ReplyDeleteI hear him talking about wealth distribution and pardoning illegal immigrants often... But nothing about the VA... Interesting.
I think what we see here is a systems failure. A lot of the visible problem, are just symptoms of that failure, concealment of wait lists, as opposed to the existence of wait lists. And the larger problem stems from the feudalistic state of health care; with each sector supreme in it's own domain, unable, and sometimes unwilling, to communicate with other sectors. It's a pattern I have seen before, in the public sector, in the private sector, and in the area where the public and private sectors interact.
ReplyDeleteThe difficulties in addressing these problems are immense. For one thing, there is no central authority, no iron fist that can rectify the situation through fiat. To make it work, or at least work better, you have to get the support of people whom you don't have power over, who have their own turf to protect, who might indeed have very good reasons for doing what you don't want them to do. I can tell you from a lot of experience both personal and impersonal that any attempt to get a grip on this situation will yield a harvest of anecdotes, about how things went wrong or might have gone better.
In other words, it's a mess, and one that requires a massive and coordinated effort not to correct but just to make a little bit less of a mess.
--Hiram
John, its funny how your responses to most issues include the words "wealth distribution." If you want to become a more popular blogger like Kevin Drum, I suggest more balance, objective, or nuanced opinions.
ReplyDeleteAlso,perhaps the VA could be functioning better if congress had distribute more wealth by funding more VA care facilities.
First, Obama knew about this for years, and now says he knew nothing about it. Second, his administration may have officially created the rules that resulted in this chicanery and the death and unnecessary suffering. Like so many other scandals-- Obamacare, the IRS, Benghazi-- he claims he knew nothing, demands it be fixed, and goes back to his golf game.
ReplyDeleteDespite the constant increase in the VA budget and the decrease in the number of veterans, the system's inherent inefficiency made these failures inevitable. The root cause, in other words, is the fact that this is a government program. There is no competition, and no accountability. Those delivering the service do not depend on the customer's patronage or customer satisfaction to be paid. They get the same (or more) whether the vets live or die, are cured or go on suffering. Any private enterprise would have gone out of business long ago, and rightly so.
We all knew about it for years. The question is, do we have the political will to do something about it?
ReplyDelete--Hiram
Sorry Laurie,
ReplyDeleteEconomist Inequality
I didn't pick the DFL or Obama's 2014 platform... Two key legs of it are wealth inequality and immigration pardons. I am sure we will hear a lot about both of these before November.
And now that there is a problem, we may even hear about the VA system that he promised to fix.
actions speak louder than words and it looks to me that overall Obama has done pretty well keeping
ReplyDeletePromises about Veterans (on The Obameter)
Since when is the number of veterans decreasing? The VA is serving 1 million more people today than when President Obama took office.
ReplyDeleteThey may be serving (or not serving, apparently) more people, but they aren't veterans.
ReplyDeletehttp://www.va.gov/vetdata/docs/quickfacts/Population_slideshow.pdf
The total veteran population is different from the number of people served by the VA for health services.
ReplyDeletehttp://www.va.gov/vetdata/docs/Utilization/VHAStats.xls
VA Gov Population Slideshow
ReplyDeleteVA Gov VHA Stats
I added an image of the VHA Stats to the post.
ReplyDeletePolitifact Obama VHA
ReplyDeleteSo Obama intentionally overloaded the system by adding people who could afford healthcare elsewhere and had no military related health conditions?
I can understand providing long term on going healthcare for those that were negatively impacted by their time in the military, however are we really giving career military personnel free healthcare after they retire?
What am I missing here? That is quite a benefit...
The current priority 8 income threshold is $31,000 for a single person, which would qualify for an ACA subsidy.
ReplyDeletePriority 8 veterans do not receive free healthcare from the VA -- the VA essentially functions as their insurance company, and they pay co-pays and deductibles.
If they pay co-pays and deductibles, who pays their premium?
ReplyDeleteHow about going back to the original question? Why are some 40 of our nation's heroes dead by neglect of the VA bureaucracy? I contend it is an inevitable result of government-run healthcare.
ReplyDeleteWE Story
ReplyDeleteWP Story
Why are some 40 of our nation's heroes dead by neglect of the VA bureaucracy?
ReplyDeleteInefficient allocation of inadequate resources.
--Hiram
The problem when one thinks they can price control something through single payer...
ReplyDelete"Inefficient allocation of inadequate resources."
ReplyDeleteIf the allocation is inefficient (and by one story it is less than 10% as efficient as private medicine), then the resources are not inadequate, they are excessive. And the reason is because there is no cost control due to competition, and imposing external (i.e., not driven by "customers") cost controls only makes matters worse.
So you guys think we should dismantle the VA, then? What next?
ReplyDeleteI would suggest that the VA follow its own rules, and send vets to private hospitals if they cannot treat the vets in a proper and timely fashion. It's a short step from there to providing "premium support" for veteran's care, with the VA hospitals becoming optional "charity hospitals" for vets, with an emphasis on their unique sorts of injuries. The good ones would continue to be patronized and the bad ones would go out of business. What's wrong with that?
ReplyDeleteSean,
ReplyDeleteI think the VHA maybe be beneficial for people injured in action. Many similar injuries and disorders that are rare in the typical public. However it definitely provides a good example of the problems with single payer/provider and price fixing.
Jerry,
ReplyDeleteSource for your 10% comment?
Hopefully apples to apples. (Ie many severe injuries with long term impact)
"If the allocation is inefficient (and by one story it is less than 10% as efficient as private medicine), then the resources are not inadequate,"
ReplyDeleteI am not sure where that comes from, If I have four bananas to feed five people, I might divide them up in ways that are most efficient, the hungry person might get more than the person who isn't hungry. But that doesn't mean I have an adequate number of bananas.
For various reasons we have to few doctors and too few nurses in this country. That just doesn't mean they can't be deployed efficiently. what it means in fact is that efficiency in the deployment of their services is at a premium.
--Hiram
"However it definitely provides a good example of the problems with single payer/provider and price fixing."
ReplyDeleteI don't agree, because the VHA doesn't work like a single-payer system would work in the U.S.
Besides, you're all ignoring how the VHA produces better health outcomes than the health care system for the rest of us.
"For various reasons we have to few doctors and too few nurses in this country."
ReplyDeleteYes, and the reasons all have to do with government interference in the free market. Right now you have many doctors planning to retire, or to not accept Obamacare plans, or Medicaid or Medicare patients. And fewer people want to become doctors because they won't be given the freedom to practice in their patients' best interests because of government interference. Prime example may be the VA, but as we learned yesterday the problem is "systemic."
better outcomes? You mean like death? It may be true overall, for those who actually get treatment, but when you ration care you do not produce a better outcome than when you don't.
ReplyDelete"when you ration care you do not produce a better outcome than when you don't."
ReplyDeleteOK, but every health care system in the world rations. The question is how do you ration care -- or is it possible to provide the resources to prevent rationing altogether?
"every health care system in the world rations"
ReplyDelete"rations
: food or supplies
: a particular amount of something (such as gasoline or food) that the government allows you to have when there is not enough of it" Merriam Webster
I guess I disagree. Please explain your rationale.
Since I can not afford to buy an incredible cabin on a beautiful lake, does that mean cabins are being "rationed"???
ReplyDeletePersonally I have never experienced any significant delay in getting healthcare or counseling... So I don't think we have a scarcity of healthcare resources.
You took the noun definition. I was using it as a verb:
ReplyDelete"to supply, apportion, or distribute"
There is not a health care system in the world where everyone gets all the health care they need. As such, health care is rationed. If you want to debate semantics, feel free to substitute your own term for the process I just described.
Our system is largely rationed on ability to pay. Other systems do the rationing on different criteria. Your personal experience means little in the larger scheme, where we know people die because they don't have reliable access to the health care system.
ReplyDeleteYes, and the reasons all have to do with government interference in the free market.
If government got out of the business, do you think investing in medical schools would be a good business opportunity?
--Hiram
So someone is rationing those lake front cabins...
ReplyDeleteSure, you could say the number of lakefront cabins are rationed. Are you done with this silly semantic argument now?
ReplyDeleteNo. I think rationing is when some "person, organization or government" decides how to distribute a scarce resource.
ReplyDeleteI do not think health care is a scarce resource. And I don't think any "person, organization or government" is choosing how to distribute it.
I'll give some thought to a better word.
"Rationing: verb (used with object)
ReplyDelete4. to supply, apportion, or distribute as rations (often followed by out ): to ration out food to an army.
5. to supply or provide with rations: to ration an army with food.
6. to restrict the consumption of (a commodity, food, etc.): to ration meat during war.
7. to restrict the consumption of (a consumer): The civilian population was rationed while the war lasted."
Well, then, by your logic, lakefront cabins are more rationed than health care because government regulations strongly control how much and where people are allowed to build on lakefront property.
ReplyDeleteBut back to the original point. Do you disagree with my statement that "There is not a health care system in the world where everyone gets all the health care they need."
Here's a useful article.
ReplyDeletehttp://www.vox.com/2014/5/29/5761482/what-the-va-scandal-tells-us-about-health-care-rationing
What VA Tells Us about Health Care Rationing
ReplyDeleteI am unsure...
ReplyDelete"There is not a health care system in the world where everyone gets all the health care they need."
In the USA a very large number of us who can afford it get all the healthcare we need...
And those who can not afford it get as much healthcare as the government budgets for them or rations to them.
"In the USA a very large number of us who can afford it get all the healthcare we need...
ReplyDeleteAnd those who can not afford it get as much healthcare as the government budgets for them or rations to them."
That answer indicates that in our system not everyone gets all the healthcare they need.
However, many of us do get everything we need and more.
ReplyDeleteIs it better to "ration" everyone in the name of equality?
Rush Trees
"Is it better to "ration" everyone in the name of equality?"
ReplyDeleteThat's the question, isn't it? Are we OK with people being left out of the system or not?
I guess my point is that they currently are not left out of the system. We have medicaid, medicare, VHA, etc to provide healthcare for the needy.
ReplyDeleteThis cold hearted saying is pretty appropriate... "Beggars can't be choosers." Therefore if one is to "ration", it seems this is the place to do it.
Rationing services for those who are paying their own way seems distinctly un-American.
"I guess my point is that they currently are not left out of the system. We have medicaid, medicare, VHA, etc to provide healthcare for the needy."
ReplyDeleteThese plans, while better than nothing, don't get it done. Health outcomes for the uninsured are significantly worse. See:
http://www.mathematica-mpr.com/publications/PDFs/health/reformhealthcare_IB1.pdf
http://www.iom.edu/~/media/Files/Report%20Files/2009/Americas-Uninsured-Crisis-Consequences-for-Health-and-Health-Care/Americas%20Uninsured%20Crisis%202009%20Report%20Brief.pdf
http://www.medscape.com/viewarticle/573877_4
http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Health Reform Care
ReplyDeleteUninsured Crisis
Medscape View Article
KFF Uninsured Facts
I'll look at them later.
ReplyDeleteJust curious... Do you think society is also responsible to pay so every person standing on American soil has food, housing, clothing, utilities, etc also?
ReplyDeleteWhether they strive to learn and work hard or not? No matter how many children they choose to have? Whether they gamble, smoke, drink, or spend their money in other unhealthy and somewhat wasteful ways?
Is providing low cost healthcare more or less important than the above in your opinion?
We already ensure they have access to a free education, and many squander that.
If we do provide free food, housing, clothing, utilities, healthcare and education, etc to every person standing on American soil, do you really see this incenting people to strive for more, better lives and a better America? Or will many happily live their minimalistic lives and go fishing, etc?
I think as a society we ought to be able to guarantee folks access to our health care system. That will actually make people MORE free, not less.
ReplyDeleteHow many people do you know that have made job decision based solely or primarily on health benefits? That's incredibly distortive to labor markets, which should be about matching employee skills and experience to employer needs.
How great would it be for American competitiveness to have the cost of health care largely removed from the cost of producing a good or service?
You're complaining about the small number of people who might freeload -- while defending a system that in fact rewards freeloading (because that's what the pre-ACA world does).
I'm worried about the large number of people who will gain security and the freedom to live life without worrying about how they would handle a medical crisis or a car accident or how they're going to fill that next refill on their expensive prescription.
And when I say "folks", I mean people who are here legally.
ReplyDeleteThe Liberal folks on MinnPost want the free healthcare etc so people will be free to pursue their artistic or other passions... Is that what you want for American citizens?
ReplyDelete"made job decision based solely or primarily on health benefits?"
Since I see health benefits as just a form of compensation, I disagree with you. People have been free to buy their own health insurance at any time. My Parents and farming/self employed friends have been doing it for decades.
By the way, you avoided my questions... To be "fair", do we need to provide free food, housing, clothing, utilities, healthcare, education, etc to every person "legally standing" on American soil?
I mean food seems just as important as healthcare... Many think housing is right up there also.
The commenters at MinnPost Resign have a lot to say about the cause...
ReplyDeleteI added my 2 cents.
ReplyDelete"Metrics matter: Top level managers tend to rely heavily on metrics when turning the knobs on a large organization. I mean what else can they do...
So yes the misreporting was a huge problem. If you are in charge of the VHA and the reports continue to show excellent care, acceptable wait times, reasonable costs, etc. Why would you lobby hard for more resources or make big changes? What would you use as proof that change was required?
This is a key problem with single payer/ single provider systems. The customers aren't free to go elsewhere when they are dissatisfied. So the problem stays hidden..."
Not all people have been free to buy their own insurance. People with preexisting conditions didn't have that freedom.
ReplyDeleteAs for your other question, no, I don't believe in an unlimited safety net. I would put health care, though, at the top of the list of things we should be providing. It's hard for people to be "productive" if they are in poor health.
I agree that metric matter. Unfortunately, the VA administrators were judged on wait times, so they were incentivized to fudge it.
ReplyDeleteNR Doomed to Failure
ReplyDeleteDB Scandal Hits New Hospital
I thought this was interesting. "For perspective, 60% of cardiologists reported seeing between 50 and 124 patients per week, according to a 2013 survey of medical professionals’ compensation conducted by Medscape. On the low end, the average single private practice cardiologist who participated in the study saw more patients in a week than the Albuquerque VA’s entire eight-person cardiology department."
"Our system is largely rationed on ability to pay." What keeps getting forgotten is that when prices rise, more suppliers enter the marketplace, and price comes down to minimize the rationing. That is, so long as someone wants to buy, someone may wish to sell.
ReplyDeleteThe systems which do the most rationing are those in which prices are fixed, as by government. In such cases, suppliers desert the marketplace and more rationing-- denial of service-- occurs.
And let me disagree that "there is no health care system" that "gives people all the health care they need." There is no system which will give everybody all the health care they WANT, and when government provides it "free," the wants quickly outstrip the available providing resources. Rationing MUST take place by people being responsible for the cost of their purchasing decisions. The system in the USA, like it or not, USED TO come closest to providing all the health care people NEED.
"Not all people have been free to buy their own insurance. People with preexisting conditions didn't have that freedom."
ReplyDeleteNot true. Many states have "high risk pools" where people who want to buy insurance for not RISK, but certainty, can buy health insurance, paying what it reasonably costs. Obamacare basically wipes out that fairness and requires all of us to pay those extra costs.
"The system in the USA, like it or not, USED TO come closest to providing all the health care people NEED."
ReplyDeleteThat's just not true. If we were getting the health care we needed, we wouldn't rank so poorly on so many health outcomes.
Yes, we would. For one example, we base infant mortality on every live birth, including radically premature babies. Other countries start counting an "infant" at age one. And few developed countries have the diverse population and violence of our society. More medical care, good bad or otherwise, isn't going to change those statistics much. And turning it over to a system in which the perverse incentives require rationing of care is exactly the wrong answer.
ReplyDeleteStanford Medical School doesn't agree.
ReplyDeletehttp://stanmed.stanford.edu/2013fall/article2.html
What can we do to reduce infant mortality: "eliminat[e] social disparities in medicine"
As usual, there are any number of ways to interpret the raw statistics. Certainly, one can expect young mothers without health insurance, absent any other factor, to have higher premature birth rates and infant mortality as a result. But finding a solution isn't nearly as simple and straightforward. The majority of these "poor" women were eligible for Medicaid and didn't apply for it. Regardless of the quality of care that would provide, one might assume it better than nothing, and the responsibility to obtain that care falls on that young mother. Now if she didn't know she needed prenatal care (which is likely) you might argue that "society" should have educated her. But she may have refused that as well. After all, she ignored society's advice about not getting pregnant in the first place.
ReplyDelete