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VA healthcare privatization – good or bad?

December 29, 2016

There has always been buzz about taking the VA healthcare system private to varying degrees.

With the incoming Trump administration under constant fire from the left, any attempt to wrest it from the hands of the government is immediately attacked as wanting sub-standard care for our vets.

Indeed, there is nothing preventing a vet from  seeking care from non-military sources now. The problem comes in who pays for it, and how. Like the rest of us, very few vets can afford to pay all of the non-covered charges out-of-pocket.

Some of the challenges facing providers are addressed in this June 2014 article in Modern Healthcare.

Besides just the amount of reimbursement, the article details how time-consuming and difficult it is to obtain and then operate under a provider contract with the VA.

The VA generally pays at Medicare rates for any covered service. That leaves many providers loathe to accept veterans whose bills are paid through the government.

Caught in the middle are the men and women who serve.

Even those service personnel who have received vouchers to seek  non-VA medical care locally say that the system is far too time-consuming and subject to too many artificial restrictions to be effective as a model going forward.

The problem seems to stem not from a lack of access to non-military care that is greater than that of the general population, but in how and even whether the doctors and facilities receive sufficient compensation to accept veterans as patients.

It is unclear whether full privatization would or even could address that issue, given that providers feel they are under-compensated by ALL insurance plans.

Veterans who choose the government as their insurer of choice are subject to benefit and care restrictions, in the same way as are privately insured patients.

Reimbursement for services provided is a problem throughout the U.S. but the difficulties for veterans are compounded by the specialized care needed by many veterans.

There are some things the VA is uniquely qualified to treat, specifically any combat-related injury, treatment  and subsequent rehabilitation, including PTSD.

On the flip side, there is no reason why a simple appendectomy or childbirth, elective surgery, general mental health issue or any condition widely seen in the general population should be restricted to the VA.

That leads many people to ask why the VA shouldn’t be reorganized as a sort of specialist referral treatment center and it’s services prioritized to favor specific conditions.

That would leave the rest of our healthcare system free to treat active-duty veterans the same way that they do the non-military population.

There is a popular misconception that if you have ever served, you get “free” healthcare for life.

That’s not true.  Although the VA benefit explanation website doesn’t always seem to have the most complete explanation, an overview of the differences between types and scope of coverage can be seen on the website here.

One thing that stands out is not the differences between military healthcare benefits and the general insurance market, but how similar they are.

What does seem to be different is that the private healthcare system is subject to much more intensive oversight when it comes to quality of service.

One former  Joint Commission accreditation inspector whose father is a veteran notes that he has never seen a VA hospital yet that he wouldn’t have failed at inspection.

Balancing that are vets who say that once you actually begin receiving care, the doctors and other hands-on medical staff are highly skilled and very caring, perhaps far more so than their civilian counterparts when dealing with combat injuries.

All in all, and given the amount of scrutiny given the multiple and repeated reports of sub-standard response times, overcrowded appointment desks and even deaths due to delayed care, it seems likely that some privatization could have good results.

Perhaps, like many of the issues facing the new President, this is one of the times that a sensible compromise would lead to the best overall result.

From → op-ed

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