VA proposes private healthcare plan
Stars & Stripes reports that Veterans’ Affairs officials proposed to House lawmakers a plan to relieve the bottleneck at the VA healthcare facilities which includes widespread access to private facilities outside of the VA with an initial price tag of $421 million next year;
Much of the shift still must be decided and funded. The VA will start with creating a new referral system and efforts to improve its customer service, said Baligh Yehia, the VA assistant deputy undersecretary for health for community care.
Republicans on the House Veterans Affairs Committee called the move crucial and said they support the VA.
Debates over privatizing the VA have raised concerns recently. But Rep. Jeff Miller, R-Fla., chairman of the committee, said the integrated private care system would “supplement, not supplant” the health care now provided by the department.
This administration and Democrats have long-resisted any move to privatize VA healthcare, in spite of the failures of the old system. In fact, when several Republican presidential candidates endorsed privatizing the system, they were widely criticized in the media and by Democrat lawmakers. When Congress authorized the VA Choice system last year, the VA and the White House raided those funds to pay for the same-old-same-old at the VA.
Category: Veteran Health Care, Veterans' Affairs Department
“Here’s a case of Deer Park water and a Costco 2 pack of 500 count 200 mg Generic Store Brand Motrin. Have a nice day…..NEXT!!!!”
For some others (Bersnaty, Queefers, etc…) here’s your box or Pamprin and douche for your mangina… it should clear up for manginitis and help ease the pain of your fractured taint.
If you knew what I know, you would be in a rabbit hole.
Well, what is it that you know?
I’ve worked in the medical world since I was 19 years old. What I’m about to say is going to make veterans cringe, but think about it and see if it makes sense. Perhaps the model does need to change. The government still needs to be responsible for the bills, period. That’s what the contract says, and the government needs to honor it. But the VA system has developed into a giant parasite. Why not do this: keep the military hospitals for active duty personnel and acute care needs of wounded soldiers. Use the VA for those wounded who need long term continuity of care. For those veterans who are no longer in service, release them to use private healthcare. Let the private physicians bill the government. There is no service provided by the VA that the private sector can’t provide. Why not give the veteran the chance to stay in his community and be provided care by a local physician/clinic of his/her choice?
Yes, PN. And Medicare works just “oh so well”, and is fraud-free.
The essential problem with the VA is it’s turned into a giveaway agency. With the exception of those 100% disabled and (possibly) former POWs and MoH recipients, I fail to see why the VA should provide free healthcare for ANYTHING that’s not service-connected. And don’t get me started about that “presumptive” BS.
If a condition is service-connected, then IMO a vet has the right to expect the VA to treat it gratis. But if it’s not service-connected, well, IMO that’s simply the way life goes sometimes. That’s not something Uncle Sam should be paying for.
Uncle Sam is flat broke. He can’t afford to keep handing out unearned freebies.
If you go to the VA for anything that is NOT service-connected, you will get treated for it, but you still have to pay for it.
That means that if you have any part of Medicare, you need Part C in order to pay for any health care the VA might provide. You can substitute VA prescriptions for Part D, but you have to meet the co-payment, which is usually $8.00, UNLESS otherwise specified.
It is NOT free. You have to pay for it.
I don’t know where this idea comes from that VA health care is free. It is not. It says so the the most recent VA benefits book issued, which I received in October. You still have to pay for it.
Not necessarily. If eligible for VA medical care and enrolled, you will be treated for pretty much anything. But you may – or may not – be charged a copayment. Whether or not you get charged a copayment, or whether you pay only part of the normal copayment, is in general dependent on your VA priority group. Here’s a quick and dirty summary. – Indigent or low-income? Copayment reduced by 80%. – Catastrophically disabled, housebound, or in receipt of “aid and assistance” payments? Copayments waived. – Have a 50+% VA disability rating, or rated as unemployable? Copayments are waived. – Former POW? Most copayments waived. – SEA service? Copayments waived for a load of “presumtive” conditions, many or most of which are also associated with normal aging. (Ditto for radiation exposure vets and those who served at Lejune between 1953 and 1987.) – Any VA rating above 0%? Inpatient and outpatient treatment copayments waived. – Drawing a VA pension? Copayments waived. – MST? Copayments waived. http://www.va.gov/healthbenefits/resources/priority_groups.asp http://www.va.gov/healthbenefits/resources/publications/IB10-431_copay_requirements_at_a_glance.pdf If you have private insurance, the VA will indeed bill your private insurance (required by law). However, VA medical care entitlement qualifies under the Affordable Care Act as qualifying coverage – so that’s an additional subsidy. If eligible for VA medical care and enrolled, you can cancel private insurance w/o incurring the ACA’s annual penalty and simply pay the copayments instead. In short, the VA treats a sh!tload more people gratis (or at hugely reduced cost) for routine stuff than you might think. And as the Vietnam vet population continues to age, thanks to the 2009 decision to make everyone who ever set foot in the RVN (plus a bunch of other people also) “presumptively exposed” to Agent Orange without any requirement for proof of exposure, we’re going to see the number of people treated for aging-related conditions (many of which are also “Agent Orange presumptive conditions”) spike over the next few years. The VA medical system needs a complete overhaul, if not a complete “scrap and rebuild”. The medical personnel do care, and they do provide decent treatment. But the system has… Read more »
Okay, I’m in Priority 2, which means I have to pay for it. The VA won’t take Medicare A or B, so that means I have to use Medicare Part C. Or just not get sick or anything.
Based on the VA’s current copayment policies, the only copayments you should have to pay for VA medical care if you’re in Priority Group 2 should be for prescription meds relating to the treatment of non-service-connected conditions (prescription meds for treating service-connected conditions don’t require a copayment). If they’re telling you you are responsible for paying any other copayments, I’d print a copy of the flier I cited above regarding copayments and your most recent rating letter, take them to the nearest VA patient advocate, and ask for an explanation why.
Two caveats regarding the above:
(a) Medicare and the VA may well have an intergovermental reimbursement agreement. (TRICARE and Medicare do.) If so, that could explain why they’re billing Medicare. That’s technically not a copayment, but can certainly look like one on an insurance EOB.
(b) Medicare Part C is technically private insurance, so by law I’m pretty sure the VA is required to bill your Part C insurer if you have Medicare Part C. That’s true regardless of whether you’d otherwise be required to pay a copayment for VA treatment.
No system works well when its coffers are raided as slush funds.
People keep talking about ‘service-connected disabilities’ like that’s an easy diagnosis. Broken neck = paralysis is easy to diagnose. Unmeasured exposure to unknown or poorly understood toxin/environmental compound = slow neurological degeneration is not so easy to diagnose. So what do medical folks do? Err on the side of assumption, so the poor bugger gets some help. Do you want to drop the ax? Or set the guidelines for length of time cutoff for exposure to equate to illness that gets paid for? It’s easy enough to talk about people getting welfare when it’s not you or someone you love who is suffering. It’s not so easy when you’re dealing with a fast deterioration of a veteran who’s only recourse for comprehensive and expensive medical treatment is the VA. The doctors at the VA won’t turn a veteran away when they realize that veteran is dying, and their attitude is the bill will get settled later. I’ve been on both sides of the desk when the bill comes due, Hondo, and they’ve got it right. The life comes first; the bill comes second. I can think of a lot of programs that should suffer loss before the VA, no matter how bloated and ungainly it is.
PN: if the preponderance of evidence indicates a medical condition was incurred or aggravated during military service, the VA should provide care. However, we’ve moved well beyond that in recent years. Here’s a hypothetical case in point. 1. A male joins the Army in 1972, at age 18. He is discharged in 1972 during Initial Entry Training (IET) due to a back injury he incurred during IET. The back injury is determined to be both service connected and disqualifying for continued military service, and he receives an initial VA disability rating of 10%. 2. The man begins smoking at age 20 – 2 years after leaving the military. 3. The man’s back deteriorates over time. In 1995, he eventually ends up with a 50% VA service-connected disability rating for his bad back. 4. After smoking for 40 years, in 2014 the man unfortunately develops lung cancer. During his brief military career, he had no documented exposure to chemicals or toxins during that would have reasonably been expected to cause lung cancer. Under current rules, since he has a VA disability rating the VA will provide care for ALL of his health conditions – service connected or not. This includes his lung cancer. And since he’s rated as being 50% or greater disabled, he will receive this treatment absolutely gratis. (He’d have to pay some copayments if he was rated between 10% and 40% – specifically, for prescriptions – $8 per month per prescription, to be precise – along with certain extended care services. But even under those conditions there would be no copayment for either inpatient or outpatient care.) In short, Uncle Sam would foot the bill for ALL of the man’s medical care – for life. That’s true even though his only service-connected condition is his back. We’ve also now deemed a load of conditions “presumptive” (gee thanks, Shinsecki) for anyone who served in Vietnam. And guess what? Various cancers are on that list – including prostate cancer and respiratory cancers, both of which are also associated with aging. Along with heart disease (also associated with aging). And don’t… Read more »
You made a very good point, and that is that a patient cannot be separated from his disease. In other words, it is impractical for a medical establishment to accept the responsibility to treat a patient for one condition, but not another. Cost aside (although that was another valid point), that factor alone should signal a complete overhaul of the VA and veteran care in general. If there was ever a day when veterans said, “I won’t go the VA with this because it had nothing to do with my service,” that day is long gone. So I think we’d either approach it from the ‘cradle to grave’ position, and prepare to treat them for life for everything, or privatize their care, and let them get treated in the public domain, like everyone else. That probably wouldn’t work, but it’s always nice to give people a choice. (That last was meant as sarcasm.) Now: cost. Our medical care payment system suffers under a fact that no other for-profit entity suffers from, and that is the inverse ratio between health and income. Most people spend money in the private sector when their healthy, and bills can expect to be paid on time as the customer continues to work. The ratio is inverted in the medical world; more money is spent by people who will be working and earning less the sicker they are, and that doesn’t even begin to cover the critically ill patient who dies during their illness, thereby leaving the bills completely unpaid. So right there, running a medical business is a losing proposition, unless something is done to close the gap between illness and income. While I can define the problem, I can’t solve it. No one seems able to. You either have socialized medicine, where the nation as a whole picks up the burden, or you use a capitalistic system that leaves people to worry about their own health. We’ve tried the latter, and are uncomfortable with the results of uninsured people suffering without care. We’re reticent to attempt the former. So, we limp along with some… Read more »
Hondo, awhile back I read about them spraying agent orange on the DMZ in Korea while I was there, back in ’72. I ‘spose the VA will start picking up the tab for that too?
You might have difficulty.
The US military did in fact use Agent Orange along the Korean DMZ at times. Further, the VA has made Agent Orange exposure presumptive for personnel serving in units along the Korean DMZ – but only for service between 1 April 1968 and 31 August 1971. I’d guess personnel serving there after those dates may well have difficulty convincing the VA that they qualify.
http://www.publichealth.va.gov/exposures/agentorange/locations/korea.asp
Hondo, I didn’t mean for myself, but the guys affected, which compared to ‘Nam prolly won’t be all that many for the relatively short time frame.
Most of the guys I know who have PTSD are rated at 50% and in my opinion that is an appropriate rating. Almost every single one of them is in a worse place in the life than they should be given the caliber of soldiers they were. Most have developed drinking problems where there was none before, most have marriages broken because of their issues, and three have attempted suicide; two of which were successful. Others have only spoke of engaging in suicidal ideation. None of these men were like this before combat. I even know of one guy who is rated at 100% and he ain’t faking, he’s just flat out mentally gone.
There are obviously bullshitters and malingerers who give the system a bad name, but that’s not a reason to punish the veterans who have legitimate problems.
Yes, there are obviously bulshitters. Use the site’s search feature with the name “Joseph Cryer”.
And pray tell – where did I say anything about “punishing” anyone? All I said was that I personally find many PTSD disability ratings highly questionable. That doesn’t mean all of them are highly exaggerated or complete bull – but IMO, a large fraction may well be. How large a fraction? Dunno. But 1/4 or more wouldn’t surprise me.
Where there’s money to be had by lying, some will lie to get money.
I guess I misunderstood what you were saying. When you brought up the 50% rating and up, I thought you were arguing that PTSD shouldn’t rate that highly. My apologies if I was mistaken.
As for the faction that you posed, I’m unwilling to speculate. It may very well be that high, but all of the dozen or so guys I know that claim PTSD are legit, but that’s anecdotal. That being said, there are likely other people I served with who are totally fine but quietly claiming dishonestly.
That sounds reasonable.
This is going to drive up costs to the veteran and not improve care.
As opposed to just letting them die while they try to get a simple appointment?
This is not really about expanding care, it is about privatizing the VA.
This will result in increasing copays for veterans. Ultimately even for service connected issues.
Other privatization initiatives led to higher costs to the government and often higher costs to the soldier.
They are going to have to charge a copay to keep veterans from using their healthcare for frivolous issues.
And then it is just a matter of the industry lobbying for more copays and copay increases year over year over time.
Ultimately veterans will just be offered health insurance options like soldiers are.
That is the endgame.
As you guys know, I am a civilian with no military service. I am however, insured. I pay the premium each month. For the sum of 2500 dollars out of pocket expense, I was informed that I have a fractured bone in my arm. Yesterday I put a cast on my arm all by myself. 3m fiberglass casting material from Amazon and a gun sock. Total cost, less than $28. Affordable healthcare behold.
How did it possibly cost you that much out of pocket? In every ER in which I have ever worked, including the one I am currently the chief of, a full series of arm x-rays, provider fees, and initial casting would never cost over about $800 even for the most complex fracture. They let you leave without a cast? That’s malpractice right there. Now, did you pad the fiberglass and do you have any way to get a follow up x-ray? post-casting x-rays must always be performed in order to assure alignment.
If that’s the total cost for an ER visit, that could be about right. Further, for a high-deductible health insurance plan $2500 (or more) might be the total required “out of pocket” expense required prior to receiving ANY reimbursement for the year.
Some health insurance plans are also very unforgiving of going to external (non-PPO) providers for anything other than emergency care. Unforgiving, as in “you eat the bill”.
Hello Doc. I am out driving around town and on my phone right now. I will answer your questions later when I return to my shop. Initial xrays and radiologist reports indicated zero separation, radial head fracture. I am simply trying to keep my arm immobilized while I work so it will heal. I would have preferred a Velcro rigid arm sling but I did not have a prescription to buy one.
Velcro rigid arm splint, sorry.
I want to go to the ED you work at DocHoncho. I had to take my wife in for a gallbladder/gallstone attack, the total for that visit was over 4500 bucks. It did come with an ultrasound and some IV morphine so maybe that drove the cost up. itemized bill available on request. 🙂
My spouse, at 50, was having a dumbs attack and got on one of those Rip Sticks. He broke his elbow. I paid over $1000.00 for the ER visit and we have insurance. They charged for the ER, they charged for the radiologist to read the X-ray and for the ortho dude. In-SANE. I use urgent care at every turn these days because it’s cheaper.
My spouse lost his job a month ago and our new premium would be $1500/month, plus the $7500 deductible before anything is covered and then you can throw in the 300/month for RX. Er….I think I’ll pay the penalty. FY, Obama.
Okay. Doctor Honcho, here’s the brief. Checking the latest iteration of my insurance website, it appears that my out of pocket costs have been lowered. I went to one hospital ER that was “in network”. I have received bills from 2 separate business entities for “emergency services”… one “in network” and one “not”. The out of network bill was $1600 alone. Apparently, sometime since my irate phone call to Aetna, Aetna has merged them into the network I guess. My bill is lower now as a result. Whereas last week my bill totaled $2556, it now totals $1264. I am paying twice, to 2 separate entities for “emergency services” although my feet were in one place. I am paying for “treatment of radius fracture”. I was there on a friday afternoon. Treatment consisted of a nurse giving me a piece of paper that essentially said “Congratulations, you have radial head fracture”, you have been given a sling (I had not), make an appointment with an Ortho spec. within 5 to seven days. I asked if I could see the x-rays but was told “we don’t do that”. I was given a scrip for 800mg motrin and Tylenol 3 (I did not fill the tylenol 3 scrip). I spent the weekend as such. Monday I tried twice to make an appointment with an in network ortho practice but they could not set an appointment because their computers were down. Monday I went back to the ER to try to get my records. At that point I found out they had mistakenly coded me as a female (not that it matters anymore I guess). I left with digital copies of my xrays, radiology reports, etc. I went to the Ortho practice lobby down the hall and asked if one of the 12 orthos on staff could speak with me for a few minutes. I was politely told this was not possible. At that point, I decided to treat myself. I found an arm splint like this one http://www.braceshop.com/procare-elbow-ranger-motion-control.htm locally, but was told I could not buy it without a freaking prescription. Hello… Read more »
Very Kool
Trump has proposed a similar plan. Your VA card will get you into any facility that accepts govt dollars such as Medicare.
Can’t be any worse than it is now.
I am a retiree. Since my last 5 years on active duty we have been on Tricare standard and love it. We pay copays, but we can pick pur doctors.
The Army certified that I am entitled to lifetime care upon, and Tricare is basically my insurance plan.
I haven’t been to the VA once for medical care, even for service connected issues.
I recognize that it is different for non-retirees, and I wouldn’t presume to tell them what works. However, I get much better care than I did when I was on active duty.
I can see a similar system for service connected medical issues- the VA determines that you are entitled to care, sets their price, and you go to whatever doc you want.
i remember hearing a discussion once on AFN in which it was alleged that if you gave every family on welfare a check for $15000 (the poverty line at the time), it would cost X billion dollars – but the cost of all the welfare, food stamp etc. programs was well over double that. Have to wonder if you restricted VA to ONLY service-connected treatment and retiree’s care – would what was saved pay for the alternative program?
David, in general a military retiree does not automatically have entitlement to VA medical care. They either have to have a VA disability rating or some other means of establishing VA medical treatment eligibility.
In particular, military retirees with either no VA rating or a 0% rating currently appear ineligible to receive routine VA medical care (they’re eligible for care for service-connected conditions only).
Military retirees are, however, eligible for TRICARE. That’s not run by the VA.
One of the few things worse than Big Government is Big Pharma. Privatize the VA and that’s who will rush in to take it over and Hoover up every last dollar they can. Fuck that, I’ll take the lesser of two evils.
Well, considering I was only in the Navy (67-71) and was not in combat (never left the USA) and only got a geedunk metal (maybe because I was in a fight in my barracks), I feel I haven’t earned VA medical care. Most everything wrong with me has to do with after-service injuries and age. I did however try to use the VA when I was low on money in the past and my experience was crappy (stories left out). If I were younger, I would be screwed because I can’t afford private insurance and would be forced into the VA system. I now rely on a Medicare and a Suppliment policy which costs me $192/mo. Private doctors are fantastic. And no way would I go with Medicaid, which many doctors don’t take.
http://www.usatoday.com/story/news/nation/2014/02/27/veterans-legislation-bernie-sanders-senate/5859217/
As I noted above, Taylor: the VA’s budget has expanded by roughly a factor of 2.5 in the past 15 years – from around $60 billion to over $160 billion.
Lack of money ISN’T the VA’s problem. Institutional incompetence and a giveaway mentality is the problem.
Uncle Sam has the responsibility to treat medical conditions caused or aggravated by a person’s military service. He doesn’t have the responsibility to treat everything else that happened to that individual in their life that has no connection whatsoever to military service. In many cases, the VA is doing exactly the latter today. And the VA’s efforts – if any – to screen out obvious fakes and frauds using their system for cash and free medical care are a freaking joke.
The Military Times article links to the pollster (Lake Research Partner: Chesapeake Beach Consulting) who queried 800 Veterans by telephone regarding the privatization issue. The polling was commissioned by the Vet Voice Foundation (VVF), whose logo appears on the results published by Lake. The VVF is not an organization I am familiar with so I began by visiting its website. It took seconds to learn that it leans heavily LEFT. VVF’s managing director is Paul Eaton, who is (or was) a member of the VOTE VETS board. VVF likes green, and diversity, and “ Of particular interest to the Foundation is outreach to the African-American and Latino communities.” One of VVF’s directors is Garrett Reppenhagen, whose bio says that he is a “dedicated activist” (whatever the hell that means) and former “Chairman of the Board of Iraq Veterans Against the War” and “Program Direction for Veterans Green Jobs.” Another of VVF’s directors is Steve Dunwoody, “a former Obama Administration appointee in the Department of Energy and the White House.” You’ll be pleased to know, as I was, that “Steve was inspired to move to California because of its natural beauty, diversity of its people and endless possibility. He is committed to keeping California at the forefront of the environmental and conservation movement.” I could go on but I think the point is made about VVF. It is not the type of org that 99.9% of the Veterans here would support. So what of the pollster, Lake Research Partners? Glad you asked. This is taken directly from Lake Research Partner’s website, where it is prominently positioned: “LRP works with leading voices in the progressive movement. We take pride in providing individual attention and strategy to every candidate we work for. From the U.S. Senate to City Hall and everywhere in between, we work side by side with our clients on developing communications and paid media, targeting supporters, and honing the messages that win persuadable voters.“ The question that is the keystone of the poll is a doozy, worded in a fashion that would influence the answer. Bottom line: The poll was… Read more »
I am shocked, shocked that the left would be so underhanded as to present a deliberately biased poll as truth!
(Well, really I’m not. But the opportunity to use the “shocked, shocked” meme was too good to pass up.)
And this, Hondo, is why I trust very few polls and pollsters. Behind them is an agenda and a desired outcome and dang! what a coincidence, the polls reveal what the pollsters hoped to see!
I’d find them more credible if they used advanced stochastics to forecast black swan events.