Thank you for your service.
1
This reads a lot like a planted opinion by a pr company, but whatever.
Uh, expand the services provided by the VA to include those needed by female veterans.
2
Let's be sure to not let the president know that partially privatizing VA services might be beneficial to female veterans in particular. He might change his mind.
1
No he's not. You don't know about his mar kago hacks trying to run the department or are you a russian shill who fooled the NY editorial board. Stop lying.
2
I'm and Vet and love the service at VA. My only regret is my wife can't use VA.
3
When MS. Bagwhati is old enough to be in a nursing home she can relate how great the privatized homes...they aren't. They are for profit, period. Google the number of failures, complaints and down right negligent incidents in privatized nursing homes over the last 20 years. Disgusting.
6
Why do so many of the NYTimes OpEds need to start with something along the lines of "I don’t like the president, but...?" Has there ever been a single NYTimes article, of any form, that doesn't have to disavow Trump? Does that same more about the NYTimes writers or the NYTimes readers?
4
tell that to my veteran friend who's funds to pay for home health care have been cut in half.
2
My husband is a 100% disabled Agent Orange Vietnam Vet. We’re in rural Montana which has the highest per capita number of vets in the country - 10%. Most of what Trump has “accomplished” has been driven by our Sen Jon Tester (D). Rural V.A. care has along way to go. The closest facility is 50 miles away. The closest major care facility is almost 200 miles from us.
When my husband needed a stem cell transplant and chemo due to Mantle Cell Lymphoma, they expected him to spend 5 days a week traveling away from home to have 1 treatment day at the SLC V.A. hospital. What cancer patient can spend 6 of 7 days a week away from home? Had we not had private insurance he would have died multiple times from multiple causes since 2004.
The Choice program is a joke. As good as it should be in a rural setting, it’s impossible to use. You can not go to a private doctor unless they make the appointment. My husband has waited on the phone for 4-6 HOURS at a time just to talk to a representative to make said appointment. Then you don’t get a return call with an appointment or follow up.
If you finally get a V.A. doc that will work with your private MD and agree to rewrite the necessary RXs so that you can get the V.A. to supply meds, that doc will resign before you have 3 visits.
We just returned home to a message from the V.A. saying his RXs for heart meds wouldn’t be covered because “Choice” didn’t make the cardiologist appointment. We can’t even get meds paid for. Just caskets.
1
I empathize with the veteran but disagree with her solution. I am currently a VA physician having previously worked in private practice and academics. I choose to work at the VA because I believe in national healthcare and feel honored to care for our veterans. I always try to provide the very best care possible, and I witness high-level expert care being given by my colleagues on a daily basis. My colleagues are some of the best with whom I have ever worked. They are dedicated, smart, read the literature, hard-working and caring.
One of the wonderful things about working at the VA is that we have absolutely no financial incentive to give too much or too little medical care. We are also encouraged to have a work life balance so that we are not burned out and exhausted. Coming to the VA from private practice has been a life altering positive experience for me, and I appreciate working at the VA so very much. On many occasions I have heard my colleagues say the same. My strong hope is that the nation moves towards national healthcare, and the VA model while not perfect is an excellent starting point. More private sector healthcare is not the answer to an over 50% national burnout rate for physicians, many people lacking affordable healthcare, insurance bureaucracy, and financial incentives to give inappropriate care.
5
All should sympathize with the Captain's experiences. She was personally treated poorly. However, private insurance is not a solution and Trump is simply seeking to destroy the VA. Anyone who has worked with the injured and disabled and has dealt with private insurance via Veterans Choice or Medicare Advantage programs will tell you they’re massively inferior to the government programs they drain money from.
The private plans are profit making schemes. Deal with them at it's obvious they care about rewarding executives and stock holders and little about fulfilling obligations to the insured. It is not anecdotal; every major study shows Choice and Advantage programs routinely deny necessary medical procedures which the VA and Medicare automatically cover. Private insurance companies know that a certain percentage of patients will not appeal denials, and those who do appeal will face extensive roadblocks, so many more give up during the appeal process.
Choice programs do cover some "quality of life" options that the VA and Medicare do not cover, specifically things the author deeply values, like yoga, meditation instruction, and natural food cooking programs. There's little doubt some would benefit if the VA covered more of these, but it's a poor tradeoff. These programs cost private insurance next to nothing and are no replacement for essential and lifesaving services the VA and Medicare routinely cover and which Choice and Advantage find every way possible not to cover.
4
As someone who suffers from service-connected severe hearing loss, and has been a patient of the VA since 1995, I vehemently disagree with Ms. Bhagwati's non-solution"solution" to the VA. Indeed, she is misguided.
On the contrary, the facts demonstrate that Trump/Republicans and the Koch brothers both of whom are non-veterans [see their website cva4a.org and its mission: to eliminate all federal spending including the VA] want to to destroy the VA through privatization and not save it.
And I have first-hand knowledge on this issue. I am a Navy veteran('65-'69) and was a Fire control Technician (Gunnery) 3rd class (FT). As an FT,between the ages of 17 and 21, I was exposed to 3-inch and 5- inch naval gunfire without the benefit of hearing protection.
I am also a retired federal prosecuting attorney (1995-2010). I first learned that I severe hearing loss quite accidentally during a trial in my first year with the agency for which I worked. I went to the VA shortly thereafter and learned that my hearing loss was service connected.
I have been a patient of the Phoenix VA, and have worn hearing aids, since then. I, like 90% of my VA brothers and sisters, am very happy with the care that I receive.
And while my recent VA hearing test suggests that I will be completely deaf within the next few years, I will fight all of those who would deny me and my fellow veterans the VA health care to which we are entitled.
6
Must have been an accident.
"...anti-government agenda."
Title 5 U.S. Code 3331:
"I ___, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God."
When government itself violates the Constitution that created it, it's your obligation-by-oath, as a military officer, to defend the Constitution and not the government.
2
The option for private care for veterans is defensible, but careful oversight is required to insure that the private contractors are both competent and honest, particularly in light of the pervasive corruption of the Trump administration.
I use a VA hospital close to home, but others, who live at a distance, could benefit from using local doctors and facilities.
A greater problem, in my experience, is that the VA has become a repository of marginally-qualified doctors who are graduates of unranked Third World medical schools who arrive in this country with their unusable medical degrees, memorize enough to pass their boards here and complete an uncompetitive residency and then fall into lifetime VA appointments in positions few doctors with broader options desire.
4
I haven’t read the article yet but if someone can read the article to Trump, he can feel that the NYT has now written a favorable article about him.
2
"For all these reasons, I’m supportive of sweeping changes to the V.A., even if they come from a questionable architect with less than honest motivations."
I conclude that this article is from someone that likely has legitimate gripes with the VA, but whose advice should not be followed when looking for a solution.
3
I am Viet Nam Veteran who has received care from the VA for over twenty five years. During several emergencies I have also received care from the private medical sector. Based on these experiences I believe the VA to a provider far superior to the general run of private medical providers. The best private providers may measure up to the VA standards but most cannot. When comparing the VA to private providers you must select those providers who care for millions of patients - oh, that's right, there are no others in the US. And, by the way, a great many advancements in medicine that are now SOP were developed from VA and military initiatives. So all Americans have benefited.
8
Just more profiteering from the private sector. The VA is a terrific health network. I get excellent and timely care. I want nothing to do with private VA care with Republican donors sucking the lifeblood out of the system. Boo
9
Hmm. If we had single payer health care for all, then all vets could chose where to get their care from. The VA could then transition into centers that focus on medical issues that affect vets while the normal medical care can be handled by what ever provider the vet chooses.
8
The VA has been my medical provider for several decades, and I'm happy to have received Community Care on a number of occasions. Typically the consult has been suggested, and set-up, by my VA provider. But I'm also thrilled at the care I've received at our Maine VA. And while I don't see that institution through the eyes of a woman veteran, I find it very difficult to recognize the culture that the writer describes as her essentially default VA experience. Most of my contact at the VA is with women, staff members who keep the process moving, or nurses who do intakes, or perform certain tests and procedures, where often one is, shall we say, quite exposed. They are professionals, and do what they've been trained to do, gender notwithstanding . I've also had two woman primary care physicians over the years, but male docs st my VA are definitely in the majority. We have more and more woman vets at our hospital, and one can not determine by passing someone in a corridor or in riding the same elevator, if their treatment is negative - i.e. sexualized - in the manner described by the writer. I think we need to hear from more woman veterans on this to get a clearer picture of the degree to which the harassment is exceptional or institutional.
5
A very informative, long, detailed personal narrative... Had the veteran's administration been properly funded by Republican lawmakers, while President Obama was in office, it's possible, right, that your wait time and ..., might have been addressed. Nice of you to praise Donald Trump and privatization, but let's shall we, wait and see. Okay? Revisit your piece in a year, to two.
2
Why does every bit of this sound so familiar?
This article -- and its readers' comments -- could have substituted words like "veterans," "health" and "hospitals" for "children," "education," and "schools," with virtually identical themes and debates.
In both cases: "Fixing" the glitches in a public good by sweeping away taxpayer investments in it and privatizing what is left -- all this is great for shareholders who have no connection to the institution but a few fleeting electronic blips. It's a recipe for disaster, though, for those who the original program was meant to benefit.
8
I thought Marines were the toughest of the tough. Perhaps this is why women shouldn't be Marines.
1
Many a marine has post traumatic stress syndrome. She sounds plenty tough to me.
3
Those politicians who invaded Iraq, destalbized the Middle East and produced a caualty producing program there should have had the guts to adequately fund medical care for those damaged by the consequences of their actions. Fund the VA at a level appropriate to the need. Forget about giving more money to the President's friends.
7
Care in the private sector will be more expensive than care in the VA. As the number of patients seeking care in the VA declines two things will happen. First, relatively small specialty care such as neurosurgery and open heart surgery won't be feasible with a small patient population. Second, small VA hospitals serving rural areas will be impacted early on with a declining patient load. A case in point is the Lincoln, Nebraska VA. When utilization review was implemented in the VA the average daily census in Lincoln dropped to 7. It became impossible to sustain their impatient mission and is now an outpatient clinic. When it becomes clear that more funds from Congress will be needed to sustain outsourcing I'm pretty sure Republicans will want to deny access to the lowest categories of veterans and/or require many categories of veterans now being seen who aren't paying a deductible or copay to pay a deductible and/or a copay. One benchmark is Medicare where a beneficiary has to pay a $750 deductible for an inpatient stay. Congress could require most categories of veterans to pay the same amount. Eventually there will be very few VA hospitals if any at all.
2
Good piece. My empathy to the writer. The veterans in my state has been assimilated into the ACA. Donald is moot argument on this issue in my state.
1
Wow an extremely delicate vet! Doesn't want her doctor looking at her? Or was she abused? Then say, I'm uncomfortable, please leave... No one cares, we understand. I'm guessing she's young and never had to deal with private PC docs? Same issues, and in MN longer wait times. Our VA docs rotate through the U of M and we ship people there if we need more experience. However I would go elsewhere for say a heart - same for me in the private. I'd head to Mayo - the wait and cost being more.
Great. Skim off a nice slice of the funding to pay for a yacht or two and watch the competition fix the underfunded remains of the service.
3
How can you possibly spin less health care for veterans as a positive? Private medical care is more expensive and the pot of money from which to pay for all veterans’ medical needs is already not increasing to match the rising number who need it. Add to that the closure of veterans hospitals in already underserved rural areas as funds are siphoned off for private care and this will be a disaster for thousands of former service members. The only winners will be private, for-profit hospital owners.
5
The greater number of the responses to this article by Ms
Bhagwati are from veterans who like the VA just the way that it is. There seems to be this penchant to publish only negative things about the VA. In Georgia, if there is negative news on the VA, one of the TV channels sends a reporter and video crew to the Atlanta VA and blast the entire system. I called that station news director and asked that the reporter go with me into the hospital, no camera, no tape recorder, no pencil or paper. I want him to sit in the major clinic waiting room and talk to vets waiting for their appointments and find out who they like the system. The repose he would get would be 95% positive. I told the news director that he would be able to show something positive about the VA system. The response he gave me was "we are no interested in positive news on the VA hospital system." I love unbiased news men.
As a user of the VA medical center in Atlanta for 26 years, I have almost nothing negative to say about it. I think the Times needs to present the views of some one without an ax to grind. As a man who has written hundreds of PR articles for a major university and one who grew up in the newspaper environment, I would be glad to write it.
3
The US taxpayers short changes its soldiers on health care. The pregnant daughter of my friend, whose husband is a military officer, was three weeks before delivery before she was allowed to see a doctor. Before that just nurses or PA’s. No company would get away with that for their employees.
Every year Congress and the President add hundreds of new missions to the military and other functions. Every other year they slash taxes to buy votes. And of course that is what Americans want—thousands of additional things at zero cost to them.
Yet we see the flags and Support Our Troops banner, and we cheer the soldiers at ball games. But adequately fund their care and that of their families—never if it gets in the way of a tax cut
They all ought to walk away and let others pick up the dirty work. Draft the children of the rich to slog through the snow and sand and get blown up. Then maybe we would do the right thing. America Great?—ridiculous
1
Pay attention people, Medicare for all?
4
The way you've been treated is a disgrace, but private, for profit medicine is also a disgrace. People are being bankrupted. So veterans get a batter deal than at the underfunded VA but that's the courtship stage.
The real solution is to stop cutting funding at the VA and to do more work (lots of it) on the treatment of women in the military. You served as a Marine Corps Captain and deserve respect instead of harassment.
3
I'm a military veteran who moved from a large city with a VA hospital about 4 years ago. I moved 90 miles away to a much smaller city that only had a VA clinic, which is basically where I would go for physicals, radiology, diagnoses, prescriptions, etc.
At the time I moved, the Obama Administration had just implemented the VA Choice Program. For the next two years it was a godsend for me to be able to go to private physicians in my immediate area, versus having to take a two-three hour bus ride, each way, to and from my former VA hospital.
Once Trump took office, his administration implemented various changes to the VA Choice Program which severely limited myself and many other veterans from utilizing its services. Thankfully, I turned 65 recently and am now on Medicare with supplemental insurance which handles all of my medical expenses no matter where I live or visit. It's worth the extra $300 a month to have that assurance and convenience available to me.
But when I was using VA Choice, which still is a form of privatization overseen by the VA, it was awesome.
A little off the subject, I just wish every United States citizen had the same access to medical care as I do now without having to spend a large portion of their income to pay for it.
The concept of Medicare-for-all, seems to me, based on my experiences, to be a very, very good thing.
2
It's good to know that when the Republicans are successful at eliminating Social Security and Medicare, the veterans will still have private health insurance.
1
This is the second NYTimes article about the VA system that I have read. It is amazing, there is rarely, if ever, a comment that supports the proposition that the VA should be replaced by private care. Read these all to prove my point.
I understand Ms Bhagwati has had terrible experiences and I don't doubt them. But the issue is the military attitude about females a system that otherwise seems solid and effective.
I hope that all veterans see this issue as a criticism of american capitalism and are at least sceptical regarding the real motivation of Trump and his followers.
2
Healthcare should not be a for profit industry at all and no benefit can come from inserting a profit motive into VA healthcare. I'm sympathetic to the author's experiences, but privatization is not the solution. All it will do is drive up costs for no good reason. Better training for VA staff can address these issues.
4
Fascinating and often compelling argument. It has strengths and flaws. Obviously some of this honorable veteran's experiences--at least some of them predating her military stint--were lamentable and inexcusable. To the extent that the option to bypass VA care has helped her, it's a Good Thing. To the extent that her campaign (and that of her colleagues) to impugn the VA ends up impairing its ability to provide desperately needed care to those who value it highly, not so much.
There's a shrill and tangential quality to her plaint (the pre-VA, pre-military trauma; the injurious portrait of the Orange Leader) that diminishes what could've been a more balanced statement of need. So ... conclusions not unreasonable (some privatization is warranted); but the path there is not only strident but potentially harmful to a valuable institution.
1
I am grateful to Ms. Bhagwati for her service, and sympathetic to her documented episodes of abuse. There is no place for that in our ranks. I have to say however, that this piece is so biased by her own experience with VA and then later, community care, that it should be viewed as completely anecdotal and non-scientific when applying it to the discussion of privatizing aspects of VA care. As a veteran myself--23+ years active duty, and a healthcare provider and leader often tasked with evaluating requests for the equivalent authorizations for outside care in the military health system, I can tell you that it is a known business strategy of healthcare providers operating near military bases to maximize the number of authorized visits once an outside referral is approved. I don't profess to know anything about her reason for her physical therapy that lasted 2 years, but if that care was provided by a VA-authorized community care referral, wouldn't you want to ask yourself what on earth takes 2 years of therapy to get better? And what was the total bill charged to the VA (our tax $$) for that? Again, not judging her particular circumstance but without oversight, I would see a widespread effort to privatize ending up costing far more than it does now to run the VA. Only way it will look cheaper is when you factor in eliminating all pensions and other personnel-related costs in the VA currently. That will likely never get through Congress though.
3
As a veteran using the VA as a healthcare provider, the present set-up is open to criticism, but the question is "Relative to what?" Trump's partial privatization proposal for including vets far from a convenient outpatient clinic (OPC) is disingenuous. He wants to destroy VA care by the technique of bleeding it dry by a thousand cuts. VA healthcare is a fragile organism that cannot survive piecemeal interventions like Trump's. Many veterans belong to a particualry vulnerable demography that requires proactive measures to get them to get into care and stay with it. The OPC's have that quaint military atmosphere of "We're all in this together", which, I'm sure, gives many Vets a sense of being part of something, gives them somewhere to go that welcomes them. Feeling valuable as ex-servicepersons breaks down a psychological barrier.
Trump's privatization scheme is also known as "Divide and conquer." Privatized health on the free market skims profits by catering to those savvy about playing the market game. Many Vets will not even try to play that game, but will curl up on the sidewalk and wait for the end to come. We know that because many Vets already fall through the cracks in existing VA healthcare and die on the street. Trump, who isn't the least embarrassed about avoiding the draft in the '70's by 4-F ing with a fake foot out is sick.
The VA program could be effectivly restructured by rolling it over into Medicare-for-all—not by privatization.
1
I appreciate Captain Bhagwati pain at the inappropriate behavior she has experienced within the VA system. However, such behavior exists within the private healthcare sector.
Below is from an article in the NY Times on Feb 1, 2019:
"Why did it take so long for physicians and researchers to recognize SCAD? The most important reason might have been that the condition predominantly affects women. “We listen less well to women,” said Dr. Hayes. “We are much more likely to associate their symptoms with psychological causes.” A heart attack is more likely to be fatal in a young woman than a young man, perhaps because women’s cardiac symptoms are more often misattributed to anxiety or depression than men’s."
Entrenched misogyny and racism is a character trait of some people not with the entire VA System. And let us not forget that the VA maybe the largest single payor healthcare system in the world. It has problems, but none of the magnitude and severity that fee for service medicine can inflict. How do i know this? Personal experience and i practiced medicine in New York City for 40 years.
As for whether the VA can be reformed. I refer you to an article in the Jan 18, 2019 issue of JAMA: "Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers"
Rather than yell Medicare for All we should yell VA for All. The VA is a great system that has been underfunded for years.
4
This article focuses solely on convenience, not outcomes. The argument for privatisation cannot be based on convenience but must be based on outcomes. Privatised healthcare has proven time and again to fail to meet, let alone exceed the care of public healthcare.
There is even a correlation between higher risk of death in a hospital and better insured patients. VA is well trained to deal with PSTD, private hospitals with doctors who have never served a tour of duty nor treated veterans is not a place to farm out business to. The facilities are not suited to deal with PTSD and other issues that veteran face that civilian patients never experience.
The right answer is to fully fund and add locations of VA hospitals, not sell it on the stock market to the lowest bidder.
3
@James Wallis Martin I will agree with those comments almost 100%. The doctors in private practice are not familiar with veteran patients. The mental health people in private practice will tell you that they can treat anything. Such is not the case, in my opinion and my opinion is based of seeing multiple mental health professional before going to the VA.
PTSD is, of course, not the major thing for the VA, but someone with PTSD and other problems, like those associated with Agent Orange, for instance, present to a doctor in the VA with compound problems that those doctors are trained and experienced to meet.
The outside doctors will not have availability to the medical records of VA patients and, therefore, have no idea what the veteran in front of him has experienced insofar as medical care is concerned. I have been there and done that. I recently had a problem that necessitated my going to a private ER. The probabilities of my problem being related to Agent Orange are probably 100%, but the ER doctor knew nothing about Agent Orange and the plethora of problems is causes.
2
The VA is expanding Telehealth services and Video-on-Demand so that some veterans may be able to avoid long rides (and achieve enhanced privacy) by seeing their doctor for follow-up visits through a computer or on their cell phone (just like Skype or Face Time). Experience with moving from VA care to care in the community does not necessarily eliminate long wait times. And veterans relying on communication between VA doctors and those in the community in terms of sharing medical plans, lab work, and results may be in for a bumpy ride. If at all possible, it's far better to stay with the VA..
1
When it is done right, there is no medical care in the world better than old-fashioned VA care. With several young veteran relatives in my own family, I don't want the assurance of their care smashed up by privatizers and haters of "socialist" medicine. This statement plays into their hands, big-time, no matter what personal considerations moved it. The privatizers want to relieve the tax burden on the Koch brothers--as well as the brilliant example of successful public health care that the VA established in the generations since WWII. I have seen too many lives saved and families everlastingly grateful to the VA to accept this statement on its face. The VA should be strengthened, not privatized, and there are ways to do that that should satisfy this disgruntled lady.
3
My wife recently retired as a VA hematologist / oncologist. She previously served in the Army as a doc. She greatly preferred her service in the Army over the civilian MD world because she was viewed as an officer with a rank, not as a woman. Her experience when looking for a position in civilian medicine after leaving the Army was the opposite. At one job interview, she was offered a job as an internist, not a double boarded hem-onc specialist, by a male department chief who told her he didn’t like hiring women because they got pregnant. He subsequently offered my wife’s male subordinate the position she had applied for.
Anyway, she ultimately went to work for the VA, was a department chief and had a great career. Her hospital, like most VA hospitals, was highly regarded by her patients. They got frustrated by administrative issues, but loved the docs, nurses and other patient care staff. And my wife got frustrated by poor funding that had direct consequences to the pay levels and quality of clerical support.
Don’t be deceived by the efforts to move VA services to the private sector. It’s a political agenda, not a patient-care agenda. And like most privatization agendas, the goal is to move public assists into private hands.
4
I get very good care from my VA provider. I have had a couple of experiences with private doctors who were contracting for VA and the experiences were not very good.
3
Please make sure you understand the record here. Jon Tester, the Democratic Senator from Montana, has been an outspoken supporter of veterans and veteran affairs. Please be aware that the first bill signed by the head of our current administration was written by Mr. Tester and signed into law in February, 2017, and related to government accountability, with eleven separate bills written or co-sponsored to do just as the author of this piece suggests, make sure that veterans receive the attention they need, whether medical or through a bill to aid in continuing education, or by allowing whistle blower status to make sure VA hospitals are treating vets the way they should be treated. Jon Tester resides in a state with one of the highest number of veterans per capita in the United States. It is gratifying that while serving his constituents it is clear he is also helping other veterans that have served to keep us all safer. But let's be clear here. Donald Trump did not write any of those bills nor did he solicit legislation from Congress. Mr. Trump has appropriated responsibility for a lot of hard work done in bipartisan fashion by lots of others.
1
Instead of making things more complicated, why not simplify and make things better? We need to integrate the VA services with Medicare and eventually lead up to a Medicare for All system, where private insurance companies can compete if they want to, but will have to open their books in the same way Medicare has to in its operations. Fair is fair.
This will eliminate most discrimination and problems. To those who bring up the DMV, fine then why don't we put our money where our mouth is and privatize the military first, the police and fire departments and so on? Pretty soon we will be a third world country, why, because we took a simplistic third world mentality. Think like a first word citizen and act accordingly.
Healthcare for all! Fair, honest and accountable systems for all! It may not be painless, but it literally won't kill us.
5
It is a disservice to the citizens of the United States including veterans as well as those in active service by providing even the slightest cover for Donald Trump. He is the enemy of the people first and foremost!
3
The way I see this there is a two-pringed approach to solving the problem. Number One - adequately fund the VA. Number Two - stop warring around the world. Just stop it.
4
As Mr. Trump is a conniving draft dodger, why should I take anything he has to say about vets and their care seriously? Has he visited vets? VA centers? I have. Many are in shambles re understaffed and overworked teams; exhausted vets and families who wait hour after hour for help; and the lack of a plan to care for vets as they require elder care/rehab/nursing homes.
3
I’m a Veteran and like the service I get from the VA. I don’t discount the Captain’s experiences but I do disagree with her solution.
MCPO, USCG (Ret) 1969-1994
71
No, he's not.
OK Donald, here’s your positive article in the NYT. Will you now shut up, stop your infantile Tweets and demonization of a free press that rightfully disagrees with what you are and most of what you do? This is what you ask for. I happen to disagree with it both on practical and intentional grounds, but that’s MY opinion (as one of 2/3 of Americans). You were lucky to get this, considering the amoral, ignorant devastation that you have reaped upon America. Don’t count on more unless you suddenly and inexplicably become human AND intelligent.
3
Not wanting to divert resources from public to private activity, the Democrats' argument, is not by itself persuasive. Sometimes resources are going to the wrong place and should be diverted. The key questions should be, most importantly, whether veterans would be better served and receive better care and, also important, whether it would cost less. The Democrats have not satisfactorily answered these questions. There is some convincing testimony, including this column, that the answer at least to the first question is yes.
I can understand the lack of attention to women's issues, and deplore it. However, I do think the VA is better reformed than supplanted. I receive excellent care, and am gratified they comprehend how my service has affected my health.
I am not sure civilian doctors and hospitals comprehend veterans' issues. Truth to tell, I do not hold them as infallible, efficient, or effective in general.
I think the VA is an example of how health care should be run. The managers and providers are responsible to the people they serve and subject to scrutiny from both public and private entities. Yes, they have screwed up and royally, but they take the heat for it and I see work on the ground on improvement.
I do not see such efforts underway in our private health care sector.
I suspect the private sector health care sector could benefit from such scrutiny as they VA gets from us, their patients, Congress, and the Executive Branch. We seem to be the most expensive in the world and not as effective or efficient as other countries in serving their people.
3
If one's experience is that they are harassed while seeking treatment, for any reason, then we should fix the VA system. That is a tall order as most are pretty inefficient. Also, they do not have to comply with healthcare regulations set by HHS; doctors can order whatever tests they like, and the VAs can spend whatever they have - actually, they have to as they work like the rest of the government using zero sum budgeting. You get a budget and must spend it or lose it. Utter wastefulness with no accountability. Fix the VA system (not possible?) or privatize and close the VA.
There are 2 issues here. One is freedom to seek health care wherever the patient chooses. The other is freedom from sexual harassment. Both are essential.
Thank you, Ms. Bhagwati, for illuminating the dehumanizing gauntlet our women veterans are exposed to at VA medical facilities. Clearly, that needs to be changed at all levels, up to and including the highest levels of our government. Unfortunately, at the moment the military has a Commander in Chief who has demonstrated he's a gleeful and prominent part of the problem, and certainly not the solution.
As if primitive, misogynistic attitudes of the VA system are not dire enough for our women veterans, the sources of funding for private VA health care also pose a separate, tough problem. Budgetarily, it's a zero sum struggle between traditional VA services and private care. The size of the pot is limited. Surely, Trump and his shadow VA administration would love to shovel VA funds into the private sector (just as he's trying to squander $5.7 billion of public funds for his unconscionable border wall). But it's great that private care through the VA can work for you. It's the least we can do for you and your colleagues. In the long run, however the zero sum game poses a very big problem for the quality, availability, and stability of VA-sponsored health care. You and your sister veterans deserve out whole-hearted support.
2
Privatization of government falls in line with Capitalists seeking to profit through government grants. Remember the the privatization of Detention Centers? How about the privatization of prisons? Oh yes, consider the closure of Post Offices in rural areas in order to sell prime real estate to the developers and investors? Then there is the privatization of public schools.
In none of these privatization moves has it served public needs better. Privatization of government services transfers tax funding from effective governance and services to people seeking to profit from public taxes.
5
I am sorry for your experience. Trump, his administration and conservative think tanks like Heritage Foundation like nothing more than privatize every government agency that serve American people as part of weakening and ultimately eliminating "deep" state. Trump could have demanded more fund to strengthen VA service instead of his rage and indignation about the wall. I predict if Trump is re-elected VA health care system will be dismantle by 2024.
1
I just read all your NYT Picks. Not a one blasted the VA system. I have worked as a physician in that system and at Cook Couty Hospital in Chicago and DC General in DC. I have had recent experience with many shared patients in the last 10 years. I have always been impressed with their medical records system, which works amazingly better than private systems, because they are all different and don't talk to each other. The physicians I have talked to about our common patients are excellent. The patients universally like the system. Yet I keep hearing about the awful stuff at VA. The system is a government precursor to a public system, and it works, so it threatens the for profit systems. There are problems to be solved in any system, but privatization of medicine in general is only half good, because of the enormous profits in the Medical Industrial Complex. Public systems don't have that flaw.
4
The problem with veterans' healthcare is not that much of it is provided by the government, but that not enough is provided by the government. The idea that the VA can do more with less should have been recognized from the start as not only false but also as a betrayal of our veterans. For a country that has always talked a lot about respecting the troops--and destroyed the career of a fine young quarterback like Colin Kaepernick--the truth is taxpayers in general are all talk and want nothing to do with funding veterans healthcare worthy of their service.
Privatizing that healthcare will be like every other government service which has been outsourced. No accountability, the businesses will get richer, and there will be fewer consumers who will receive even less coverage. Maybe not at first, but in the end, that's what will happen.
Citizens need to examine themselves, because WE are the problem with veterans healthcare.
2
And this, in light of reports that wait times for our veterans have increased with the addition of private providers to this mix. I already found the waits intolerable and a few personal anecdotes do little to counter the system problems that keep growing as attempt to privatize increase.
1
Unfortunately, Ms. Bhagwati, ALL medical complexes discriminate against women. Women are used as corporate/academic welfare credit cards and lab rats. Few medical conditions that affect women are actually attacked with the goal of finding the cause.
Veterans who use the "private" medical complex will simply be furthering the robbing of government funded health care. The VA can negotiate drug prices - Medicare and Medicaid cannot and private insurers created the outrageous prices we pay.
Privatization of any government program only enriches the already bloated-beyond-comprehension stolen wealth of the 0.01%. It certainly will not serve veterans and their families unless they are part of the "elite" group.
5
Careful here...as soon as you put the public's money into the hands of private, for-profit enterprises, you will cease to have lack of accountability and plenty of opportunity for abuse. One could look at Medicare as a prime an example. I'm constantly amazed at the services, tests and unnecessary "aids" that are constantly pushed to my 80-year old mom who is in great health. It seems to me she is treated more like an ATM machine than an aging patient with some basic healthcare needs.
True the problems are broad and deep at the VA, and some level of private partnership may help, but as with education, the military and nearly every other government entity that has shifted more and more to doling out our money to for-profit organizations to provide better services, all we seem to get is that sound of cha-ching.
1
Women, particularly those of us with PTSD, have problematic relationships overall with health care providers. My partner, veteran of Vietnam era, receives V.A. care - generally well-coordinated given his complex medical conditions. He had a choice, at one point, of seeking private care for a medical concern or waiting for the V.A. to meet his needs in-house. He chose to wait. I WANT the level of coordinated services that the V.A. provides for HIM. I’m his caregiver/MPOA - the V.A. GEM team listens to my concerns and values my input. They’ve kept him alive through stage 4 cancer (decade in remission), permanent feeding tube, hip replacement, bouts of pneumonia and on and on. The V.A. does NOT overtreat nor require unnecessary invasive testing. We’re a family with medical training - the V.A. in south Texas does a superb job - for geriatric male veterans. Other groups - probably not as well served.
3
In 1981 I was tasked with writing a chapter for a book on the proceedings of a conference on Computers in Critical Care and Pulmonary Medicine. Published sources and examples were few and far between at that time but the VA medical records system was a shining example of what was possible and I leaned heavily on what had been published about it. They were far ahead of the rest of us.
During the past week using MYHealth.VA I've ordered prescription refills and printed out portions of my online record for an appointment with an "outside" provider who does not have nearly as complete a source of information available to her in her own office. I can make appointments, message my VA providers and view test results with that system as well. The private system seems best able to keep track of my insurances and billing information. I'm fortunate in that I have both VA access and comprehensive Medicare and Medicare Advantage coverage but if I were forced to choose between private care and the VA I'd choose the VA.
2
The concept of privatizing health care for veterans essentially validates corporations to maximize profits over delivery of care to those who defend the country.
6
As a physician and retired Navy officer I have multiple concerns, but one is the most serious. America has a critical shortage of primary care providers. If there were a large surplus, this plan would be brilliant, but there isn't. Right now, on average, it is easier to get a new primary care provider at a VA than in most private systems. Don't believe me? Give a call to your local healthcare system and ask for a new patient appointment.
Private healthcare systems cannot offer veterans better access or specialized services. The public that thanks us for our service would not thank us for taking doctor appointments away from their kids.
There will, no doubt, be individuals - like the writer - who will benefit greatly from this program, but on the whole, costs will outweigh benefits.
6
The need for change within the VA doesn't go away because vets can see a private doctor. That only masks the problem and perpetuates it.
It doesn't make sense to pay private, for-profit providers for services the government should provide for free. We can't let the VA off the hook.
No, the proper tack is to fix the problems in the VA, in the military and in the country. We made a good start on diversity in government. Let's expand that to all sectors.
1
Please... having worked for the VA for eight years and DOD for 24 years I am well aware of the needs of the vet community. Give me a gold-plated tri care for life, Medicare or access to a similar system and let the VA focus its resources on what it does best, i.e., dealing with war related injuries.
2
Let us have a single payer system, a medicaid for all, and this includes the Vets, they will get the same care as the rest. We already have about 60% of our care paid by the government, lets organize it, add a bit more and make it efficient , fair and reasonable.
3
@RichardHead Sorry, but I'm very happy with my private insurance. Don't even think about taking that away. Having access to medical insurance does NOT mean you have access to health care.
1
Of course it does.
1
I was a Fleet Surgeon during the Vietnam War; and a VA surgeon during the late 1990's. VA health care can be great; but the system is an economic disaster and hugely inconvenient for veterans. Give our veterans the freedom of choice - give them Medicare.
4
I appreciate your point of view. I'm weary of privatization which in my mind equals free market capitalistic for PROFIT business practices which have gotten us in the health care mess we're currently in. NO THANKS!
5
"I don’t like the president, but I’m thrilled about his efforts to bring private health care to veterans."
Good luck with that Ms. Bhagwati
4
The charter school parallels are striking. And should not be repeated.
3
I have absolutely NO problems with the VA. I am sorry to hear about the Captain's issues but I am reading some hyperbole in her editorial. None of the female vets that I have spoke to over the years have made similar complaints. I do agree that the VA is more attuned to male vets but then the military is majority male.
The Captain did a bait and switch in that she praises the President in the headline but then criticizes him to no end. She has an obvious agenda that male vets really have no interest in. Hopefully she gets well and has a change of attitude regarding the VA and the President.
1
Anything that is privatized is usually worse. Maybe not specifically for one person, but for everyone as a whole.
It’s like a cancer. Sure you can live with it for a while, but then it takes over, and by then it’s too late.
If the VA is underfunded, the answer is to fund it. Taking VA money and putting it in to the pockets of private companies is a travesty.
7
The VA needs more investment is what it comes down to, it can't cope with current demand levels. Using private care to reduce the pressure and bring waiting times down is an obvious solution, at least in the short term, but it doesn't reduce demand. It meets demand faster by paying for additional services. If you're taking the money to do that from the existing structure then you're degrading the services that part can provide, increasing the amount needing to be spent on private care and round you go.
CBO analysis indicates that the VA provides better value for money than the private sector, but either way what's needed is more money to expand services. The math on redirecting existing spending and somehow treating more patients for the same cost just does not add up.
2
5.7 billion can build a home for EVERY SINGLE HOMELESS VET IN THIS COUNTRY So what is right about anything this president does on any issue; let alone Veterans health? I'm just gonna drop my mic right here
5
First it was education; vouchers for private, for profit charter schools. Diverting the dollars out of the public sector has gone a long way to destroying the public education system. And don't even get me started on Medicare Drug coverage..you know, that glorious program set up by a Republican that does not allow the federal government to negotiate drug prices. Have you also noticed how perscription drug prices have skyrocketed while the government sits on its hands? No brainer what's going on there. Now they want to do the same to the VA. Repubs have been trying to get their hands on every single American tax dollar that they can and funnel them into private bank accounts. Along with allowing vets to go outside the VA system is there any cost control on what We the Taxpayer will be charged? NO. That should be the first clue. I ask, why is it impossible for the greatest country on earth to fix its own VA system?
4
My father died at the VA hospital, and my complaint was he received too much care. I'm heartbroken that I didn't honor his last words to let him go before doctors induced a coma, and we let him suffer for two weeks. Conservatives have never approved of any public enterprise be it Social Security, public power, housing, Medicare or the VA. I laughed that a 30-minute drive to the VA is a hardship. It takes me almost 30 minutes to drive across my small town to see my doctor, over 30 minutes when trains roll through town. We should proceed in the opposite direction and finance health insurance on the principles of public, non-profit administration, universality, accessibility, portability, comprehensiveness, and cost efficiencies--the heart of the VA vision for veterans.
4
I sympathize with Capt. Bhagwati for her treatment experiences from certain VA personnel. My husband is a veteran who has extensive experience in taking advantage of the excellent care provided by our regional VA facility. I’ve accompanied him on several of his visits routine visits, as well as visits when he was hospitalized for back surgery and for severe case of pneumonia. In all circumstances both he, and I, received courteous, friendly, professional, excellent care.
As for Veterans Choice, this in not a Trump Administration initiative. Veterans Choice was established duringPresident Obama term in office. And my husband has also obtained care through the Veterans Choice program for acupuncture pain relief when our local VA facility was unable to provide it. Currently, the Veterans Choice program is cumbersome to use and my husband’s private practice acupuncturist has experienced extended delays in receiving payment for her services.
As a female obtaining health care in private sector, I have on numerous occasions experienced the same types of unwelcome, sexist behavior from male doctors Capt. Bhagwani describes. Privatization of the VA is not a solution to counteract offensive, unwelcome behavior from VA personnel.
2
I'm glad you have an option more compatible with your needs, especially when distance is the barrier to care.
BUT the choice of the government to divert health care dollars to for-profit environments is not for improving services to you. Make no mistake. It is part of a larger plan to compromise the budget of a federal program (which runs with a 4%operating margin), watch its performance degrade, complain about government's inability to do anything right, further compromise its budget, and shrink it to nothing so that for-profits (which run with a 20% operating margin) can have that money instead for boosting stock dividends.
The VA is exactly the kind of "problem" THAT IS SOLVED by throwing money and proper management at it. With the exception of distance from a care facility, few other excuses for using veteran health care dollars at private facilities have virtue. The service culture modernization that is needed at the VA has been done in the private sector time and time again. The template is there and reproducible. But this administration would have to want that result, and while their words sound sincere, their actions tell the real story.
VA is a major contributor to physician education for both public and private sectors. A VA model center for excellence, i.e. for prosthetics or behavioral health, can concentrate expertise and shorten the timeline from R&D to standards of care.
This president's intentions for VA care should never be mistaken as altruistic.
3
Rather than spending more money on private medical care (in essence feeding the rising healcare industrial complex), perhaps reasonable assessment and assignment of funding for local clinics, increases staff (both medical & administrative, and developing a workable transportation network...even “mobile” clinics...would seem a quicker and more functional solution.
Private medical care often results in 2 to 3 week ahead appointments now, and is overloaded. Let’s not privatize the promises we’ve made to those who have put their lives at risk to keep America safe...that would not be American patriotism.
1
I very much respect your service, Captain Bhagwati.
I also very much respect your personal experiences with the VA. You should never be treated with anything less than respect and dignity.
I am not opposed to private companies filling a gap when public services are performing poorly, especially when it comes to people who have served our country. However, the current privatization plan for VA healthcare does not seem to be working well across the board.
While you have had great service, many other veterans have not been so lucky, with wait times even longer than they would have gotten from the VA. Worse, according to funding reports, around 25% of the funds spent on the privatization program goes to overhead--nearly double what most private insurers spend on civilian overhead, and triple what TriCare spends.
I am glad you have had great service from your private providers, and hope you continue getting great care. I hope the VA gets properly funded--and hope that an updated privatized care plan will do a better job of filling in coverage gaps while reducing certain overhead inefficiencies. The current plan being pushed, though, looks to be more of the same for your brothers and sisters in arms. This makes me wince.
I think that many posters missed the main aspect.
It is a " private care " for disabled veterans who are forced to drive more than half hour to a VA care facility.
1
Like many other commenters, I want to thank Captain Bhagwati for her service. It's unacceptable that her needs were not met adequately or respectfully within the VA system. And, like most here, I must say that her analysis of the VA is dangerously limited. The experience of my family member at the VA (for routine and chronic care) has been consistently positive. It compares favorably to my own experience (with far better than average benefits) in the private sector. When I consider how the VA dealt with my relative's unexpected setback following a routine surgery, I'm depressed--for myself and other private-sector patients. There was no question that he would remain in hospital for needed care. If the average American had any idea how profoundly respectful--healing, too! that it is as a patient to be treated from the outset as if one had every right to the care one is "consuming," they would clamor for universal health coverage. No one at the VA interviews patients (as happened to my mother in an ER) about their insurance policy. The presumption of equality and inclusion extended from the officer referred for advanced cardiac care to my lower-rank relative with less complex needs to the two homeless men of different races who were admitted during my several days' observation of the post-surgical ward. Yes, fixtures are a bit outdated at the VA, but each and every person we interacted with treated him (and, from all I saw and heard, other patients) with unvarying respect.
2
I am a physician and a female military veteran with private health insurance, yet I CHOOSE the VA for my health care over the hospital where I work. The quality of VA care I receive is superb and the respect I receive from the staff is exemplary. That being said, I recognize that this is not the universal experience. I believe the solution is NOT privatization, however, (have you looked at our private health care system lately??), but providing sufficient support to the VA to make the needed improvements. Certainly the money requested for an unnecessary wall on our southern border could be better used for improving the VA.
4
WHILE I EMPATHIZE With the trauma suffered by the writer in VA facilities, I caution against polarized thinking about the delivery of medical care. Specifically, the VA is NOT all bad and so-called private healthcare is, conversely, not all good. Part of the challenge I see is that being forced to use VA facilities was, for the writer, a traumatic trigger. Once traumatized patients begin a course of treatment in private care settings, part of the process involves retelling of the traumatic history, whereby patients experience traumatic triggers that may generalized beyond therapy sessions. It is difficult to predict to what extent a patient will be retraumatized by treatment with private providers. I have experienced grossly inappropriate behaviors from private providers over the years. Trump has got precisely nothing right! All he's capable of is branding. So the most anyone can expect is that if legislation does not include the words "Trump" in the title, it's DOA. That's what happens when you have a "president" who protests reading memos of longer than one page and whose highest level of written communication is 140 character tweets. Not to mention his describing of himself with great delight as a sexual predator on the video tape with Billy Bush (an unfortunate co-occurrence of the last name with allusions to sexual assault). So far, Trump's rate of getting things right is down at absolute zero, the lowest temperature in the universe. Aside from that he be OK.
2
I think many of us here know what a disaster the for-profit, privatized health care systems is for Americans. The writer should be advocating for a single payer system, or to adequately fund the VA. Frankly, I'm jealous of the health care the writer receives compared to what I get on private health care. Private health care is traumatic also. I always say that my health care is making me sick.
Acupuncture covered in private health care? You can kiss that goodbye.
5
Integrate VHA facilities with community health care. These massive resources have been paid for by citizens: they should enjoy access. Retain Veteran specific care for PTSD, TBI, as needed; provide priority care for Veterans; implement a national EHR system. We can’t afford duplicative health care systems.
3
My father was a long-time Air Force veteran. He got some treatments when needed from the VA and a regular Air Force hospital, as well as a private physician. This was before the Reagan years and trickle down economics. Afterward, his private healthcare became too expensive and he went to the VA exclusively. Private now equals profiteering. Indeed, healthcare in the US (since Nixon privatized it) with the help of Reagonomics has become unaffordable for most of us. Privatization of VA services will just put those services out of reach for most veterans. This is a serious catch-22 situation, and heartbreaking given the sacrifices veterans have made for the good of us all.
5
As a disabled veteran and consumer of VAMC services myself, I am deeply sympathetic with the Author’s plight. My experience leads me to believe she is over-generalizing her unique experiences, and indicting the VA Healthcare system in general. I, too, know the fear, paranoia and hyper-vigilance and -sensitivity associated with PTSD, and I am grateful she has found refuge in Choice programs more local to her home. However, to paint VA Healthcare with too broad a brush is a disservice to millions of veterans who receive high quality, cost-effective healthcare through the VA system. The same empirical indicia that rate private and for-profit providers consistently rate VA Healthcare among the very best in the nation, and we should not rush to ‘throw out the Baby with the bathwater.’
3
never had better care than at the va. their emrs (electronic medical records) makes other paper based charts of private hospitals a joke. I can order meds via the web, message my provider and more. local hospitals are no match for va care and understanding of vets. maybe they can be more sensitive to gender issues but when it comes to a missing limb they are magic.
1
VA was ahead of its time originally when it came out with CPRS (their electronic health record), but they never updated it. It still looks, and runs like a program made in the mid 90s.
Every hospital uses an electronic health record now. In fact, most hospitals use a far superior version of EHR now.
to privatize the VA is to throw the baby out with the bath water. i believe we can easily see without any further investigation how well our private for profit healthcare system has worked for the public. the problems the writer describes can be solved without privatizing the VA. you can't trust trump or any policy he puts forward and if republicans had any really good ideas we would have seen them by now.
3
As the wife of a veteran who gave up on the VA when it missed his clogged arteries and didn't read his chart to see he'd had a previous heart attack, who refused to renew his opioid pain prescription when he admitted that he had once smoked marijuana, to say nothing of the "psychiatrist" who wanted to put him on anti-psychotic drugs when he didn't need them, or the endocrinologist who wanted to remove his thyroid which had a negative biopsy, or that he never saw the same doctor twice. We paid out most of our savings to get his by-pass at a private hospital, and when he took on a supplement to Medicare, we were saved many many expenses. We lived 40 miles from one VA hospital and 60 from the other. Though we pay more for his care, we are happy to because he gets good care. Locally. The people know him and are familiar with his medical history.
1
A Veteran Gold Card that gives veterans free medical coverage for life in local private and public hospitals will save money and improve the quality and access to care. The only reason this is not embraced is the desire to keep federal jobs in so many districts.
2
Money, money, money. Big biz sees a pot of cash and wants it. Privatizing does that but fixes nothing. Most of these well insured lawmakers never even served, certainly bone-spur didn't. They don't care about vets, not really or it would be fixed. It's always all about the cash.
4
I don't think the VA should be privatized but vets ought to be able to use private providers if it is better or easier for them why drive 2 hrs for a the flu when you could go to a local clinic.
2
With no limits on spending, not bothering about budget deficit, and not minding how much debt we leave for our children, one will be always getting it right; not only in the case of Veterans Care but about about everything.
2
Dissolve the VA and give the Veterans the best private health insurance money can buy. That way, they can go to the best private hospitals and see the top doctors and specialists. The Veterans should have the best health care plan, period.
1
@Robert James If you really want Veterans to get the best health care available then you wouldn't make the suggestion to dissolve the VA. One of the VA's primary missions is to care for the combat wounded veteran. In answering that mission, the VA, not private health care, has led the way in making great strides in overcoming the loss of limbs, with advanced prosthetic devices, and, while progress is slow, as it is with most mental health and neurological afflictions, the VA is also leading the way in working with patients suffering from combat related PTSD as well as other neurological disorders resulting from injuries sustained in combat. The private health care industry is under no mandate to prioritize its research into the unique needs of combat wounded veterans and because there is only a minimal profit motive research and inquiry into the needs of combat wounded veterans is minimal. For the combat wounded veteran the VA is the way to go.
4
My experience with VA Healthcare here in Los Angeles has been great. As a male, I certainly have not been subjected to or witnessed any mistreatment of my sister vets. Had I, I would have immediately reported it to those in charge, and feel certain that it would have been resolved. Of the half dozen doctors I see, 4 are women. At least here, we don't seem to be subject to long waits, although many of my friends who have private care wait as long as I have to.
It's not broken. Don't try to fix it!
4
There is obvious merit to privatizing some aspects of VA services. The health of our veterans needs to be upper most in our mind when considering changes. Trump's impulsive decision-making may worsen an already challenging situation. He is not the first president to call for VA reforms. Recent changes in VA services have improved care and access for vets. A careful analysis of information on a variety of veteran needs and VA functioning is essential is we make positive changes. Trump's decision to appoint Ronny Jackson to the head of the VA says a lot about his decision-making.
3
Here is a question. Does Medicare for All include Veterans? It was Bernie Sanders who advocated for better treatment of Vets, not Donald Trump. Trump wants privatization, almost as a policy, one where the rich will get richer. Vets need to get better treatment, treatment that is substandard at present and likely suffers from the excellent points made by this author. Whether that path involves the efforts of Trump and or Sanders, we need reform. Vets include women and every other unrecognized group in the military previously labeled as invisible. Would a Medicare for All program encompass reform of Veteran care? It should. And more would vote for it. Place some of the savings to increase and improve care for Vets. Care for Vets should be the standard bearer for heath care, not unlike the Mayo Clinic. Medicare for All Veterans. How about that as a start?
2
Veterans Choice program began in 2014 under Obama.
2
This writer’s important perspective unfortunately tells me little about why she has taken so strange a policy position. It’s almost as if she went searching for the most jarring headline she could find— but then wrote a piece about a an even more jarring subject— gender-based dehumanization in the military— that has little to no relationship to the wisdom of privatizing the only fully integrated public health system in a nation desperate to rid itself of profit-motivated healthcare. Someone needs to break down the argument for me maybe— I cannot say I persuaded.
4
Sadly, the author overlooks the pure greed that guides trump’s motives; this privatization is not to improve veteran care. This scheme is to divert money to cronies many of them st Mar A Lago who can’t wait to get their greedy paws on all that dosh.
Care will decline as more and more money lines their pockets and the federal system is starved of funding.
Under any other president this may actually be a lifeline for veterans under this scammer it is just another way to defraud the government. Look for it : Trump VA Hospital.
3
First off, my profound gratitude for your service. Secondly, I am appalled to hear of the treatment given to women veterans in VA hospitals. I never thought it'd be like that, ugh!
Privatization ALWAYS === "take this system and redesign it so that it also lines the pockets of some fat cat".
ALWAYS ...
4
Privatizing = license to steal, no legit oversight, bloated middlemen profit.
5
The Charter School Strategy. Siphon off public money to make a few extra bucks while weakening a public institution.
4
Getting it right? Trump only cares about himself, his ego and his money.
Whatever he says today, he can and probably will change it tomorrow even if occasionally he may say something you agree with and/or says something right.
If you are for what he says today, speak up for yourself why you think it is right, don't give Trump any credit.
2
I am not trivializing this veteran bad experience and fully appreciate that she deserves better service, I would have expected though the NYT to seek broader views especially from veterans who have way more medical issues and needed the VA for serious war related medical problems. This is not about agreeing or disagreeing with Trump, this is not about politics, this is about doing right by our veterans and it is important for a serious publication like the NYT not to present one voice that raises issues that are clearly colored by bad experiences that preceded her visits to the VA
1
I'm a veteran and trump is not getting it right on VA care! Go out and asked any veteran that he thinks of his VA care. Another money grab my trump's elites...follow the money!
4
Socialized Medicine for Veterans? Of course. And one day perhaps for all of us.
2
It would be foolish to believe that Trump is NOT acting in his own self interest. We haven't found the con man's "hook" yet, but past performance says it's there.
Trump ONLY cares about Trump, plain and simple, so before people castigate opponents of this idea, look for the con man's angle.
Every American deserves quality health care and affordable drug prices. Medicare for all Americans solves the problem alongside allowing medicare to negotiate drug prices like every other developed nation.
2
Ms. Bhagwati, I must disagree with your support of any type of privatization of VA healthcare.
I am a beneficiary of that system, a system that I find much more responsive to my needs.
With the VA I have "one stop shopping", that is, my care provider coordinates my care with other VA providers which reduces my anxiety in attempting to get referrals and scheduling specialized procedures, my medical records are in one place and there is no need to go from provider to provider to gather these records myself.
I am truly sorry you have had experiences that soured your trust in the system, however, a small percentage of missteps by the VA does not warrant a wholesale revamp of the system. Work to improve within would be more appropriate.
4
They GOP typically under fund's the VA. They profess to live under the mistaken,and false, impression that the 'free market' can solve all problems. I don't really believe they actually buy this lie. Fact is, the idea that competition alone will solve all problems gets lost in the race to corrupt everything they touch. We end up with monopolies, not real competition following this nonsense.
Greed alone drove Trump to turn the VA over to his cronies in Mar a Lago. He and his cronies milk all that they touch and that, in addition to sheer incompetence, explains Trump's many business failures. He has a pathological need to support his lifestyle, never mind the vets and others who suffer because of neglect. How does one lose money when one own's a casino?
If the GOP is, in fact, driving itself off the cliff, then we may see a renaissance of what is, under democrats, a caring government. What are the appropriate functions that a government is supposed to provide? An age old discussion we need to revise.
I am a vet. What do I do when I lose my employer provided health insurance? Medicare, itself, is underfunded. Finding a qualified provider that accepts medicare alone is next to impossible. And, I am not alone.
3
I have experience with the V.A. and their outsourcing to private providers. I find the V. A. personnel much more qualified .
I took a licensed practical nursing course to get a better handle on health care than the typical layman client for health services. A course which has enabled me to avoid unnecassary treatments by money grubbers and to spot errors from gross to minor. Do not privatize the V. A. For Medicare I selected a physician who graduated Magna Cum Laude. I further selected a her because women are about accomplishment and men are about being somebody.
This piece is a sad comment on the quality of va services. Whether or not her solution is right, the broken VA system must be fixed
Dear Captain Bhagwati,
As you have shared something personal with us, allow me to share something personal with you from a European perspective.
My brother, a British Army officer, returned from the Bosnian conflict with PTSD - the military wasn't interested, the government wasn't interested despite their claims of running 'programs', and he committed suicide a few years later.
Today, the UK's veterans' needs, mental and physical, are handled mostly by charities and not by government. And this with a flagship social medicine program. They say they help, but that help is to send a privatised assessor around to disqualify from you from assistance.
Governments are keen for news reports to show ships sailing, families waving from port, afterburners of jets at dusk, but they are not so keen on footage of flag-draped coffins returning in C130s or disabled veterans, be that physically or mentally.
Your VA is so much better than anything we have here. Don't be so keen to privatise it, even parts of it, and address the issues that caused you such personal grief in the VA.
Privatisation of healthcare ruins it and transfers your needs to someone else's wallet. I empathasise with your article but my family has been on the receiving end of a privatised section of healthcare and it failed us all utterly.
The NHS, however, has never let any of us down but they're not equipped to handle the needs of ex-servicemen and women. You need people who understand and you have that group.
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@Zoe
Since one of my young U.S. Army relatives spent some time at a prestigious British university before shipping off to war and its wretched consequences to him, I appreciate this statement. He needed the VA and its support. Thank you.
5
@Zoe Our VA needs a lot more staff to help Vets with mental health issues. Thanks for your support tho.
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"Veteran's Choice" assumes facilities, competent care professionals, and appointment availability would/will be available for those veterans seeking care outside the VA system. As a veteran (combat disabled rated at 100%) of 50 years I am skeptical these criteria would adequately meet my medical needs. A long drive time or wait list is not solved by dumping patients in a medical market place with neither the resources, preparation, nor inclination to meet the needs of veterans at a price the government will approve. This whole privatization scheme has been waiting in the wings for eager enablers for at least four wars.
In the minds of the oligarchs who sent young men and women off to get wounded, protecting their Military Industrial Complex investment, it's only logical that they should profit from the treatment of those injuries. Their objective is to gain control, break the VA, then come to the rescue of the wounded by giving them a voucher to get care at a for-profit facility in which they've probably invested and bingo, they win twice. From war profiteering to wound profiteering it matters not to them who bears the cost, rather who reaps the profit.
the author is fortunate in that she benefited in her unique experience. The history of medicare/medicaid abuse, not by recipients, but "professional" vulture capitalist providers should be a warning of the potential abuse a complete privatization scheme would encourage.
Thank you for sharing your perspective. My husband uses the VA Hospital in MN, and has had excellent care with minimal wait times. Ours is an outstanding facility. We have always been against privatizing the VA because of how important it is for the medical personnel to be knowledgeable about service related health issues. Now I see that the experience of female veterans is not being addressed in the VA medical system. Yes, options for private care should be available. Hopefully we can still keep the VA system intact, safe from those that want to exploit it for a profit, while at the same time expanding options as necessary to make sure ALL veterans receive proper care.
84
Having served as a physician in the VA system, the answer to this reader's concerns is very simple: adequately fund the VA healthcare system. The choice program is a joke, it doesn't work all,that well. There are many excellent caring healthcare professionals in the VA. There are many administrative and bureaucracy-related rules and regulations that lead to the scandalous behavior of some, but clearly a minority, of VA civil servants. To ensure that the veteran, the widow, and the orphan are cared for, it's time to stop cutting taxes, and substantially increase funding for the entire VA system. The problems otherwise will continue to erode the confidence of many deserving men and women who put their lives on the line for this country. The injustice and the hypocrisy of our government regarding VA services is shameful.
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@ChesapeakeOne system, single payer, all Americans including Vets get same care by all providers. Why segregate them ? Medicaid for all citizens.
7
I get that the author wasn't treated as well as she expected to because she's a woman. However, that type of behavior is not exclusive to the military nor the VA. Private health care isn't going to be the magic wand that the author seems to expect. Ask millions of Americans how satisfied they are with the cost and quality of private health care. The fact that someone might be a veteran, either a former Army corporal or a former Marine Corp captain, means zero in the private health care system. No special treatment. I'm a veteran also, and if I required more than routine care I would place my bet with the VA as a better option than private health care, which many people can't even afford.
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@Trajan
As a veteran and one who has practiced 35 years in the private sector and the last 5 years at the VA, these comments are spot on. Many of those caring for the veterans are themselves veterans who understand what the vets have been through. In the private sector a vet is just another body to make money on. Try finding mental health care for PTSD outside the VA. For female vets who feel uncomfortable in the male-dominated military or VA setting, private health care should be an option, but female physicians and NPs are rapidly becoming the dominant providers in the VA and elsewhere.
83
@Ohio MD Exactly. I find it much easier to get appropriate mental health care for my issues at the VA. Civilian health care providers often don't know how to respond to veterans with mental health care issues, and especially not female veterans with mental health issues not caused by sexual trauma. I don't fit the VA mental health care paradigm perfectly, but I fit it a great deal better than the comparable civilian paradigm. My behavioral responses to psychological stressors are far more similar to male responses than they are to womens' responses. I'm far more likely to clam up and go dig a really big hole, or kick in a door in response to those stressors than I am to cry. I pretty much don't cry, and I don't want to cry. I wanna go kick in a door or dig a big hole. I don't want to explore my feelings. I want ways to deal with it when my head is set to "amok".
21
@Lisa These are really important points. The VA is light years ahead of private medical practice in providing behavioral health services responsive to the needs of veterans. The same is true regarding services for chronic pain and traumatic brain injuries. Is it perfect or even sufficient? Of course not. But, the VA has made large and sustained investments in improving care. We have all allowed the Pentagon to send our soldiers on repeated tours of duty to combat zones where exposure to physical and psychological harms are orders of magnitude greater than experienced by typical WWII vets, and several times greater than typical for Vietnam Vets. If VA resources are diverted to private care to serve the Republican agenda, shame on us.
29
Let's not throw out what works quite well within the VA system. Improve what does not. Most of my VA care is through a local clinic with backup trips to a nearby VA hospital, about 60 miles away. If my care was totally private, I would see the same type of travel for specialized or advanced care. I have used private care through the VA system when it was not available within the VA. Having relied on mostly private care in the past, I find the level of care at the VA equal two or superior to private care. If anything I spend far less time in waiting rooms at VA facilities. I cannot speak to the sense of sexual discrimination or harassment referenced in this article; however, from what I have seen VA personnel treat all with dignity and respect. I use the VA "My Health" online system. There are several reporting channels for such issues. The VA is seeing an increased level of patients as more of my generation avail themselves of VA services and our continuing conflicts keep increasing the number of Veterans needing care. I don't think the VA budget as a whole is sufficient to meet the challenges. In addition, too many politicians and their cronies smell a profit opportunity in VA funding and want privatization, not to improve care, but to raid the VA as a source of easy revenue. Going forward, funding of any military action or deployment of troops should include sufficient funding in an escrow account for future care of the affected troops.
I am 80 this year . I am an American citizen retired in Thailand. I volunteered and served in the US Navy 3 years.1963 -1967. at that time I was told when I needed , va medical would be available for me .I now need a VA card to get Va medical care in the USA. Va has denied my application because I make more than 35k a year from social security and my pension.
Also because I live and retired outside the USA I am NOT eligible for medicare.
@JERRY VA denied your medical card due to your income? Well sir, there is a category that would require you to pay a copay due to your income and the possibility you have no service connected disability.
I was in that category at one time and was provided a health care card from the VA.
Perhaps there is another issue that causes a denial?
I am sorry for the author’s pre-military service trauma, problems she encountered while in the USMC, and post-military service negative experiences she’s had in the VA. I’ve had care at one VAMC in our area for years and am overall pleased with the care and my medical team. I don’t trust the President and his Mar-a-Lago circle to have veterans’ need foremost in their minds, but to have their own for-profit healthcare ventures in mind. I like the comprehensive range of services available at our local VAMC. Don’t throw the baby out with the bath water! Perhaps wider options for private care is a good choice - for some, but not for all. The new program has no funding, so will they be cannibalizing our VAMCs? I want my local VAMC to be able to staff up and provide the best care for veterans. NO to Koch brothers et al. NO to privatization. I’m proud to be a member of the American Legion. Use your voice. Join a VSO.
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The author may be knowledgeable and well meaning but has a very limited grasp of the future of privatization on services. Taken to the extreme, let's close or privatize all VA hospitals. Like private prisons, contracts will go to the lowest bidder, oversight will be limited, and services falter as Congress looks to yet another "entitlement" target to cut. Once the Vietnam Vet bubble has burst, the limited number of veterans in the system will result in even lower funding.
The fallacy of our Defense budget is that it does not factor in the cost of veterans' care. Take that away and let's see how well the spectre of Eisenhower's Military-Industrial Complex looks in the clear light of day.
Like this Veteran, even though Trump is not personally liked by many, his policies are showing better results. One of the reasons why Trump got elected even though he was not liked is that likable politicians were not showing readiness to implement common sense solutions like private care for veterans. This will most likely reflect in the next election as well.
1
Veterans medical care for routine care is available during the day in this Iowa city, but for weekend problems you can’t simply check in to the local hospital. You have to drive elderly, invalid patients 120 miles to the nearest VA hospital. This is where privatization is needed if it means better care.
1
While sympathizing with the author, this is a clear example of the type of fallacy that over the last fifty years in the Republican party ended up giving us Trump - you have something good - a government that works, a VA system that is actually the direction health care should be going for all Americans...
when problems are identified, however, instead of working to fix them, and make a good system better, the knee jerk reaction is to burn the good system to the ground and worship the Golden calf (after Trump it's clear that's really an appropriate Idol) of capitalism, trusting that it will deliver something better for no better reason than it is our chosen Idol.
This article is wrong headed and dangerous on so many levels.
if the current system is broken, improve it based on the evidence. Don't destroy it for the false promise and magic of the profit motive. That really is what gave us Trump
115
Without disputing the author's personal experiences, this op-ed piece is the functional equivalent of publishing an opinion on climate change by someone who says it isn't getting warmer where she lives. There is considerable research evidence relevant to whether Veterans would be better off with privatized VA services or not. Fee for service medicine is often inferior to and less accessible than VA care. Moreover, tax dollars used to pay for privatized services would eventually be siphoned away from VA clinics. That is the Republican agenda. In areas where there is considerable scientific evidence, personal experience should be used to illustrate points supported by generalizable and valid evidence, not to make claims based on personal experience alone. The editor did not do his or her job in reviewing this piece.
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@MVonKorff The author has an opinion based on the facts of her personal experience. The VA employees who treated her disrespectfully are highly likely to have treated other women disrespectfully, and to be surrounded by others that encourage and enable them to do so. Human behavior is predictable enough for us to make such a statement.
Your comparison with global warming denial is inappropriate.
1
@Andrew M.
I agree with you totally. I didn't like M's generic response or comparison. Thanks for this.
Rubbish. The private sector is not equipped to deal with veterans' issues. It was tried in Britain and failed miserably. The private sector is in business first and foremost to make money. Patient care comes in a distant second, always. Privatizing veterans' medical care will further enrich private enterprise while eroding the quality of care. Built in to this Republican scam is that there will be little or no oversight, just as we have seen with the Republican push for private charter schools, which steals money from public education to enrich private enterprise, while lowering the standards of education.
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The VA has largely treated women veterans very poorly, and at the facility I will be resigning from soon, the women's division treats on old protocols and is out of date.
That being said, this editorial throws the baby out with the bathwater. The VA is an extraordinary system in the US. It has it's flaws, but it is fairly coherent and consistent health care for many individuals (veterans and sometimes spouses). This is not true in the private sector where I have to obtain my health care. Congress has been starving the VA of funding for years. This has allowed the electronic medical record - the best I have used - to become unwieldy and difficult to update. Starving the facilities of funds keeps our telephone systems and facilities shoddy and out of date making communication very difficult. Hiring freezes and insane pay-scales that pay more to providers in powerful senator's districts rather than in facilities that need providers, or have high living costs make it impossible to meet the unreasonable appointment thresholds (and really, I have rarely been able to see a private sector provider in 30days) purely due to not enough staff to see patients. Women's Health Care is poor because there is not enough staff that actually understand the particular aspects of women's health care.
The VA facility where I work risks becoming a ghetto of employees who could not work anywhere else. Is that what we want?
Donald Trump is NOT getting it right on Veterans Care. No, not at all.
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@Katherine Moore
You have identified the primary problem for staffing and quality of care issues...starving the facilities, and the system of funds and thereby, competent staffing. That is how private entities milk the government cash cow to their benefit. Their mantra is that the VA system doesn't work, (which is ensured by years of denying funding to cripple the system) and we can fix it by privatization. Let the cream flow into our buckets.
As a military retiree who lives 2 hours from a VA facility and 4+ hours from a military medical center, I have to make a followup neurology return visit 3 months in advance to see my civilian provider, for my local PCP MD, 2 months, otherwise the clinic (5 miles into town) refers to an urgent care facility 20 miles distant or to an ER even farther away.
Good luck with the idea that civilian care, where care continuity seems irrelevant is the answer to veteran health care.
4
While I appreciate the author’s problems from a gender inequity basis and am sorry she has had those problems, I have to say that my service connected 100% disabled husband has had great care from multiple V.A. centers and nothing but headaches from being referred to private care through Veterans Choice. The latest fiasco involved his waiting an inordinate amount of time for a prothesis only to be told when it finally arrived that it wouldn’t be released because the V.A. had not yet paid for it. He refuses to deal with Veterans Choice now after we have been threatened with collection agencies etc. He would much rather get 100 % of his care at his V.A.
3
As a VA physician, I have done some research on this subject. I think that the VA's bad name is not always well-earned. In fact, year after year the VA ie beating the private sector in most measures of care, including mortality. It may be stunning to most people, but a patient who walks into the average VA hospital has better odds of survival than a comparable patient walking into the average private hospital.
As for wait times, VA patients wait longer for the same services at private hospitals, and predictably increased privatization has therefore led to longer wait times for appointments. Your experience is a terrible one, but we should base our choices on data, not on anecdotes. Patients in situations like your own should be allowed to seek care elsewhere to preserve their mental health, but for most other indications, staying in the VA is the best thing veterans can do for their health.
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@Grant Thank you sir for your service to the Veterans. As a beneficiary of the VA system I have found my needs are attended to, time is spent by the provider to listen to me rather than being given the "bum's rush" in order to maximize profits.
My one-way drive to the CBOC or the local VA medical center will exceed the 30 minutes I will live with that drive to insure my care is continuous within one system.
9
@Grant Thank you for your service to us veterans. I personally got out in 2013 and I'm one of the lucky ones. I don't have PTSD, only generalized anxiety and OCD. Since leaving the army, I have always gotten prompt care and i use the veterans choice program for my mental health and those gentleman are "private" providers. So i agree with you comment 100%.
6
Hard to believe that someone would be shilling for privatizing the VA.
Trump gets it right??? Perhaps the author should have done research on how Trump allowed wealthy elites connected to him at Mar-a-Lago to have unauthorized, profit-motivated influence over VA policy. That secret, disgusting arrangement was uncovered by Pro Publica.
Trump is a draft dodger, and none of his children have served in the military either.
He hasn't gotten it right on much of anything, and this article isn't right either.
4
if there is money to pay for private veterans care why not load into the VA? the cronies that want this are 3 Palm Beach pals of trump... they are the silent hand over the VA right now.... bring it out into the daylight ... looks like "private" care will end up filling the pockets of the "caretakers" not the vets
4
When and where it works, the VA provides much better care for male veterans than private care could or would. Be careful what you ask for.
7
I worked for the military overseas as a civilian RN. Most personnel were decent and hard working but some experiences with medical personnel were nightmarish. Old fashioned and incompetent even though it was partly during a disaster situation. I never worked for the military again but this experience makes me imagine what the VA might be like. I certainly hope not.
Private doctors have quotas of how many medicare patients they will admit to their practices. Most are already maxed out with that number. When I became a eligible for medicare I could not find a doctor but luckily I was able to afford a concierge doctor. How many of our veterans could afford this alternative?
2
This vet is sympathetic to the author's comments. Of course the VA isn't perfect nor are all the personnel and not being a woman I have not had the experiences the author has been subjected to. Having said that I feel obliged to say that my experiences over the course of many years have been generally positive. I know the system is overloaded and wait times are sometimes greater than I would like. However, the imposition of layers of bureaucracy such as Veterans Choice is not the answer, I'm having my own issues with this "for profit" intervention at the moment and it is worse than I have ever experienced previously. Frankly, I am not altogether convinced the intent here is better health care for vets. Ifthat were the case more would be done to expand and better staff the VA. What I am seeing is just another "for profit" boondoggle.
5
I'm a veteran from the 1950s who is neither disabled nor a retiree. I'm no fan of Medicare, but I think that the VA health system should be rolled into a revamped Medicare system. I believe that not only would this produce better health care for veterans and make it more available to those who live in outlying areas, it would drastically reduce costs. Veterans with combat-related injuries --- including PTSD and delayed -results like Agent Orange should receive medical care in military hospitals.
I have been a patient with the VA for well over 15 years and overall I can say the care Ive been given has been pretty good, not perfect, but pretty darn good. Like any hospital the VA has good departments and not so good departments and doctors and nurses that are outstanding and some that are not so outstanding. I have also had the opportunity to be "outsourced" via TriCare to a privatized service and that wasn't so good. I honestly don't know the process by which a private doctor can access the VA system but believe me some horrible doctors and medical services can dip into the VA and I suspect make some pretty good money doing so. I truly believe our current president is not so much concerned about the plight of veterans as much as he is about tossing money toward the privatized economy. The veterans just happen to be in the way.
13
Here's a question to ponder: If we only had one system, would it be better to convert Medicare to a VA-style system with government-owned hospitals and clinics and government employed doctors; or would it be better to convert the VA to a Medicare-style system with private providers but government payment?
2
The VA serves a population that has special needs not seen widely in the general population. Battle injuries require specialized care many times. If you dispurse the knowlege neededd to provide this care throughout the general population, this care wont be as readily available to veterans.
3
Try and find a dr that is taking new patients ( I.e an internist). Then try to find a dr when your insurance reimburses at the lowest rate ( I.e Tri Care or VA). Putting VA patients into the private health care system, just creates another problem IMO.
9
I am a Veteran and it really depends on who and how they go about using private doctors. Over the last couple of years, while trying to get the VA to recognize my disabilities, I had to see several of these doctors. I have a rare condition and none of these doctors knew enough about it to make an adequate decision. Also two of the doctors were so difficult to understand, due to poor English, that I have no idea what they said or wrote down in the system. The VA could have used the medical information I brought from military doctors that I was currently seeing. Instead, they paid these civilian doctors and ignored the military doctor’s recommendations. It was a total waste of money and it took me a year to get my final disability ratings.
5
As a retired Navy Medical Service Corps Officer, I know that the military has been contracting out medical and dental care for active duty dependents for over twenty years. I also know that these contracts typically embrace the least qualified practitioners at the lowest cost. Not all, of course, but enough bad eggs to spoil the whole system. I could tell tale of many very bad health care practitioners I've had to work with while managing their contracts. Expect the same, probably worse, for the VA.
6
I am a psychiatrist and a veteran via being in th Indian health service branch of the Public Health Service. I do not think that starving the va of funds to give money to private contractors will help with chronic care needs. Great for scute Care sometimes, but not funded for research and development and social and income care and not able to deal with other veteran issues.Bad idea
4
Veterans and VA employees are right to be concerned about plans to privatize VA healthcare services. Let's face it there is big money to be made by connected people if VA healthcare is privatized and there would be sweet kickbacks for politicians who open the money floodgates.
That said, the Veterans Choice Program is a good stop gap to help meet current demand for veteran's health care; however, it is not sustainable because there is no good way to control costs. An alternative is for the VA to bid out health services/hospital management contacts to regional private healthcare providers to provide local healthcare to veterans and manage VA hospitals. Advantages of such an approach include:
Veterans receive health care in their community.
VA hospital employees remain federal employees.
Fraud detection and quality care standards could be provided by the JCAH, VA oversight teams, the Justice Department, etc.
Cost control could be provided by using the Medicare payment system/model.
Folding TriCare —private health insurance for retired and active duty military families— into the VA bid services would improve healthcare for all people who served or are serving our nation.
As a retired military person I am provided healthcare by TriCare but denied VA healthcare benefits because of a law passed during the run up to Iraq. That said, I believe all veterans should be served by the same healthcare system and provided the same high quality healthcare.
3
@old soldier I too am retired and just recently signed up for V.A. care as there is only one urgent care clinic in Elko Nevada that accepts TRICARE and no other general practioner docs accept it. So I’ve got my first V.A. appointment next week. What law prevents you from seeing the V.A.? I only signed up as I no longer have coverage thru a private employer since I retired from my civilian career
Agree: Do not like this President.
Agree: Fold VA health care into the existing system.
Knowledgeable health care administrators have been requesting this for many years. It's not Trump's idea.
The VA health system was once a good idea, to ensure care in middle America, but that is no longer the case. It is unnecessary and expensive. For veteran's, the gov't will be the payer rather than an insurance company.
@Rick You’re correct that it’s not Trumps idea. It is straight from the Koch Brothers, yet another attempt to enrich themselves on the taxpayer’s dime.
2
Are you a veteran? I am and I am lucky to live in San Antonio, site of the Audie Murphy VA Hospital, one of the best in the US.
The federal government needs to fix the problems that exist, not privatize. Any money going to the veterans should go into the VA system.
What is wasteful and expensive is the 24% of every dollar going to private care that goes to overhead and profit.
Privatization is nothing but a scam by President Bone Spurs to enrich his cronies with taxpayer dollars.
America’s private healthcare is in shambles. It costs the highest prices per capita in the world yet provides some of the lowest quality. Wait times are now approaching those of other western nations like Canada.
Why would anyone want to put our vets into our broken private, profit-based system?
10
I think this is an appropriate time to say that while I support Democrats’ effort to expand access to healthcare, and I believe healthcare should be a right for all, its a mistake to approach this problem with an intransigent view of private coverage as being a terrible thing. There are a lot of ways to deliver healthcare-for-all. It doesn’t have to be 100% government-controlled. I have heard so many stories of the VA’s dysfunction. I can’t accept that the program is irreparable, but the massive obstacle to fixing the program cannot get in the way of veterans who need better care now.
I've observed efforts by republicans and legislative votes since the early 90's to privatize the VA. And their efforts to make the VA inept through attrition. The biggest problem with the VA health care system is consistancy with some regions putting out great care and others on par with 3rd world health care. Lets get into the process most veterans go through with Veterans Choice...1st get a refferal from a primary care physician at a VA CBOC clinic 2nd wait 30 - 60 days for an approval from a contractor administrating veterans choice for an approval for specialized care for a consult only 3rd wait another 30 - 60 days for private care specialist to schedule an appointment 4th wait another 30 - 60 days for Veterans choice to approve the actual work or surgery needed 5th wait another 30 - 60 days for private care to schedule an appointment.....this pretty much sums up my experiences with veterans choice....congress and Trump need to allocate equal funding for VA med centers and primary care...not starve the VA so that the private sector can profit off of veterans misery! Specialized care in the private sector has meant longer wait times for care for most veterans, in my case 27 months of extreme.pain for spinal injury, 6 months wait for treatment for skin cancer, 6 months wait for specialized care for dental...tell me again how this sham and misnomer called veterans choice is of any benefit to veterans..
3
Bhagwati's (legitimate and valid) troubles aside, let's understand this:
1. Most VA medical care is as good as "private" care (except for the very rich) and is available from physicians, psychiatrists, psychologists, physical therapists, social workers, etc. who are dedicated and have a long and almost universally successful history of helping veterans.
2. Medical care outside the VA system is also broken, maybe even worse than the VA—and most "providers", who have never served, have no clue about trauma from war—PTS and moral injury so are unqualified to treat veterans...especially combat veterans. (Moral injury, by the way, is the primary cause of veteran suicide and is a major contributor to Bhagwati's difficulties),
3. I am a veteran and Medical Doctor. I was a battalion surgeon in the American War in Vietnam. I did a significant amount of my training in a VA hospital. So, from this point of view I suggest the following: The VA compile a list of practicing health-care professionals outside the VA system who are also combat veterans who would be available for veterans' care and make that list a primary source for veterans to seek care outside the "system."
4. Such a registry would be a god-send for veterans...and for their comrades in arms providers, nearly all of them, I suspect, scrambling to add their sisters and brothers to their list of patients.
2
We shouldn't privatize the VA.
We should nationalize our entire health care system.
The VA does a fine job for people who live close to the facilities. It is a problem when a veteran lives in a rural area far from a VA facility able to provide for her or his needs.
If we simply created a single system for everyone, paid for through progressive taxes, everyone would be better served. Only the US among wealthy countries is too stupid to understand that.
Medicare for all is a catchy phrase but Medicare is not an adequate health care system as it now exists. Only if one buys supplementary care does one have adequate health care coverage. For an elderly person in poor health, Medicare's Part B 80-20 coverage can leave patients with huge uncovered expenses. Private health insurance companies offer nothing but waste.
Privatizing the VA health care system because there are inappropriate or abusive personnel working for the VA is avoiding the problem, not fixing it. Those people need to be disciplined, re-educated or sensitized or if that fails, fired. The chances are that doctors fired by the VA will find jobs in the private sector.
As VA patients are redirected to private health care settings, those settings will need to hire new doctors. And where will those doctors come from? Perhaps from the VA as it is forced to continually downsize as it loses patients.
The solution for Ms. Bhagwati is not to privatize the VA but to force VA personnel to behave appropriately.
4
Why do I instinctively and intuitively (i.e., a priori) know this to be false
1
I'm sorry this whole argument is bogus. Because this officer is female and has received unwanted stares we should privatize the VA. Gimme a break. You want to argue that sometimes it is to far away to the nearest center I'll listen. But once again the many, by a long shot, has to cater to the few. The VA needs more money put in for trauma related injuries. It does not need money siphoned off.
9
the VA is not run to make a profit, or to provide its top level executives with million-dollar salaries. the VA is woefully understaffed. privatizing it will result in a lower quality of care for veterans, but increased profits for the mega-corp entities that increasingly dominate the socalled private sector.
a well-run VA facility is an example of what the federal government can be: ordinary people doing extraordinary things for their fellow citizens.
7
Not sure why this individual thinks / believes private insurance will be any better?! Decisions like this by trump are a cover - he is trying to fulfil the GOP line of privatization under the cover of "helping" veterans. Veterans, as well as every other individual in our country, need affordable and excellent healthcare - this isn't how the current private insurance system actually works - at least not for many.
6
I am appalled by your treatment. The treatment of our veterans is unconscionable.
But if you think anything with Trump's name on it will be positive for you or other veterans, you should consider Trump University.
The best move for the country and all its citizens is to get rid of Trump and his Republican enablers. None of them care for anything but themselves, and their personal agendas.
5
@Democracy / Plutocracy There is no reason to be appalled at the care and treatment of veterans. For 26 years I have received noting but the best. I am 77, in good health and I have PTSD and several things associated with exposure to Agent Orange. I would have been dead of a heart attack about 10 years ago without the VA, it is hard to hate them.
2
I find that veteran worship (code for I'm glad I, or my kid didn't have to go) peters out when it costs money. My big beef with the VA is drugs. Newer drugs on their formulary still may not be prescribed because older drugs - in their view, might be just fine. Trump, or anyone else in government who says they want to provide the best for our vets is at best disingenuous.
US Army Vietnam Vet 69-70
2
@Curt The VA is hesitant about new drugs and for a reason. In the past several years there have been, for instance, a plethora of diabetes drugs. Listen to the ads carefully, but they do not tell it all. One, or possibly more, of the new drugs can cause gangrene. The VA lets those things wind themselves out in the market before they go to use them. It has nothing to do with the cost of the drugs, if has everything to do with their overall efficacy. I have diabetes and am taking nothing but pills and my A1c is within acceptable numbers. If something better is accepted by the VA, my endocrinologist at the VA will prescribe it for me.
3
Seriously, seriously look at the Kaiser Permanente model. It works very, very well. Stay away from United Healthcare model. Any that has stocks you can buy is a model you want to stay away from.
6
Sounds like a big old Dose of Medicare For ALL might be just what’s needed. Just saying.
2
@Phyliss Dalmatian Medicare for All will, inevitably, wind up hurting seniors and senior vets.
They privatized prisons. Look how well that's working out.
4
Does the private sector have the background and research capailities that the VA has been using and developimg during all the previous and present wars? Does the private sector know how to treat PTSD when they don't do very well now on mental illnesses?
I know the vA needs better administration and other management structures, but they have been treating our Veterans for many years and know how to deal with complex combat injuries.
What might be better than a handover is a comprehensive combination or partnership of the VA with the best private medical centers. Go slow and don't just hand the VA over to private - for profit - enterprises whose chief goal is to increase the $$$ in the bottom line of the budget.
2
@edmele The major problem with the VA system is not the hospitals, but the Regional Offices. My disability case was 18.5 in getting resolved due to the absolute ineptitude of the RO. After 10 years of nothing happening, my case went to the Board of Veterans Appeals whose response was that the local RO had done absolutely nothing on my case for ten years except send me monthly letters telling me that they were working on my case.
Taking on the medical accessibility problem certainly needs to be addressed. Capt. Bhagwati's sensitivity to exposing her body to medical personnel would seem to be more of a neurosis on her part, a personal problem, that shouldn't be used to overthrow the entire system of veterans medical care.
1
All veterans should have the option to be enrolled in Medicare. We already have a healthcare program that allows patients flexibility to choose their providers so they get the care they need. Medicare gets high marks from older Americans, so why not offer the same level of care to our veterans.
2
I have found the Veteran's Choice program and TriWest in particular to be inept and wasteful. They have set appointments at locations which are closed--they never bothered to get the correct address. On a number of occasions, they set up an appointment with a medical provider and when I get there, the voucher/order has not been received. This happened so frequently that I wrote to our congressman and notified VA and TriWest I did not want to be in the program any more.
I have a service-connected disability rating of 80%. U.S. Army, 1LT-Infantry, Vietnam combat service.
6
I'm sorry for this veteran's experiences , but I don't think her views or experiences represent those of the majority of veterans, men or women, who receive care in the VA system.
Most veterans' organizations, other than Concerned Veterans for America which is largely supported by the Koch brothers and their ilk and whose motives are thus highly suspect, are not in favor of diversion of substantial amounts of VA funds to the private sector. Reasons include the fact that this will inevitably take away needed money from the core VA hospital and clinic system. It will also open the door to potentially wasteful spending, overcharging of the VA for services and it has a huge potential for fraud.
In recent years the VA has as much as its budget will allow provided timely and appropriate care to the increasing number of veterans using its services. The VA already interacts with the private sector to provide as much as 30% of veterans' care, either due to need to travel extensive distances or to provide timely, usually specialty, services.
The vast majority of VA employees of whom I was one and many of whom are veterans themselves are committed to the VA's mission.
I can also see problems ahead when a private provider wants specialty referrals for a patient. These may or not be appropriate, but who is going to decide? I have had experience in reviewing these issues within the system and it is a significant problem especially with non-physician primary care providers.
6
What stood out to me as a former board member of a nonprofit providing support to women veterans is a common theme that doesn't have much to do with VA care. The theme is that women are sexually abused prior to joining the military, believe that by joining the military they will be able to move forward with a better life, and then find out they they are simply abused again in one way or another while in the military. I applaud the mostly female members of Congress who have targeted the military for its maltreatment of women. It needs to continue. Changing the culture is a monumental task. I also am grateful for those in the military both male and female who have tried to make things better.
5
Years after he returned my dad died from a tropical illness he caught during WW2. The private doctors who treated him didn't recognize the symptoms because they had never seen the disease before. Dad was misdiagnosed and given inappropriate treatment.
The surgeon, who was his personal friend, told my mom that the disease was seen often in VA hospitals. He said he hated to see a good man die from something that was curable as this particular disease was. He refused to bill us for his part in Dad's care. (I'm told not billing for his services was this surgeon's standard practice when a patient died.)
5
This is mostly an advertisement for the privatization of a federal service. It is not very different from campaigns to privatize social security etc. The forces behind this use a female former military captain as their front-person. It helps that she has claims of sexism and assault. Her statement that 'she doesn't like the president' perhaps helped too, particularly here.
Most arguments require a comparative analysis and there are none of any significance here.
21
@Cynical
The old saying "Watch what you asked for, you might get it". Anything Trump offers will ultimately benefit the rich like him more than anyone else. If anyone thinks they have problems with the VA (I don't) wait till the VA is privatized and loyalty is strictly geared to make a profit at our expense.
11
VA health care was once the best in the nation. Health care provided by a salaried staff, rather than private practitioners, is best because staff doctors are supervised and evaluated regularly whereas private practitioners can wing it.
VA health care fell apart because the Bush administration neglected to expand VA services to meet the needs of casualties from two prolonged wars. Today, the clinics are too few and too understaffed.
Arrangements for VA patients to be treated by private practitioners should be a temporary measure while traditional VA health care expands staff and builds facilities.
7
As much as I hate to, I agree with this article. As a physician, I can attest that VA care is woefully inefficient. Granted, it has had many benefits (including opportunity for medical education) but the bureaucracy and civil service requirement are horrendous. It is virtually impossible to remove inefficient personel. I am also at a loss to understand why the VA provides so much civilian care; most of this would be provided by Medicare at a much lower cost. My view: the VA should make sure all eligible veterans have medicare for use in more efficient systems, EXCEPT for truly service related injuries. In these cases, our veterans deserve gold-plated specialized service which could truly be provided by a properly trained and dedicated staff. Let's face it: the insistence for having a system addressing mostly non-service related care is a hold-over from a different era and wholly irrational. We need better care at lower cost; we cannot go on bankrupting the country.
4
The President's real contribution is passing legislation that allows the VA to fire incompetence, thus improving Vet services. He has also provided a private health care option. He probably has done more for Vets than anyone in last twenty years.
4
The writer of the article mentions Choice. Although Trump has claimed that was his, it was instituted during the Obama administration and Secretary McDonald. But Choice is dead, it is no more. It as replaced by Community Care which did not work, was managed by a private concern on the outside and it too is on the way out.
The problem with private care is that many states do not have the doctors necessary to take care of all of the patients seeking outside services. Georgia, for instance, has numerous counties with no doctor at all and especially with no specialists. The VA has the most up to date system of maintaining medical files in this country. I use the hospital in Atlanta, but if, for instance, I am in Nashville, the facility and doctor there simply has to put my last name and last 4 of my Social Security number and they have all they need in medical files for the 26 years I have been going to the VA.
6
The elephant in the room which nobody has yet addressed, is that anyone who attempts to get an appointment with a medical specialist finds there will be a long wait.
As a civilian, I tried to get an appointment with a Neurologist in October. His first opening, I was told, was in February.
And now, there will be more people attempting to find these appointments. So, take off the rose-colored glasses, people, and realize that this new policy will not solve the problems of anyone waiting for an appointment with a specialist.
5
@Pat is a person who knows what he/she is talking about. I also had to see an outside neurologist about thing akin to Agent Orange. I did get an appointment with probably one of the best neurologist at Emory in Atlanta. It took 8 months to get in the door. Even with the plethora of doctors in the Atlanta area, there will not be enough to take care of their newly found veteran load. And the doctors will not be happy when some slovenly dressed veteran sits in his spotless waiting room amongst bejeweled female patients. Every mental health professional provider that I have either gone to or talked with "knows" how to treat PTSD. That is a lot of bunk. They will be glad to take your insurance company's money, but they know nothing about PTSD.
There are no two PTSD cases that are even similar. The only psychologist that I found that truly knows PTSD was my doctor at the Va until he retired almost a year ago, now my therapy is sitting on my secluded patio smoking my pipe and watching my birds. It works!
There isn't a nickel's' worth of difference between Trump handing over veterans' health care to for-profit providers and, soon enough, insurance companies, and George W. Bush's attempt to hand off Social Security to Wall St.
It's the same old story: get those hands in the cookie jar.
14
The author’s experience appears to be uniquely personal. Her own perceptions do not necessarily mirror those of others, and if she lives within 30 miles of a VA facility, she’ll still experience the trauma she speaks of. I’ll clue her into the fact that hyper-masculine men can be found in private clinical environments as well. Choice takes funds away from VA to enrich certain segments of Trump’s mega-rich supporter base. Veterans will end up paying more for less care and poorer outcomes from practitioners who do not have any knowledge of the particular needs of veterans.
Don’t use your individual biases to argue that the veteran population will be better off with privatized care. It won’t.
13
Captain Anuradha Bhagwati has a person ax to grind is how her article appears to me. I gone to the VA for medical care now for 26 years and there have been a minimum of problems. I have never seen a patient treated with disrespect and for her information, most of my doctors at the VA have been women.
On two occasions in the last 26 years I have had to go to a private hospital for Emergency Care. One time I collapsed in my front yard and could not get up. I had no idea where I was and my wife took me to the local hospital where, as long as I was in there, nothing of consequence occurred. There was no diagnosis, the prognosis, no medicine, just a group of medical professional walking around me like the ten blind men and the elephant. Luckily, that occurred on a Sunday.
Monday morning my wife took me to the VA. I saw my primary car physician and tests were ordered. Within three hours, a fraction of the time I spent at the private hospital, my problem was found and a regiment was prescribed and I have had no more problems.
I had the same thing, basically, happen at the same private hospital on October 30th of last year. I could not balance and was taken to the hospital ER. Again, they all walked around me like the aforementioned 10 blind men with no diagnosis, no suggestions, no prognosis and no medication. The VA, on the other hand isolated the problem and began treatment.
There is no EM club nor officers club at the VA, walk in and you are equal.
8
I'm also a woman veteran and I have to say never been treated badly at a VA facility. I have always been treated with courtesy and consideration by the doctors and nurses who were treating me. I live in upstate NY and have been treated at 3 different hospitals in the area and have always been made to feel valued as a veteran. Occasionally someone treating me has asked if I was a veteran or the spouse of a veteran but I find it hard to be offended by that.
10
Be careful what you ask for. The US healthcare system is not patient based. It is about profits for big pharmacy and insurance companies, executives and stockholders. Within that system the vast majority of providers are caring and highly competent who are respectful of patients regardless of gender, race or culture. I speak not only as a healthcare consumer but as an RN who worked for the VA as well as the private sector as we moved for my husbands work around the country. The VA does need to improve in many areas, but siphoning money into the pockets of the CEO’s etc. will not be helpful.
I’m still waiting for the more comprehensive, better cheaper healthcare that Trump promised. Repeal and replace is what we have heard for nine years now from the GOP. It’s time to deliver for our Veterans and taxpaying citizens
10
Lovely for some veterans, not the majority, but a gift to health providers within the 30 minute radius and a first step to privatize the VA, a catastrophe. One thing that the private sector does better than the VA, profit, deny services, and injure veterans,
Only government wages war. Citizens who fight for our country were promised healthcare for protecting us and for risking their health and lives. They have paid in blood and deserve coverage. Private coverage means “marketplace” coverage wherein providers are rewarded for saving money, not lives.
Americans have been under a spell since Reagan’s inauguration. He confirmed the distrust that Republicans rely on to gain power: government can’t be trusted. Who should Americans trust? The evermore powerful corporations. Handing over healthcare, education, national defense, infrastructure to the “private sector” always costs more, and evades liability. All because government of, by, and for the people “is the problem”? It is not the problem. Greed is the problem. Democracy is not as efficient as autocracy right? It’s just our history that our founders fought and defeated autocracy and established a democratic republic with all it’s inefficiencies as the best servant of all of the people.
10
Why does "privatization" have to be all or none? My VA card should entitle me to choose whether to seek care from the nearest VA hospital or clinic or from my hometown physician or local hospital. Consumer choice is almost always a good thing. If the VA had to compete for my business, they would either deliver higher quality and more timely service or I would go somewhere else. Over time, the market for veterans’ healthcare would find an equilibrium between the government-operated system and the private sector with productive resources such as doctors, nurses, hospital beds, and medical equipment shifted accordingly.
3
@Earl W. I mistakenly clicked the recommend on this comment. Our local VA delivers high quality care. Local veterans who have experienced private sector health care and VA care love their VA health care. The private sector health providers do not want to see VA patients as the reimbursement is much lower than insurance reimbursement. VA doctors are paid about 1/3 the amount of money they could make in private practice. VA mandates patient consults must be seen by a doctor within 30 days or less. Try making an appointment in less than 30 days with a private sector specialist. The VA healthcare system must operate within the budget assigned by the federal government. Unlike private health care systems who can hire more doctors and nurses as demand increases, the VA system must see every patient with the staff they are given.
4
@Jay I believe you've proved my point. The VA is working great for you, so you're content where you are. That's wonderful for you. Why not give me a choice where I obtain my health care? If the VA turns out to be my provider of choice, I'll also stay with them. Did you honestly love the days back when ATT was a monopoly and you could have any phone you wanted as long as it was black and tied to a landline?
1
The author vividly points out what ails the VA system. Had she spent time in private hospitals cared for by private doctors she would be able to make the same about them.
Our private medical system is plagued by greed (e.g. the price of epipens and other drugs) that has resulted in care that costs about twice as much as it does in any other western country.
The author has made an excellent argument for fixing the VA. She has not, however, convinced me that privatization will do so.
10
Not so fast. Privatization advocates are, primarily, about saving money, and that means cutting some vets out of the loop.
As a veteran, I have concerns about the privatization of the VA. Sure, some vets would find the ability to use any local medical professional or hospital efficient, but I truly fear that, over time, the new system will shut out many very needy vets who get their vital medical care from a VA hospital or clinic, but who are not service connected for their care.
As it is, the system takes care of 100% service connected vets well, even taking care of their dental needs. But most veterans, especially the poorest, are not service connected, that is, their injury or disease isn't from their service time, so they are not eligible for VA care, unless they are impoverished.
Will the new system allow a very poor veteran the same care that he/she gets today? Will that be written in stone so that in fifty years vets will get care?
I was able to use the local clinic to get help with a recent flu that for some reason shut down my liver, and I am grateful. But I strongly suspect if the VA were totally privatized, low income vets like me would be shut out. I haven't seen any commitment by the political world that they will help all vets, not just 100% service connected, in that new system.
May the day come that all all Americans get full health care, no matter how service connected they are.
Hugh
7
@Hugh Massengill All veterans, whether 100% or less, even no percentage, are entitled to use the VA. If they have insurance of any type, that will take care of their expensive. There may be some copay. They may have to pay for their medicines, but they will pay far less than in the private sector. If they are impoverished, their care will probably be free.
1
@Hugh Massengill
"Privatization advocates are, primarily, about saving money..."
Yeah, no.
They frequently use cost savings or quality of service as a big foot in the door, Republicans being particularly complicit.
But costs inevitably rise, missions always somehow creep, and services available are always curtailed for very good reasons.
Privatization advocates are virtually always about taking your tax money and mine while giving as little as possible in return and avoiding scrutiny at all costs.
People who care about the issues address the issues they care about, not the money.
1
@Bill Dooley
https://www.veteransaidbenefit.org/health_care_benefits_for_veterans_receiving_pension.htm
There are many very poor and/or homeless honorably discharged vets who are able to get lifesaving medical care from the VA. I, for one, recommend all vets check out the VA, even if they aren't service connected or impoverished. One day the VA may be a lifesaver.
Hugh
1
Captain Bhagwati is one voice, but sadly, she is way off the mark. If you have a problem with sexism, or discrimination, speak up and right that wrong. Go to your patient care advocates, go to the facility director, but don’t think that privately run health care doesn’t have the exact same issues. I’m a veteran, my father was a veteran. It took me years to convince him that the VA was better than the esteemed Cleveland Clinic. Once he switched, he too became a believer.
If anything, we don’t need Medicare for all, we need the VA for all. The problem is there are some very rich people in for-profit health care and insurance industries protecting their cash machines. The VA just protects veterans and for that, I’m thankful.
11
I don't know why Ms. Bhagwati believes she will receive better care in the private sector. I'm not a veteran but I do have many of the issues requiring care that she does. I have faced the exact same treatment from private care that she has from the VA.
These problems are not about the VA, they are about the substandard treatment most women experience. The difference is that Ms. Bhagwati wants and is demanding better.
For that I applaud her and am behind her. Women do not get a fair shake from their medical care givers and that includes women doctors, techs, nurses trained and have completely drunk the male, authoritarian mindset that is integral to medical training in America.
8
This is more political theatre. The VA has been subcontracting for years. They sent me to my choice of a private Opthalmologist twice in three years. My care there, and at the VA has been outstanding.
6
As an older male veteran that has both worked at and used the VA for years, I wish to add some additional comments. Some of Ms. Bhagwati’s observations are related to being a woman in a predominantly male organization that grew up after the Second World War. The VA, along with society, is changing, but it takes time to change course. Older male medical and administrative staff are retiring and being replaced by younger men and women that are more in tune with the culture that recognizes women’s as well as LBTQIA issues.
In the last 12 years, I have been treated by two excellent primary care physicians both are women. Had Ms. Bhagwatti been treated by my primary care physicians, she would have had a somewhat different view of her VA care. Also, it is unfortunate that it took years for the VA to recognize that travel time and not distance is an important factor in determining eligibility for the Veterans Choice program.
4
No, you are not seeing the issue clearly. I served 30 years and have been retired for five. Every year, my benefits are chipped away. Every year, this Administration and a "conservative" Congress sees me as a "taker" and up the deductibles and drops more options. Just this year dental and vision coverage was no longer offered for retired vets: we have to find it in the private sector.
You need to get informed. Join MOAA (Military Officers Association of America) and discover the scheme to deprive us of what we were offered.
When my country called I answered. Now that I'm of no longer use, I'm just an expensive nuisance. "Privatization" is just another tool to cut me completely loose.
10
@Mjxs--Retired military has always been given the option of TRICARE dental and vision coverage. That is hardly "the private sector".
2
"Not seeing the issue clearly"? If the writer's concerns are treated as dismissively and patronizingly by the VA as you have done, then she certainly has a point.
@Mjxs. How can you possibly read this woman’s experiences and say she is “wrong”? And by the way, those of us on Medicare don’t have dental or vision care either.
Never understood why we have a separate health care bureaucracy for non-combat related health care issues. But I would merge the current program with Medicare, with special programs for combat or work related issues. There is no sense having two programs or propping up the expensive and private insurance option.
2
I am a retired VA physician, having spent 30 years working for the VA. Like many VA's the Pittsburgh VAMC is closely affiliated with the University of Pittsburgh Medical Center, a world- class facility. Most of the VA physicians hold university faculty appointments, and many also practice at UPMC. The VA is a major teaching facility for the UPMC residency programs. The quality of care there is on a par with that of UPMC. Although I am not a veteran, I would be happy to receive care at the local VA if I were eligible.
The VA's issues with accessibility and treatment of female veterans are eminently fixable. I suspect the real reason behind the President's policy is the Republicans' long standing desire to privatize the VA. As more money is shifted to the private sector, VA will be starved of money and resources. This will ultimately lead to the collapse of the VA health care system. The result would be enrichment of the private sector and loss of a major resource for medical education and research.
13
@Hoarbear: I concur. The VA system has been a standout in high value care. Certainly it has been short in money, but it makes the best of it. Multiple studies and publications have shown that the VA health system provides superior or equal outcomes compared to the private health-systems. What the author touts as an improvement will turn out to be a Trojan horse, a clandestine attempt to take it down and throw veterans into the wilderness of the for profit system.
6
Privatizing the VA is a terrible idea. It will increase costs and provide a very inconsistent service. Privatization in Medicine leads inevitable to: profiteering paired with inequality.
9
I'm not in a position to assess the wisdom of these changes. My primary concern is that this should not in any way enable the VA to abrogate its responsibility to provide for veterans' medical care. Assigning a veteran to a local, private clinic can't mean that his or her care is now somebody else's problem.
2
Name one federal service that has been privatized and the cost went down?
I'm sorry for your experiences as a woman in the military, but as a former Air Force medic, I can assure you women were always treated with dignity and respect. Most of my "bosses" were women because medics are overseen by nurses and I assure you they would never tolerate different levels of care or treatment.
The VA is practically privatized already as it is being run by 3 or 4 civilians at Mar-a-lago.
True the VA has problems but they are due to a failure by Congress to provide adequate funding and oversight, both of which can be addressed.
Go to any VA facility that houses private providers and you will see their lush facility in contrast to the drab VA. If the government can afford to pay the lavish lifestyle of the private insurers why can't they do the same for the VA?
We don't need two healthcare providers for veterans, we need to fix the VA with adequate funding and oversight.
18
I’m wondering if anyone knows how to get medications that are not in the VA’s formulary? Private pharmacies charge too much money even with private insurance. If the VA would agree to pay a private pharmacy for some medications that would be helpful. The best medical care will fall short if medications are not available or are too expensive. Brilinta and Humalog are two that come to mind that are not in their formulary.
2
@Florida"If the VA would agree to pay a private pharmacy for some medications that would be helpful."
They already do so.
1
The treatment, medically and socially, I have received at the Tucson VA has been exceptionally good, professional, and actually enjoyable. The technical quality of care has been excellent, but the attitude and humanity of the providers has consistently been “above and beyond.”
The Tucson VA is quite crowded and busy, but the wait times at the clinics are not long by any comparison to my experience at prival medical facilities. And, once in the room with a provider, the atmosphere and the attention received is superb.
I am sorry Captain Bagwati has experienced what she has described al less than professional and compassionate care and experiences at her VA. But, from my experiences, and that of many fellow vets I routinely meet at the Tucson VA, If all life’s interactions were conducted in the warm, loving atmosphere I have experienced there, the World would be a much better for us all.
If anything these days makes me proud to be an American, it is the VA. The promise it keeps to us veterans ennobles our service.
13
@Matt Cook
The VA in Little Rock and the VA in Fayetteville, Arkansas are both outstanding.
Privatization = increase corporate profits while decreasing the quality of service and products.
See: military-industrial complex; financial-industrial complex; medical-industrial complex.
15
@June: whenever I read the claim Trump has gotten something right, I find the opposite true. It just means he had a simple solution for a complex problem, which invariably turns out to be wrong. So in this case.
8
Female Veteran here. Married to a Veteran, the daughter and sibling of those who also served. I’m very glad than you have found better care, and have that choice. BUT, a total privatization of the VA Healthcare system will inevitably lead to less care, and worse care, on the whole. WHY ??? The companies providing this care are driven purely by Profit. It’s all about their bottom line, and paying their CEOs and other high ranking officers Millions. How about a test run in certain locations, where the waiting times are completely unacceptable? Let’s find out what might work, before burning down the system.
Best wishes.
15
OK. But when you’re standing in line behind everyone else on Medicaid and Medicare, waiting to see a doctor that accepts what the government is willing to pay him or her, and you realize you’re getting third rate care while some “providers” are inflating claims and getting rich (putting in unnecessary heart stents, for example) you may find that that the VA healthcare system wasn’t actually as bad as you thought.
8
@Cold Eye--In the private sector, you will also be vying for an appointment with people who have employer-provided health insurance.
2
She can't see the forest for the trees. Big picture? A money grab. Public money for private profit.
13
I am sorry the V.A. health care system has not met your needs. I am an older veteran who was at first reluctant to use V.A. clinics as memories of military health care and the V.A. circa 1970 were not encouraging. Care is sometimes uneven but, I think, much improved. There are many great providers at V.A. facilities and furthermore, for what ever reason {in-affordability of outside care?}, the place is packed with patients. Destroying the V.A. health care system has been an ideological goal of the Republican party since the mid 1980s. I fear that privatization is the methodology to this goal. Once they have degraded the facilities themselves, they will designate care only for service-connected issues {some of which private medical facilities have no expertise in}, and then slowly cut back there too. These "conservatives" do not believe in government 1) helping anyone or 2) taking money away from potential party donors.
19
I agree the VA is way to efficient at what it does. If we can introduce some "business oriented doctors", we can definitely provide more "choice" and get away from the excessively low administrative overhead that plagues the VA.
The "choice" that the American people will get is to pay more for less and worse care for our veterans.
Fixing the "health care" system is different from selling the VA health care system. Privatization means selling it.
17
I do hope you enjoy having your credit score trashed, being sued by the providers, and being charged the rates from the private system charge master. I had one procedure done through the VA's program to send Vets to private providers. That was about two years ago and they haven't paid the bill yet. Fortunately for me the bill was within my ability to pay.
I learned the lesson that the private sector wants our money - all of it and they resent that the VA exists to prevent them from profiteering.
No system is perfect. My wife is in the private sector for medical care and there are all the same problems you say belong only to the VA system.
In the meantime have a ball watching your credit score plummet, you phone and e-mail filled with collection calls and you will wait because your bills won't get paid and then the providers won't see you.
23
There are advantages and disadvantages to privatizing veterans' healthcare. But the quality of care that veterans will receive in the non-VA private sector is frequently overlooked in the discussion. (80 percent of veterans are prrsently receiving most of their care from civilian docs -- most of whom dont even identify them as veterans.) Physicians do not routinely receive training in veterans cultural competence òr on how or why to take a proper post-military health history. Without this training, service-related health issues will be under-diagnosed and veterans will not receive benefits to which they are entitled. Provider education that is not presently part of med school or post-graduate training must be included as an integral component of any attempt to make privitization successful.
4
As a white 76 year old male receiving most of my medical care from the VA I have several observations: My private sector provider has been, on several occasions, unaware of important information on procedures performed at another branch of the corporate medical group of which she is a part. At the VA the entire record, including information I've provided has always been available to each provider at every visit.
Of the five VA physicians I see regularly, three are women and two are people of color. All five are at least the equal of those I have encountered in the private sector and four are superior in all respects. I have comprehensive medical insurance but prefer the VA for most of my care.
29
@Raphael Warshaw---One way to improve the VA would be to transfer patients over to Medicare once they turn 65 years old. Older patients are clogging the system, making everyone wait longer to see a Physician.
@Pat....How about providing the resources to have sufficient providers in the system to eliminate the backlog?
I have had excellent, sympathetic, individualized care from the VA system. I have had waiting room vigils for my name to be called in both the VA system and in private healthcare settings. I have also had superficial, thoughtless and sub-standard care from private healthcare providers (as a physician I know whereof I write), and more often than in the VA system.
Nonetheless, what the country needs is a system giving Universal access to all, but also a system in which the special needs of the former military are addressed when necessary.
This article is really a cry for Universal healthcare in the United States!
35
The author supports allowing the VA to spend its funds on private care because she was harassed and her commute is shorter? Her experience is anecdotal and not a reason to allow private concerns to divert funds. Sexual harassment is not acceptable, but neither is her solution. She also ignores the nefarious forces behind the push for VA privatization, eager to pounce on opportunities to profiteer. The profit motive does not lead to better care on the whole and this is a terrible idea.
45
This essay on the privatization of veterans’ health care contains an important reminder of the conditions women face in the military. Let’s remember it when the push for a universal draft heats up again.
Dropping women into the warrior pool means subjecting them to an uncontrolled risk of being raped or sexually harassed. And it's unequal on the face of it. A serious attitude toward this issue starts with understanding what it means to abridge a woman's freedom of association.
In civilian life, women can practice a degree of self-protection by prudently choosing among people, places, and times. In the military, choice is a civilian luxury. The self is a joke. You go where you're sent, and if you think you'll limit yourself to obeying lawful orders, you don't know the remoteness and tardiness of the law. When a sexual threat is clear enough to justify saying No, the scene has already been set for inescapable violence. The law may come along later to tidy up, but that's about it.
In civilian life, women also have the support of people who genuinely care what happens to them. In the military those people are far away, rigidly barred from interfering by a kind of authority which most Americans can't comprehend till they come up against it. Even getting answers to questions can be surprisingly hard. Getting a life put back the way it was is impossible.
A universal draft is not an equalizer. It means stripping women of personal and social defenses which they particularly need.
4
It is simply not rational to have a parallel health system for Veterans. The majority of them do not suffer uniquely because they served. Most have the same conditions as the rest of us. Use funds to pay for quality care from any willing provider. Pay at a Medicare fee schedule to reduce fleecing of the payers. But make no mistake, the current system has become a world apart. Veterans and taxpayers deserve better. This idea is long past due.
5
@Seeking Truth
Or maybe the opposite option is what's long past due: a comprehensive, no questions asked, single payer plan for everybody, not just veterans.
Such a plan would do away with your primary concern, a "paralell" system of service centers and providers, while assuring every American gets qulaity care when and where needed from private providers free to offer whatever services are required.
Cheaper, universal, reliable, and better care all around.
Added bonus: a single payer system would help control the greed-driven mess that is Big Pharma and eliminate the trillion-dollar-a-year profit factory that is private health insurance.
13
I am a Coast Guard veteran who retired following 25 years of service. I consider myself fortunate to have access to an excellent V.A. clinic and a nearby V.A. hospital. The medical care I have received in the three years since my retirement has been unequivocally exceptional. I was unhappy with the prospect of a shift to private healthcare. However after reading Ms. Bhagwati's Op-Ed, I realize that yet again, as a white male, I am blind to the experience of those not in my demographic. Her words were, sadly, revelatory to me. However upon contemplation - they are not surprising. We are fortunate to have brave veterans who share experiences that are not only difficult, but also traumatizing. These experiences, made public, shine a light on how those who are not white, and not male, experience life in the United States. I commend her for challenging my conception of what constitutes "excellent" or even "good" healthcare. Upon the advent of the Me-Too movement, of Black Lives Matter, and excellent Op-Eds such as this, I have, more than ever before, become aware of how narrow and privileged my experience - in all aspects of life - has been. I commend Ms. Bhagwati's courage and thank her for helping me better understand the experiences of veterans who happen not to be white and male.
15
I have worked in PP and As a resident rotated at the VA. In PP, I am amazed how many people have their gallbladders and appendix out. Simply amazed. The reason is that in Private practice, you make money by removing gall bladders and appendix for flimsy reasons. In VA, the doctors are salaried and they don’t have to remove gall bladder just to make work unit.
17
For every story told by one person about a specific issue, there is a different one, told quite differently, by another individual in similar circumstances.
It is Important not to assume that anecdotal evidence of one person’s experience is representative of everyone else’s in the same group.
A young, female veteran who is a close friend of mine has spoken of her VA experiences as extremely positive. that too, is anecdotal evidence, restricted to a single person’s experience.
As readers of individual accounts such as this one, Before we are tempted to form conclusive viewpoints, we must do the homework of looking further for information that will support the individual’s perspective on a particular issue.
6
“We can never do enough for our veterans”. Our standard ought be to provide medical care and treatment on a par with the private sector. Those in the private sector ordinarily do not wait long times measured in months for treatment. Why should our Veterans. Our VA is a good example of how government bureaucracies fail to achieve their prescribed goals. So why should anyone who cares about securing top quality health coverage for our veterans complain about supplementing the VA with access to private medical care.
1
I’m sorry the captain was ill-treated because she’s a woman. That doesn’t change the central facts. The VA health system was once the pride of the country. Through mismanagement and a lack of appropriations, that’s no longer the case. The solution isn’t privatization, which Republicans have been set on achieving for years. No, the solution is to rebuild what the VA healthcare system once was and what it delivered: the best healthcare in the country, without charge, for those who served their country. That’s what they deserve. Anything else is shameful.
19
"We don’t need to fully privatize the V.A. to make it better. But we shouldn’t have to wait years to have access to the best providers in safe, welcoming, state-of-the-art facilities."
I understand your point based on your experience Captain Bhagwati. And I'm glad you qualified that you don't feel as if the entire VA health system needs to privatize.
But my fear is once the camel is in the tent veterans might find that long-term, costs will rise to the point that healthcare service rationing might occur.
Knowing the perverse incentives built into our fragmented and extremely inefficient healthcare delivery systems, I have questions.
For example, unlike Medicare, where the government sets prices for all providers serving Medicare patients, will the VA be able to limit what it will pay for private providers?
And, will veterans be asked to pay more for their care if private companies refuse to accept VA pricing?
Because the regional VA system is so diverse and sprawling, quality and access to care aren't uniform. But if privatization ends up supplanting, instead of supplementing, VA healthcare long term, vets might find they're paying more for less.
11
Just like Medicare pays to doctors, the VA health care system pay to the private doctors at a predetermined rates but with some out of pocket expenses to the patients. If the patient seeks direct VA health care, there will be no out of pocket expenses. This would help VA patients in getting health care without long waits or drive long distances.
1
"Last week, the administration took its most definitive step in that direction by releasing rules allowing veterans who live more than a 30-minute drive from a V.A. health care facility to choose to receive private care instead." I was disheartened by what you said about your care, surprised by the mistreatment and indifference. It is nice to hear that improvements are being made. It is perplexing to read that special interests seek to impede progress and stand in the way of improvements in a system we have all heard is broken. How ironic that the party devoted to the people once again fails to act on the people's behalf. Ironic, too, as you say. that the man vilified for indifference shows once again that he wants results not empty rhetoric. Good for you. All is not lost.
1
Thank you, Captain Bhagwati. It is awful that you have had to go through such humiliation while serving the country. As always, the issue is one of having choice. I don't see why taking away a choice from a patient can help a patient, just because some are happy with their care doesn't mean it works as well for others. Also, giving the government exclusive power over healthcare is at least as dangerous an idea as giving corporations exclusive power over our health. The government makes laws that skew towards partisan interests and is friends with the insurance companies too.
1
The issue with privatizing medical care for so many of our country's bravest, yet most vulnerable soldiers, is not how much higher the standard of care can go with private medicine compared to the VA. The issue is how low the standard of care can go once Trump's donor profiteers pull out their expertly honed axes and chop away services to generate their windfall.
29
Just you keep on being real. As soon as those private providers realize that they would actually have to provide services for their money, they will demand all of your money. You won’t need it. The point here is not to help the veterans it is to get the federal government out of the VA administration.
10
My 2 cents ... My family belongs to Kaiser Permanente in California. In my opinion, California veterans should be integrated into their healthcare system. Hands down, they are the best health care provider I've ever experienced. They provide onsite doctors on site, extensive website scheduling, email notice of test results, urgent care, radiology, pediatrics, laboratory, education classes for individuals with pre diabetes, the doctors, specialist and nurses work directly with their patients. They send reminders for appointments, phone calls to schedule appointments and more. They are connected with local specialists for surgeries. The physician will call to discuss results and recommendations. Healthcare doesn't get better than this.
5
I have mixed feelings regarding Captain Bhagwati's article. On the one hand I (and my private office) stand to benefit from this privatization move and have in the past as part of the Veteran's Choice program. On the other hand as an optometric resident I saw veteran's receiving excellent medical care in VA facilities such as a VAMC (Veterans Affairs Medical Center) or a CBOC (Community based Outpatient Clinic). The VA's use of electronic medical records allowing a more complete picture of the healthcare issues facing a patient, including the ability to view records from other facilities in the VA system. It was also nice as a healthcare worker to be in a "one stop shopping" environment where the lab or X-Ray facility was just down the hall, enabling improved care due to the ability to make faster decisions as a result of getting test results in a very timely manner. Most of the staff in the centers that I worked in were very dedicated and sought on a daily basis to provide the best care that they could.
Many VA facilities are struggling to meet the needs of their patients due to high demand for their services, and I can see where there would be benefits to giving veterans the option to seek care at an outside facility that might be closer or have an environment that a veteran might feel safer in. I would just prefer that this be done as a supplement to the VA medical system with additional funds set aside for it, not removing funds from the system's current resources.
12
If the author doesn't like the care she is receiving from the Veteran's Administration, she'll like it even less when it is stripped down further by for-profit insurance corporations.
I support making improvements to care provided to our Veterans. However, stripping the VA to enable profiteering by the few is not going to improve it.
46
This piece changed my position on this issue. Good article, good perspective.
My father, a Korean War Veteran, and was thrilled with the care of his local VA clinic in Northern Nevada. I myself, have been very impressed with my local VA clinic. 'They get me'. I can't say the same about private insurance. I fear this is a 'bait and switch'. Initially, the money will be there for the private insurance by taking and draining funds for current VA services. When that money is gone, after private health care has made billions, all Captain Bhagwati and other Veterans will receive is a "Thank You for your service". Most Veterans recognize an ambush when they see one.
35
I appreciate the author's service, as well as her point of view.
I'll make one statement and ask one question.
My statement:
Privatizing veteran's healthcare is another example of the GOP's neverending quest to remove the government from helping people, and returning it to the private sector so it can be slowly killed and taken off the books of the Fed. This is always the first step toward preparing for another tax cut for the rich.
My question: Do you know of any examples of this same sort of thing where the GOP didn't do what I just described?
I didn't think so.
39
The author is simply wrong. I am sorry for her experience, but the millions of veterans who have received excellent care from the VA need to be heard from. The Administration's policies are a cynical attempt at privatization of the VA; not to care for veterans, but to funnel money into the hands of corporate interests. The fact of the matter is that veterans have different health care needs than civilians. They need specialized care to treat the unique physical and mental illnesses incurred in defending our nation. They can't get that are from the civilian health care system. The care I received at the VA saved my life. I have nearly 35 years of military service, and know many veterans who have had the same experience. To take one person's experience, and extrapolate that into policy is irresponsible. We need to listen to veterans organizations like the VFW, American Legion, DAV, and other legitimate organizations. They universally defend the VA because they speak for veterans as a whole. Listen to veterans, not one disgruntled source or organizations sponsored by big money interests. This is an unfortunate editorial based on one person's experience.
75
@Todd I agree. However the Veterans think this administration is adding funding to the their benefits. As a matter of fact one just left now stating this very thing.
The V.A. should be fixed, not abandoned. The military has a history of fighting certain elements of its own culture, such as racism, and it should fight anti-woman bias in its medical service for veterans.
Trump is not privatizing the V.A. to enable female veterans to escape its insults. If we go towards privatization, we should be able to keep cost figures on providing treatment in and outside the V.A.; if care outside the V.A. is more expensive, then the V.A. should be provided the resources to provide it. Part of the V.A.'s problems come from underfunding; dubya kept cost figures on his wars low by not providing money for the V.A. to build up its resources to treat this new group of veterans. The other part of the V.A.'s problem is its leadership (up to and including Congress), which chose to run a coverup rather than be loyal to its patients and complain. This problem exists in the military as a whole; the military was aware of a complete lack of realistic contingency planning for Iraq, but was afraid to take on Dick Cheney and accepted going into a war that could end badly (as it has).
23
Only if you think privatizing is the better option. But be careful what you ask for. Comparatively, the VA has as good if not better ratings than most private, large hospital groups. Further, they offer some services that Medicare, for example, does not (certain medications, for example). And they keep costs down for American taxpayers, something private providers don't do over time due to the way costs are calculated over time. Maybe privatizing some portions may be OK (consider TRICARE's contract services for medical administration services), but should be carefully analyzed and vetted before any move is made.
20
Okay, hate to burst your bubble. I'm a veteran and I work at one of the top tier VA hospitals. The vast majority of veterans receiving care at veteran hospitals are NON-service connected. So that means these folks, just like me, spent 2-6 years in the military and were not injured mentally or physically nor did we develop a disease (HTN, diabetes, HIV, gout, depression, etc., etc.) that was documented in our active duty medical record. But for whatever reason, usually financial, these folks have decided to receive free health care at the VA. The small minority of veterans with service connected injuries and illnesses (and let me assure you, all kinds of things are considered service connected) should receive unlimited care wherever they want. But the rest should be told to grow up, get a job and get some health insurance. Or go on medicaid. You have no idea the amount of wasted resources that are being spent on these people. The VA is also a jobs program. It just wants to keep expanding and covering more and more people. People who are not even veterans but their wives and other family members and the volunteers that help out at the VA. If you are service connected and need a cardiac cath there is no reason to be flown out of state because your local VA hospital doesn't do them. You should be able to go down the road to your local hospital and present a card which covers your service connected illness or injury completely. Give them a choice.
8
What a novelty to read the personal account of someone not among the wealthiest who is actually benefiting from the 'policies' of the Trump administration. The Veteran's Choice program, however, represents a serious effort to divide so as to conquer. The Department of Veteran Affairs was ever a work in progress until the self designated plutocrats running the show out of Mar a Lago stuck their beaks in and, vulture like, started ripping it apart. It cannot be denied that any weakening of the mandate of Department of Veteran's Affairs can only come at ultimate expense of all its charges, including Ms Bhagwati.
30
@Leigh please know that the NH delegation has successfully sheperhed this through DVA during the last six years in a careful common sense way. Improved service while not disrupting things that work well.My husband,veteran, gets first rate service at our VA, we live close enough. Thank Sen Jeanne Shaheen and Cong. Kuster, working on it way before trump decided to run.
2
As a veteran who has been using VA medical services for over 20 years I can not agree with Ms. Bhagwati's assessment of the Veterans Administration Healthcare.
30
This is a recurring theme in this administration. Some folks thank heavens that certain actions are taken. Other folks see corrupt motives behind these actions.
1) troops are being brought home
2) VA folks have private choice
3) tariffs are imposed
The core problem is lack of credibility of leadership. It’s as if Bernie madoff is proposing changes. You never know what’s the ultimate goal. Give a penny, line your pockets with pounds?
Perhaps some VA beneficiaries may opine that VA needs overhaul. They may be right even. One cannot trust that policy changes proposed by current leadership has only beneficiary outcomes in mind. Why would I say this? Examine these actions:
1) Proposing Ronny Jackson to head VA
2) tax cuts to 1% that drain resources for 99%
3) Steve mnuchin et al tilting scales in favor of donors/ friends
12
I am sorry to hear about Capt. Bhagwati's experiences, and I applaud her efforts to raise awareness of military sexual trauma. While Veterans Choice may have been helpful for Capt. Bhagwati, this program is unlikely to improve the healthcare of veterans in the aggregate.
As reported by ProPublica in December 2018 (https://bit.ly/2UUkY5e), the Choice Program has not resulted in shorter wait times and it has increased expenses. Veterans can qualify for the Choice Program if the wait for care within the VA system is 30 days or more. However, 41% of veterans using the Choice Program had to wait 30 or more days - and the average wait was 50 days. The report also found many errors in care, for example, a veteran referred to a urologist was instead sent to a neurologist.
The cost of care in the private sector has been higher, with greater overhead. Of the $10 billion dollars spent in the Choice Program since 2014, 24% has gone directly to medical care for veterans - the other 76% has gone to the private contractors administering the program. About 24% of the money spent by private contractors was on overhead - twice the industry average.
The best way to promote high quality healthcare for all veterans is to ensure that the VA system has the financial and personnel resources it needs.
30
Ms. Bhagwati seems to believe that, since VA care isn't living up to her (and, no doubt, others') expectations, it follows that non-VA (private) care will meet those expectations. Isn't that a non sequitur?
14
After a generation of privatization of government services how can any moral human being suggest more of it? Shoddy services and downright theft of tax dollars is the order of the day. How typical that this Administration, and Congress, would want to advance the interests of their corporate overlords by putting profits ahead of veterans. Properly fund a publicly administered VA health care system. Or, wait for it, Medicare for All. God forbid something good for all Americans would win the day these days.
25
Ms. Bhagwati offers an extended, if quirky, anecdote and shares the very large ax she has apparently been grinding for some time. That, and a talent for misinterpreting what is going on around her.
I am happy that she has found a convenient, state of the art, medical resource sensitive to her experience and her preferences, but it is bizarre she believes her experience would be typical of a wholesale transfer of VA services to private providers.
I'm not a vet, have never used those services or facilities. But I have shepherded my dying mother, a wife, daughters, friends through some of the most prestigious hospital systems in the nation. They are not paragons of gender-sensitive service, many not even competent.
Bully for Ms. Bhagwati that she found her ideal right there in the neighborhood. But she might want to consider that in many parts of the country a half hour drive for sophisticated, comprehensive services would be a godsend.
If resources for even a significant number of veterans are removed from the VA system to shuttle them into boutique care elsewhere, that half hour drive could well become hours.
Ms. Bhagwati might contemplate recent conversions from government services to private because "government (ugh)".
When higher salaries, and profits, are deducted from the same money, how does she think the quality of care will fare? Costs are virtually guaranteed to go up, and the scope of services to diminish.
23
Universal healthcare for all! We are all equally important and deserve better than our present healthcare delivery system provides.
12
I am all in favor of allowing veterans to visit their local doctors and hospitals when needed. I also believe veterans would be better served if the VA focused on injuries and illnesses unique to the battlefield. My only issue is that, before you know it, as with Medicare and Medicaid, a future Congress will begin to monkey with doctor reimbursement rates. When that happens, like Medicare and Medicaid, there will be fewer private sector doctors willing to participate in the program
7
The government contractor’s reimbursement rate is less than Medicare. The contractors make their money by squeezing the civilian providers.
3
I totally disagree.
Why doesn't the author go even further. Instead of letting private healthcare plunder the V.A, why not just have trump give his rich friends the keys to Fort Knox!
14
You have obviously never been to a VA hospital. They all need to be torn down Anderson vets get care a regular hospital. They would be much better cared for and would save all the money that we are spending on VA administrators that provide zero care. I have worked in several VA hospitals and they care there is laughable. Long lines and doctors who couldn’t be licensed to work elsewhere, but get to work at the VA without passing test the rest of the doctors is US have to take. Shameful.
Though I empathize with Captain Bhagwati's situation and find no excuse for such poor treatment, the idea that privatizing veterans' medical care would automatically result is better treatment does not logically follow.
Moreover, given the poor economic and customer service history of privatization of services previously administered by government or affiliated entities, a much stronger argument based on better treatment outcomes would need to be advanced to continue to advocate for such increased privatization.
As others here have mentioned, perhaps the best way to start would be with efficiency based reforms of and much better funding resources for the system itself. The tactic of starving a government entity of resources and then pointing to bad outcomes as an argument for privatization is one more and more people are able to see through.
19
Unless outside providers can give veterans's almost immediate same day access to mental health and social work services than this effort will be a failure. My VA can provide that plus obtaining CT and MRI scans without prior authorizations, almost immediate physical and occupational therapy access. We also have a separate Women's Health clinic. Please don't generalize and blame an inappropriate provider as an indictment of the entire VA system. I spent 25 years working as a PCP for a local hospital; we could never provide these services like my local VA can today.
22
That’s just false. Every test at VA has to be approved. Same day PT. Most of my patients that even got PT were given one appointment and then a home program. Care at the VA is laughable.
1
@D B I am a Primary Care provider at my VAMC. There are no prior authorizations. Period. Yes, they will do a cursory review - you can't order a head CT because someone has abdominal pain, but otherwise, that's it. Same with PT. And if they feel a HEP is adequate, find. I've never, never disagreed with PT/OT's assessments.
3
My late father was a WW II veteran. He and military culture were a contradiction in terms.
He had the best of medical care when he needed it in the best of private and university hospitals, but there were certain issues in which he received the best care in the VA hospital (and granted, he did not have far to travel being a NYC resident).
Hearing problems and subsequently hearing aids, issues related to his feet as he aged, for whatever reasons, the VA did this best.
As far as I know, any care and any visit to the VA was of the highest standard by a polite and efficient staff.
He had had only good things to say about the system (albeit being an old white Jewish man).
28
I am a veteran disabled due to combat, and the medical care I receive is provided by VA. All aspects of my healthcare have been excellent at VA. Several years ago I was subject to 1 years of private healthcare which was a nightmare of carelessness, arrogance, insult by insult, and whose main ideas for treating most cancers is medieval surgery and transfusions of heavy metals into the body, to this day. The writer may want to dwell upon the following question before criticizing VA healthcare: Do you really believe that in private healthcare, when one is admitted to hospital or emergency room wearing soiled underwear, that there is no difference in the timely quality of care received? There is a difference and one can do nothing about it. The writer of this article does not speak for me.
27
Yeah, good on Agent Orange for caring so much about delivering quality healthy care to veterans. Now what about the rest of us?
4
@stu freeman: Make that "HEALTH care."
I used private health care for over 50 years before availing myself of my veteran's benefits.
My experience with the VA has been outstanding. The services I have received have been surgical, hospital care, primary care and internal medicine, audiology, and eye care.
The doctors and medical staff have been very good, and all of the staff and administrative folks have been friendly and efficient, and I have unfailingly been thanked for my service.
Privatizing will divert funds from the VA and will inevitably compromise the level of care and services.
If it ain't broke, don't fix it.
53
Private health care for veterans was never the answer. I don't care if it is better than the VA. The answer was to fix the VA. We need to move away from capitalism and work on socialism. That is the only extant answer to our woes.
26
All I can say is look out - privatizing seldom works, except to the privatizer, who is happy to take the cash. Be careful what you wish for with the V.A. Look at the outcomes for prisons, public schools, and be grateful it hasn't yet happened for the post office near you.
66
Yes, there are veterans like the writer, who find care outside the VA system to be a better fit. Yes, they should be able to access appropriate care as if it were VA care. I have no doubt that for some, Veterans' Choice is a godsend.
I am not one of them. I am female and a veteran. I don't want any care other than VA care. I don't want private sector healthcare for myself, because I found it sadly wanting. I do far better in the VA system. Part of my issue is that I now work in healthcare myself, and I don't like what I see in the private sector. Part of it is my obstinate insistence on personal autonomy. I not only want, but insist on the right to say "No" to anything at any time. Part of it is my preference for minimal health care intervention.
31
When I was getting out of the service a few years ago, I was expecting the worst when I transitioned to the VA. Overall, it wasn't nearly as bad as the rumors that I'd heard. The worst part is a simple appointment usually turns into a full day at the hospital.
I think just about any veteran would prefer to go to a private business for non-emergency treatments then go to the VA hospital. However, these private clinics are not open to free-market competition. The ideal scenario would be to leave these non-emergency clinics up to the free-market so that competition could drive up quality and drive down cost. This would not only allow us veterans to get better care but also bring down the insane $200 billion dollar VA budget.
1
I sympathize with the writer’s plight and can relate, but I will attest that every one of my Veteran’s Choice consults took nearly as long to book as it would have to get a “regular” appointment at the VA. Anymore, the only reason I even consider using the program is when the service can’t be provided otherwise. At the time I needed it, the Durham VAMC had no podiatrist, and as far as I am aware, they still have no prosthetics provider for orthotics. The major upside to this area (I live just within the 30 minute radius) is that a lion’s share of the doc’s come from Duke University Hospital across the street. The downside is that, as is pointed out, funding is getting slim; and nurses and other employees can find much better work around here.
3
In the VA system, veterans have a great deal of influence over their care that they will not have in the private sector. A veteran who feels he or she has been mistreated within the VA system simply walks into the Center Director’s office and shortly thereafter the offending provider is held accountable. Conversely, in the private sector an offended or mistreated veteran will hear “it would be best if you find another doctor”.
18
With all due respect, a cherished friend of mine is a Vietnam Vet who worked for years at the VA Psychiatric unit in Boise. Presently, due to long-term results of agent orange exposure, he has been treated by the VA. He is against privatization bringing the perspective of both an administrator and a patient.
Separately our local Boise Vietnam Vets Chapter is also anti-privatization.
I defer to all of them.
51
Medicare for all would allow veterans to choose their health care. One could even imagine a supplemental VA plan that would cover combat specific health care that could be delivered in existing spaces. If we believe in providing the best health care to our veterans we would provide them options.
13
@Sara I don't want Medicare for all for myself. I want my VA care, and I don't want anything else, anything more, or anything less. I want what I want. As long as there is VA care, that is what I will want. If I end up having to pay for Medicare coverage, I will always resent it to a small degree, because I will never use it. I just won't. On the other hand, paying a Medicare premium to ensure that non-veterans have at least some access to health care--I can accept that. I'm willing to pay for something I will never use if it pays for a common good. Universal health care is such a common good. Just don't take my VA away from me.
7
Military service could be a method of buying into Medicare. A VA supplement for veterans could cover the remaining costs. This would allow veterans to choose the VA for military related health care (eg. prostheses) but retain the option of having care unrelated to service (eg. chemotherapy) at a facility of their choosing.
I am sorry the writer has had negative experiences with the VA. I thank her for her service & wish her the best in the future with her health.
I object to her generalization about older male Veterans. Perhaps she has had interactions with some older men who are sexist but all Vets of a certain age are not as she describes. My father, who served in the Air Force, is one of many “older” Veterans I know for whom her statement is narrow minded and hurtful.
My Navy Veteran husband has received care for over 30 years at 7 different VAs in 5 states and has no complaints. He has also never had unreasonable wait times. The level of specialized care he needs and receives is typically not readily accessible outside the VA. Many non-Veterans he knows with the same medical condition do not receive the same level of care in the private sector that he receives from the VA. At one point, when the VA did not have a provider available for 2 procedures, he was referred to private providers with billing sent directly to the VA.
He has also received care at a nearby CBOC - Community Based Outpatient Clinic. It is new, “state of the art”, & nearby.
Is the writer familiar with the CBOCs?
Finally, the Choice program was NOT implemented by Trump. It’s the very Veterans Service Organizations she criticizes that pushed legislators for modernizations to this program. The VA is for all Vets, and Privatization is not the answer if it is to continue treating all who have served.
57
As a doctor in the private sector, I think veterans would be better served by the VA.
Many veterans have complex medical problems and that's not a big deal for us--we have many other patients like that. But the private sector does not have the psychiatric and social work backup that many veterans need.
Some VA patients that I have seen have been frustrated by our practice's unwillingness to deal with the VA bureaucracy--filling out extra forms and so on. I tell that straight up that we are not willing to do that and that they should use their Medicare just like everyone else.
Sometimes that little conversation is the last one we have and they move on. Might be best for both sides.
I only see VA Choice pts because my medical system contracts with them.
25
Thanks for sharing your experience. I would however like to point out that 100% service connected vets have better coverage through the VA paying system than Medicare for there service-connected conditions - there is zero copay and zero deductible. With all due respect (and I mean that in all sincerity) I’m sorry that the paperwork is such a bear, I know that it that it requires manpower and I understand that, but if I could afford a civilian provider on my Medicare, don’t you think I would have done it?
5
Well, when Trump’s privatization leads to decreased funding to VA hospitals, sad for veterans who have gratefully utilized services that their VA facilities have provided.
As a very experienced nurse and wife of a veteran who has utilized VA services, I have observed professionalism in every aspect of service he has received.
Sorry to disagree with the writer. I accept her criticism on behalf of her experience, but I believe there are thousands of others who fear the decimation of VA services.
Was Melania Trump a patient at Walter Reed..
86
@MIMA I am a nurse too here at the VA. What people seem to forget is we have social workers and mental health provider on-call ready to take on any homeless, suicidal with a phone call, no way will this happen with private insurance.
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Unfortunately, as with most of these privatization pushes, the care will eventually decline and the private insurance companies who are overseeing the veteran's care will begin to capitalize on the "free" money from the government. It happens all of the time. Just see Charter schools for one example.
Money finds money and the consumer (in this case veterans) will start to suffer even more from inferior health benefits.
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My wife is a Retired Marine Master Sergeant. I often take her to the VA hospital in Baltimore MD. She has never once been mistreated or been exposed to the situations described in this article. I have witnessed firsthand her scheduled treatment that are performed on time, and handled in the most professional manner. Sometimes, because she is eligible for Tricare, she elects to have medical treatments at a civilian facility, but as I previously stated, she has had no problems at the VA.
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Different person, different situation.
If I recall correctly, President Trump also promised to build us a wall, repair the infrastructure, give us a beautiful medical care system and put Mrs. Clinton in jail, none of which he has delivered.
I hope the veterans and Ms. Bhagwati are not counting on him to move very far in fulfilling any of his promises to them, especially the ones that cost money.
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With all due respect, the current system needs reform, not replacement. Private care will not be better than the VA, as copious research has already indicated.
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@Dan: It will be better for the specific issues faced by the veteran author of this article - that information is in the article.
Having worked as a physician in the VA system from 1980 to 2015 usual as a volunteer without compensation I fully agree regarding access. Local, convenient care is critical especially for patients with transportation problems, mobility issues, the elderly, and the seriously. No one should have to drive two hours for a scan or to see a sub specialist. Most of my patients had terminal cancer and elderly. Making them travel more than 30 minutes is unconscionable. Allow local private care if veterans matter to you
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I deeply appreciate this author’s concerns and I am troubled by them. I would encourage this writer and others like her to consider connecting with the Vet Center program. The Vet Center, or Readjustment Counseling Service, is a program within Veterans Health Administration that is separate from the medical center system and provides benefits counseling and mental health counseling to veterans who have experienced military sexual trauma (MST), as well as veterans who were deployed to a combat zone, and bereavement counseling to families who have lost a loved one on active duty. Vet Centers are sensitive to the needs of MST survivors as well as combat veterans and Gold Star families. Vet Center clinicians work to support veterans in receiving sensitive medical care wherever they seek it. And Vet Centers are located in the community. In fact, many offer Mobile Vet Centers that travel to veterans who are a distance from their services. Vet Centers were stood up by Vietnam Veterans in the 1980s and they are very special places that understand military culture and work to heal, not perpetuate, the trauma and moral injury that can occur in the line of duty. All services are provided at no cost. Treatment records are confidential — separate from the V.A. medical record and not accessible to DoD. We all deserve to be treated with understanding, dignity and respect.
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If history is any judge, VA centers will become nonexistent. Treatment costs will triple after the private sector becomes the method of treatment.
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@Mishomis Thank YOU! My thoughts precisely. Once the VA is fully privatized, the services will become prohibitively expensive for taxpayers to afford. I am predicting that the healthcare costs for vets will outstrip the costs of even the sickest non- veterans and Medicare/Medicaid recipients. Why? Because in a privatized system, it is the COST of care that is paid, not what the care is actually worth. As a retired rate setter for the Pennsylvania Medicaid (Medical Assistance) System, I KNOW this to be the case.
COST is manipulated based on what is acquired, NOT ON WHAT IS NECESSARY. Healthcare COST has nothing to do with its necessity or effectiveness. It is a number that is literally padded with junk.
If my salary were cost-based, I would go out and buy a mansion, a Ferrari, several other cars (one for each of my family members), a 32 foot yacht, thousands of acres of land, several rental properties, and a closet full of designer clothes, handbags and shoes. Then I would calculate my COST and present this to my employer. I didn't NEED any of these things. None of them have anything at all to do with what I am worth, or have any bearing on my job effectiveness. These are simply things I WANT. It is the same with healthcare costs.
You can be CERTAIN that private VA care will be padded with all types of stuff that vets DO NOT NEED and that is NOT MEDICALLY NECESSARY. FRAUD will be rampant. Privatization will mean the end of the VA altogether.
I
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The VA is a mess for sure. It was starved of funds that actually provided care for veterans, but tons of money for university training programs for students. If you are a veteran and need services, you are lucky if there is one MD general practitioner, in the entire building. I'm a veteran, I lost my private insurance subsidy in Mass health connector, because of computer sharing, which they say they respect your privacy, but they really don't, I lost good local care because Mass Health Connector said I had a separate insurance plan with the VA. No, VA benefits are not medical insurance plans. 20.8 million living veterans out of 375 million Americans, is 6.3 veterans per 10,000 Americans.
You might think they are able to cut us a break.
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he absolutely is not. It's a disaster. It does not work well. It's not well organized, it creates more problems for the veterans and the employees who are trying to take care of them. This is not some altruistic attempt to help veterans. It is a way for others to line their pockets. It has nothing to do with caring for veterans and don't forget that.
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Agree. On those rare occasions where Trump does the "right thing" it is for the wrong reasons, and depends only on what he perceives is best for him or his wealthy cronies.
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I greatly sympathise with this veterans experience. Healthcare environments must feel safe for all, and I am happy to hear that she had better experiences using the Veterans Choice program. But this is not the experience of the majority of veterans. Anecdotally speaking, the patients that myself and my colleagues treat at a VA hospital found little relief with this program. From a meta analysis perspective, Veterans Choice failed to improved outcomes but did increase costs. Other studies have shown that VA healthcare yields better health outcomes at a lower cost. Therefore, I am a proponent of strengthening the existing VA healthcare system so that we give veterans the healthcare they deserve, and prevent situations that this veteran experienced.
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I would like to thank Ms. Bhagwati for what is, to me, a new perspective on the V.A. that makes me re-think some of my dislike for the privatization move. I am so very sorry that women and others are harassed and ignored because they do not fit with a still somehow traditional view of who belongs there.
My hope is that as we move towards a better national health care plan and a Medicare for All system, we will see the V.A. improve. The current administration seems to see it as a profit center, with country clubbers getting to decide what happens next. I have to believe that we will find common ground and health care that works for ALL our veterans.
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One aspect of VA medical care not discussed is the historical UNDER FUNDING of the VA by Republican presidents and congresses. But that’s an issue for another discussion...
My complaints with the VA are two-fold:
1. Dealing with the VA is the same as dealing the military itself: same mentality, same rigidity, same worship of rank, etc.
2. In a rural community/area having to travel literally hundred of miles for basic services that could be provided locally is, too say the least, inconvenient, often costly and always time consuming.
My solutions:
1. Merge the VA into Medicare, etc. Give vets a modicum of priority in scheduling appointments, treatments, etc. Spend the money maintaining VA hospitals, etc, in paying for greater Medicare access and service.
2. Better yet, have a single payer system for every US citizen from the moment he/she gets his/her SS number. When, if, a SS cardholder becomes a vet, give the vet some bonus points to ensure prompt medical care.
With no draft on the horizon, an ever shrinking pool of WW II, Korea and Viet Nam era vets ensures that there will be fewer future vets needing medical care.
Privatization of the VA is simply another ploy of the Kochs, et al. to get the federal government out of ALL social services, and responsibilities.
USN 1967 - 71
Vietnam 1968
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Dear Ms Bhagwati,
Thank you for your service and I agree with you. There's not a one size fits all that applies to every veteran. As a former psychiatrist with the VA, and as a psychiatrist who has had to move several times for her husbands career, I have found the VA services UNPREDICTABLE - varying from site to site from the very best at one center to the very worst I have seen ( and often varying between specialties at a given center.)
Based on my first hand observations, nothing I hear about a VA would surprise me - I have seen it all, from denials of care for those with bona fide head injuries sustained while serving ( sometimes undocumented - because not all MDs understood that a "brief blackout" after an IED blast might actually represent a traumatic brain injury ) until the same veterans are incarcerated with a police file for "new" behaviors -related to this same head injury ) to a granting of a service related disability for people with flat feet documented in adolescence. Never could imagine or believe the degree of misogyny and neglect and disrespect for people until I saw it myself at the VAMC ( I could cite many many specifics but will never do so publicly )
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@Hapinoregon - excellent comment.
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