Seal of the Handicapper General – Harrison Bergeron
One of the bigger problems with the ACA or any health insurance system which outlaws medical rating is its removal of the financial consequences of bad health habits. Progressives believe heavy taxes on cigarettes will reduce smoking and thereby reduce lung cancer and early death; a financial penalty on a self-destructive habit justified by the social welfare state’s future payment of medical expenses. (One issue is whether this is even true — it turns out most actuarial calculations show those who die early as a result of lung cancer have less spent on their medical care in old age and forego social security payments, so they save the welfare state money.)
But if you equalize the cost of medical insurance regardless of health habits, you are reducing the consequences of unhealthy habits and thus encouraging them. Accountability — having to be responsible for one’s actions — suffers under equalizing systems. Drivers with many accidents and drunk-driving convictions on their record will pay much more for (and find it difficult to even obtain) car insurance, and that’s normally considered a Good Thing because we want there to be financial penalties for habits that endanger others, like driving recklessly or under the influence.
The reasonable objection to charging for health insurance based on health record is that health status is only partly controlled by previous habits and behavior; a big chunk is genetics and chance. So it seems unfair to those who are sick because of bad luck in the genetic lottery — or even by accident, as cancers, for example, are thought in some cases to be created by accidental mutations, and only some cancers are caused by avoidable environmental exposures like smoking.
And many children begin life behind the eight-ball, having inherited problematic genes that make them more likely to suffer from conditions that cost a great deal to treat. Should insurance companies be able to use the results of genetic tests to offer low-cost policies to some, and much higher-cost policies to the unlucky?
In a laissez-faire world, insurance is an adversarial game with customers trying to hide any damaging information from the insurer as the policy is being sought, and the insurer doing their best to deny claims afterward. As a result, governments set up insurance commissions and regulators since it was impractical to adjudicate disputes over every consumer’s insurance policy in an expensive court of law. Arbitration and insurance commissions have done a fairly good job in the past of managing this conflict of interest, with some states being more pro-consumer than others.
One partial workaround for the medical rating problems is the idea of “continuous coverage.” The initial risk pool is assumed equal, and anyone who keeps paying for coverage continuously is allowed to stay in that average-risk category because some small part of their earlier premiums is true insurance — covering the risk that a health issue will turn up which makes them a bad risk in the future. Insurance contracts typically cover one year, and so if there is no requirement to continue coverage beyond that contract, rates could adjust upward or renewal could be denied based on negative events that happened during that year. Requiring renewal at the same rate as the rest of the risk pool makes the contract insurance against the long-term costs of treating any illness acquired during the period, not just that year’s costs.
What happens to people who allow their insurance coverage to lapse because they can’t afford the premiums or simply forget to pay? Most states had a high-risk pool with required must-issue, but rates were very high (of course — since the people seeking insurance under it were far more likely to need expensive care in the short term.) Some hybrids, like exclusions for pre-existing conditions for six months or a year, helped get people coverage at in-between prices.
The PPACA (“Obamacare”) tried to eliminate the problem with must-issue (no one could be refused insurance) combined with narrow time windows for seeking coverage and penalties for going uninsured. These were intended to force everyone to get insurance and to keep them paying for their insurance even if they were being charged much more than they were likely to receive in benefits. Younger, healthy people were expected to pay more to cover the costs of older, sicker people. In practice this did not work — even the subsidized rates were too high to get healthy young people to join up, and the penalties of going without insurance were small compared to the inflated new prices for insurance. So individual insurance coverage pools shrank and were dominated by new customers needing a lot of expensive, deferred care, and rates rose further as doctor networks were narrowed and more healthy people stopped paying.
The Supreme Court’s ruling deeming the ACA constitutional was only partial — the attempt to force states to increase Medicaid enrollments was deemed unconstitutional, so many states did not expand Medicaid. This left a bizarre hole in coverage in those states where a person could make too much to get Medicaid coverage, but too little to get private insurance subsidized through the exchanges. And the expansion greatly increased Medicaid enrollments in those states that participated, accounting for nearly all of the decrease in the uninsured in the US, but Medicaid itself has never been shown to improve medical outcomes or decrease mortality, and many people complained that they were forced to join Medicaid when they would have preferred to buy private insurance.
Also, the Supreme Court’s swing voter on the case, Chief Justice John Roberts, specifically warned that the fine for not having approved insurance was only constitutional if it was viewed as a tax, and an increase to the fine to an amount sufficient to force compliance would make it unconstitutional. This cuts off the ACA proponents’ attempt to raise fines to try to force more enrollment.
Which brings us to the subject of this essay — how do we decide what is fair when consequences of simple bad luck and genetics are mixed with the downside of behavior under a person’s control? Suppose a well-off person (let’s say the son from a wealthy family who left him a trust fund) drinks, smokes, and plays video games all day throughout his life. In his 40s now, he’s obese and unhealthy, with emphysema and cardiac problems imminent. Should his expensive future healthcare be subsidized by middle-class families who have worked hard, exercised, and been careful to avoid bad habits? That is the way ACA policies are now set up. Even unsubsidized, policies for wealthy people in poor health are much cheaper under the ACA than they would be in a free market, and those who have restrained their appetites and sacrificed to maintain their health pay more than they otherwise would to make up for those costs.
But there’s no easy way to separate those “bad unhealthy” people whose illness is due to their own choices from those “deserving unhealthy” people who are ill because of chance or genetic inheritance.
The ACA plan tried to compel more equality of premiums regardless of actual risk or likely use of medical services, which removed some of the incentive for healthier behavior and burdened those who made the effort and sacrifice to keep themselves healthy. This tried to protect those who were simply unlucky, but many of those people are worse off than they were under previous high risk pool plans provided by the states, and have had their care disrupted or cut off by the high prices and narrow networks.
Every complex system is adaptive, and human systems especially so, with people quite capable of understanding the rules and seeking out every loophole to their advantage. The ACA has failed because people aren’t easily herded by programs designed by committees, and by finding the loopholes (paying for one month and using it for three, staying off until actually ill then signing up under the many loopholes in enrollment windows to get expensive care then dropping out again), the ornery people have ensured the ACA cannot be sustained in its current form.
The ACA, which was promoted as saving everyone money, has ended up being much more costly for most than the old system. It has helped a few, but cost far more tax and premium dollars to help those few than a direct subsidy to the existing high-risk pools would have. The redistributionists have again discovered that unintended consequences will make nonsense of their social engineering schemes.
Philosopher John Rawls is usually cited by progressives intent on redistribution; his thought experiment suggested we view a system as just if we would choose it willingly, not knowing in advance what advantages or disadvantages we would be born with. You can argue that much behavior is also dictated by fate — our example of the obese videogamer may well have been doomed by being born into his particular family with parents who could not guide him toward a better way of living. But under that view, no one is responsible for anything, and we know that people can change to overcome even the worst background and genetic inheritance. Removing rewards for modifying one’s behavior toward the socially-valuable means a society which is less civilized and poorer in every way.
The classic Vonnegut story “Harrison Bergeron” takes equality to the extreme. The government has decreed that all must have equal abilities and outcomes, and so those who are more intelligent or talented are handicapped to bring them down to average. Of course, this becomes a nightmare with tragic outcomes as society grinds to a totalitarian halt.
But suppose we already have a little bit of this deadening effect introduced by the government’s emphasis on hiring by ethnicity or sex rather than ability. Would we even realize that the but-for world where only merit is considered would be wealthier, happier, and more fulfilling for most if not all people? If one has never seen a ballet performed to perfection by the most talented dancers on Earth, would we notice that the dancers are being dragged down by lead weights they have been forced to carry — or selected for political reasons rather than talent — making their performance less satisfying?
Socialists and redistributionists tend to think diversity and choice and product improvement are not as important as providing the poorest an equal quantity of goods, and the central planners of the USSR counted quantities of production, not quality; the stories of great quantities of useless, poor-quality, ugly products available from state stores while people schemed and bribed to get better-quality goods from abroad show how central planners failed to understand what mattered to the people. Even Bernie Sanders, who should know better, suggested there was too much choice in deodorant and shoes, and restricting choice would somehow allow more poor people to be fed, clearly missing a lesson or two of the socialist past.
So if you had never seen a perfect ballet or operatic performance, you might not notice how the ones you have seen have been compromised for the sake of political goals. Similarly, if you’ve never seen a world of free enterprise without identitarian politics or Party corruption, you will never realize how much freer and more productive your society might have been. The US overcame a history of race and sex discrimination to more closely approach the standard of merit alone — then has been backsliding incrementally as race- and sex-conscious employment policies took hold. While it appears the US is now limiting progressive overreach by not electing Hillary Clinton president, there has been a lot of damage already, with government agencies especially dysfunctional. It will take a lot of work battling entrenched special interests to reverse the educational system’s failure to teach children civics, history, and economics.
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The problems with Britain’s NHS are echoed in the Veterans Administration (VA) scandals. What is supposedly free ends up costing lives and health for those who have already paid through their military service, because a civil service and union-protected bureaucracy can’t be held accountable for gross incompetence or even negligent homicide.
The medical benefits for veterans started out as military hospitals and care for those who had been wounded or disabled while in service, but over time (the ratchet effect at work) benefits broadened and were extended to cover most veterans for general healthcare needs, even those unrelated to their service. “The VA health care system has grown from 54 hospitals in 1930, to include 152 hospitals, 800 community-based outpatient clinics, 126 nursing home care units and 35 domiciliaries.” The number of living veterans has declined somewhat but aged in the last decades, and with rising medical costs generally, as of 2015, the VA has nearly 300,000 employees in its medical care area, spending about $75 billion a year for veteran medical care and rehab. There are about 22 million eligible veterans, so the VA is spending about $3,500 per year on each. Since many eligible veterans get their care under other insurance, per person spending on those who primarily rely on the VA is much higher.
Customer satisfaction surveys show most VA clients are reasonably satisfied with the care they receive, and VA staff and doctors appear to care as much about their patients as private-care doctors and staff. So it’s not the quality of doctors or care that are in question — when it is scheduled promptly and part of an ongoing treatment process, VA care is good. Problems appear to be related to the bureaucratic scheduling and other access issues, and again the NHS is similar — patients tend to be happy with the doctors and nurses they see, but getting to see them in a timely manner is hit-or-miss, with delays and mismanagement of facilities prominent.
Like the NHS, staff at VA facilities and offices are civil service and union-protected. Even a motivated manager has trouble firing or removing negligent workers, and management priorities are often enforced by numeric targets which can be gamed by “losing” applications or forging timestamps to make delays in individual cases disappear from performance review and bonus-setting numbers. Managers who might want to implement reforms leading to more responsive systems for patients find themselves blocked or subjected to retaliation for “troublemaking.” Patients caught in bureaucratic snafus have little recourse, since they can’t take their business elsewhere. VA facilities that would be fined or subject to license removal for falling beneath state medical care standards if they were private are exempt and can’t be fined or replaced by better-managed facilities.
The cycle of scandals and bad publicity followed by demands for VA reform and new legislation has occurred several times. The VA was raised to cabinet level in 1988, then underwent drastic reform in 1995-2000, shedding 10,000 employees and keeping costs flat for five years by implementing better management and some of the same numeric performance measures that were gamed in the scandals of 2014.
In any bureaucratic organization there will be two kinds of people:
First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agricultural scientists and advisors in the former Soviet Union collective farming administration.
Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.
The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization.
Management reforms, however well-meaning, will always be gamed by those subject to them. The motivated top-level managers who set reforms in motion soon depart, to be replaced by new political appointees with different priorities and less knowledge of where the bureaucratic bodies are buried than the career civil servants who remain in place.
At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.
The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources….
Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The [doctor said] the Phoenix VA works off two lists for patient appointments. There’s an “official” list that’s shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there’s the real list that’s hidden from outsiders, where wait times can last more than a year.
“The scheme was deliberately put in place to avoid the VA’s own internal rules,” Foot said… the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor’s appointments for veterans within the computer system.
Instead, Foote says, when a veteran comes in seeking an appointment, “they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there’s no record that you were ever here.” [T]he information was gathered on the secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed. “That hard copy, if you will, that has the patient demographic information is then taken and placed onto a secret electronic waiting list, and then the data that is on that paper is shredded. So the only record that you have ever been there requesting care was on that secret list,” he said. “And they wouldn’t take you off that secret list until you had an appointment time that was less than 14 days so it would give the appearance that they were improving greatly the waiting times, when in fact they were not.”
Foote estimates right now the number of veterans waiting on the “secret list” to see a primary care physician is somewhere between 1,400 and 1,600.
The reforms of 2000 had included establishing waiting lists for less urgent care, similar to the rationing-wait lists in most government-provided medical systems like the NHS or Canada’s. For some less urgent operations, a few months of delay smooth demand and hold down the costs of facilities, encouraging those who can afford faster alternatives to seek care elsewhere, a safety valve which many in such systems use — better-off Canadians frequently pay for care in the US to “jump the queue” in their provincial healthcare system, for example. Those who would be most able to cause political problems for the system — well-off and well-connected people — are thus taken out of the complaining group. But VA patients are already self-selected as having no affordable alternatives, and so patients made to wait when there is a significant chance of death or serious worsening of their health have little alternative, and the unfairness of their treatment rankles much more in a society which pretends to honor their military service. A “sacred commitment” dishonored so that managers can get big bonuses while some veterans die unnecessarily is especially potent politically.
The 2014 Phoenix scandal brought out more allegations of secret waiting lists and unnecessary deaths at other VA facilities, including Austin, Texas, Ft. Collins, Colorado, Columbia, South Carolina, and Cheyenne, Wyoming. A VA audit in June 2014 found upwards of 120,000 veterans left waiting or denied care as a result of secret waiting lists intended to disguise actual waiting times. The FBI opened a criminal investigation and Congressional investigators found that all 470 senior managers at the VA received at least “fully successful” performance evaluations and were paid $2.4 million in bonuses for the previous year.
On June 11, 2014, the Senate voted 93–3 to pass the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014, the bill written by Senators McCain and Sanders to reform the VA…. Acting VA Secretary Gibson said he plans to fire some VA executives under an expedited process as soon as he is given the authority by Congress to do so.
In late June 2014, VA General Counsel Will Gunn and VA Acting Undersecretary for Health Robert Jesse stepped down from their positions. Other changes in June 2014 included:
• Moving more than $390 million inside the VA budget to fund care for veterans outside the VA system;
• Deploying mobile VA medical units;
• Ending the goal of providing appointments within the 14-day window that Nabors criticized as unrealistic and said may have “incentivized inappropriate actions”;
• Posting twice-monthly public updates of VA wait times;
• Banning performance bonuses;
• Removing some senior managers from the Phoenix VA system;
• Leadership emphasis on protecting whistleblowers from retaliation.
While many politicians decried the scandal and worked for reform, Senator Bernie Sanders (Socialist-VT) defended the VA and minimized the scandal as long as he could, since the VA is exactly the sort of government-provided medical insurance he believes would be ideal for everyone in the US:
Sen. Bernie Sanders touted his record on veterans’ issues during Tuesday’s debate, citing his position as the former chairman of the Senate Committee on Veterans Affairs when Congress provided billions of extra dollars to boost healthcare for veterans last year.
“We went further in than any time in recent history in improving health care to the men and women of this country who put their lives on the line to defend us,” Sanders said Tuesday, referring to $15 billion given to the Department of Veterans Affairs to decrease wait times and reform the troubled agency.
Yet some veterans groups and others criticize Sanders for what they call a lack of oversight of the VA, and for at times coming to its defense in the midst of the scandal that rocked the agency in 2014.
Paul Rieckhoff, founder and CEO of the Iraq and Afghanistan Veterans of America, said Sanders largely ignored the appeals of organizations like his during a time when media and government reports exposed how veterans were waiting months for appointments and VA officials were covering up the delays. “For far too long he was apologizing for the VA. He was refusing to acknowledge the severity. He was positioning it as a smaller issue than it was while veterans were dying waiting for care.” 
Sanders has supported the Castro regime in Cuba with admiring comments about Cuba’s universal healthcare, which like all such systems in communist states can be good for the well-connected in select showplace facilities while bad for the rest:
The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba’s burgeoning black market economy, sometimes termed “sociolismo”. According to former leading Cuban neurosurgeon and dissident Dr Hilda Molina, “The doctors in the hospitals are charging patients under the table for better or quicker service.” Prices for out-of-surgery X-rays have been quoted at $50 to $60. Such “under-the-table payments” reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the “Special Period” in the 1990s aggravated these payments. The advent of the “dollar economy”, a temporary legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans were able to obtain medications and health services that would not be available to them otherwise.
But in the US, despite the political uproar and some long-delayed firings and resignations of high-level VA managers, the scandal did nothing to make lower-level employees more accountable, and the tales of malfeasance and even criminal employees being reinstated or promoted because of union and civil service rules continued:
The VA is a place where people tend to somehow magically fail upward. By that I simply mean that workers at all levels can be caught up in any sort of malfeasance or incompetence and not only retain their jobs, but apparently profit from their actions. We’ve told you the story of the executive who ran her department into the ground and was punished with a plush gig in the Philippines. Then there was the Albany, New York administrator who was found to have drug addicts on staff who were stealing the medication of the veterans and was fired, but somehow got her job back at full pay. And, of course, who could forget the Arizona VA chiefs who cooked up the scheme to keep veterans on phony waiting lists where some of them literally died without seeing a doctor, but will keep their positions with full pay and benefits for as much as two more years. But today we may finally have the story which tilts the pinball machine once and for all.
This one takes place down in Puerto Rico where one diligent VA worker found herself unable to report to work for an extended period of time. She was held up, you see, by an inconvenient inability to get a pass out of prison to make it into the office.
The VA worker was in jail on an armed robbery charge, and missed work when she could not make bail. When she was finally released from jail, she had been fired, but the union got her reinstated despite her guilty plea because in some previous instances other employees had been allowed to keep their jobs:
[The union argued] that management’s labor relations negotiator is a registered sex offender, and the hospital’s director was once arrested and found with painkiller drugs…
Employees said the union demanded her job back and pointed out that Tito Santiago Martinez, the management-side labor relations specialist in Puerto Rico, who is in charge of dealing with the union and employee discipline, is a convicted sex offender. Martinez reportedly disclosed his conviction to the hospital and VA hired him anyway, reasoning that “there’s no children in [the hospital], so they figure I could not harm anyone here.”
The “safety valve” money appropriated by Congress to allow veterans to seek outside care at the VA’s expense required VA bureaucrats to implement it, and not surprisingly it did not go smoothly, since the VA’s mission and monopoly on veteran healthcare would have been threatened if it had been successful; a working program of vouchers for outside care would have made the possibility of expanded VA-paid private care for more veteran healthcare needs more likely. So it was sabotaged:
A survey of non-VA hospitals in Florida, for example, found VA owed more than $100 million in unpaid claims for services provided to veterans under the Choice Card program. Sixty percent of the hospitals described the problems in getting paid as inexplicable, with their claims mysteriously getting “lost.”
A growing number of doctors across the country are refusing to treat patients using the Choice Card for fear of never being paid.
Now the American Federation of Government Employees, which represents most of VA’s nearly 350,000 workers, is using the failure to process payments to justify ending the program–which it opposed from the start because it said it could reduce the growth of its membership rolls. The union also complains that government workers are being forced to talk to non-VA doctors and hospitals about payments.
Incredibly, senior VA leaders are also pressuring Congress to repeal the program [claiming that] it – not the wait-time scandal – is why their agency’s image is in tatters.
Payments were delayed when the VA inexplicably refused to pay bills from outside providers unless detailed records of treatment had been received and filed at the VA. Both VA and contractors promised to improve their systems. Meanwhile, the VA argued for increased funds, and outside observers believed the VA intentionally sabotaged the program to drive veterans back to their facilities:
Last year when VA leaders claimed budget shortfalls threatened to force closure of government hospitals and related healthcare facilities, they asked Congress to let them transfer up to $3.3 billion originally authorized for the Choice Card program. Congressional leaders were skeptical but reluctantly went along.
Sen. Richard Blumenthal of Connecticut, the top Democrat on the Veterans Affairs committee, said “we’re in this situation, quite frankly, because of gross ineptitude in planning that can only be characterized as malpractice in management.”
Numerous veterans have described being hounded by unpaid doctors and being made to feel like scofflaws and deadbeats, thanks to VA’s failure to cover the costs, as Congress and President Barack Obama promised when they approved the Choice Card program.
“It is now believed by veterans that this is happening by design to force veterans back to VA to justify the existence of VA,” veteran Tony Woody said. “VA administrators fear losing too many veterans to the civilian sector, thus causing them to lose their jobs because they know the civilian sector is far more efficient.”
The situation prompted Woody, a retired U.S. Navy Chief, to ask “since when did a government employee’s job become more important than the lives of the veterans they are supposed to be serving?”
In San Diego, a vet committed suicide in 2014 after waiting for months while his counselling appointments at the VA hospital were repeatedly cancelled at the last minute. The San Diego Union-Tribune editorialized:
The script after each scandal — in 2007, 2014 and now — is predictable: Government officials insist that their only priority is helping veterans to lead healthy, productive lives. But while we have no doubt that the great majority of VA employee are well-meaning and hardworking, actions speak louder than words. It is hard to fathom that all seven of the San Diego VA officials identified as manipulating data to present a false front on the success of local mental care weren’t fired. Instead, after wrongdoing was found, three resigned, two retired and two more still work for the VA.
Meanwhile, on March 15 — nearly two years after Veterans Affairs Secretary Eric Shinseki resigned from President Obama’s Cabinet largely because of pervasive, lethal problems in the Phoenix VA system — the department finally got around to firing the three executives responsible for those deadly debacles. And that came only under intense pressure from Sen. John McCain after the Arizona Republican learned in January that the VA wanted to reassign — not fire — two of these executives.
Nine years after the Walter Reed expose, the Department of Veterans Affairs still looks awfully quick to go into forgive and forget mode when it comes to deplorable employee behavior
It’s appalling to admit, but we think the next infuriating VA scandal is a question of when, not if.
This cycle of scandal, political posturing, and temporary patches will only continue unless the root cause — the structure of the VA’s medical care arm as a civil service-protected, unionized bureaucracy — is dismantled. No one in politics should be proposing any similar government-run universal healthcare schemes until they can demonstrate the will to overcome union bullshit to cover veterans with the excellence and responsiveness they deserve.
Political decisions and monopoly public service providers will always be less efficient and responsive than private providers — largely because competing private companies live and die on performance, and undergo evolutionary pressure to be more efficient and customer-centered. If they are incompetent and fail to satisfy customers, they eventually are replaced or reformed. But the accountability of government agencies is indirect, through elections, where only the largest failures affecting the largest numbers of citizens can overcome the inertia and vested interests supporting incumbent representatives. Certain key functions of government must be accomplished through political means because they are inherently public goods — since no citizen can be excluded from the benefits, it must be a joint enterprise, jointly paid for and controlled. Defense is one key example, and there are serious efficiency problems with defense department weapons procurement and contracting precisely because it is a political process with all the opportunities for graft and pork-barrel spending that entails. But there is no other alternative — and our military does well compared to other world powers because it is still less corrupt and politicized, although that may be changing.
Healthcare for vets is not inherently a public good — it is a benefit for the individual vet, and so it is very possible to imagine different means of providing it that capture some of the benefits in efficiency and responsiveness of multiple competing providers.
One of the problems with the VA system is that not every vet lives close enough to a VA facility to easily use one. The private service option resisted by the VA helps resolve that, making it possible (for example) for a patient to visit the nearest providers rather than drive for an hour or more to a VA hospital. While there are specialties the VA is likely to be better at providing in its own facilities, like rehab for returned injured vets, more routine coverage could be contracted out to insurance carriers on a regional basis, allowing the VA to bargain for best rates and letting vets use the same facilities their neighbors do for care — like the various Tricare insurance programs, which are generally liked, now covering active-duty military and dependents. Eventually VA hospitals could be opened to other patients, where they are underutilized, and employees could be spun out to independent hospital companies without a huge disruption.
The errors and deaths will continue unless there is some drastic change in the structure of the VA’s healthcare services. Will we elect politicians who are courageous enough to do it?
Several of the largest veterans’ service organizations in the US are criticizing a proposal drafted in secret to shut down veterans’ hospitals and clinics across the country and turn over veterans health care to the private sector. The proposal was circulated outside the normal process by several members of a congressionally mandated Commission on Care created to study how VA will provide health care over the next couple of decades….
The proposal also calls for an immediate halt to new VA construction and for a “BRAC-like process” to begin shuttering existing hospitals and clinics, referring to the Pentagon’s base realignment and closure process. The department’s future role would essentially be to pay the bills of veterans getting care in the private sector….
Instead, the document simply asserts that “the current VA health care system is seriously broken and … there is no efficient path to repair it” without backing up the assertion, the chiefs wrote.
But VA whistle-blowers say schedulers still are manipulating wait times. Shea Wilkes, co-director of a group of more than 40 whistle-blowers from VA medical facilities in more than a dozen states, said the group continues to hear about it from employees across the country who are scared to come forward.
“Until the VA decides it truly wants to change its corrupt and poor culture, those who work on the front lines and possess the true knowledge relating to the VA’s continued data manipulation will remain quiet and in hiding because of fear of workplace harassment and retaliation,” said Wilkes, a social worker at the VA Medical Center in Shreveport, La.
This is not the first time the VA has said it would fix problems with scheduling. When the inspector general found in 2005 that VA schedulers were improperly booking appointments — and wait lists were therefore underestimated by as many as 10,000 veterans — the agency initiated a “national education plan” to retrain schedulers and supervisors. In 2010, VA officials discovered schedulers were using “gaming strategies” to falsify wait times to meet agency performance targets, and they required all schedulers to undergo new training, once again.
Fourth PS!: CNN is doing some excellent original reporting on the VA. This item just popped up: a scam Vietnam Veterans charity (95% of the funds go to fundraising and “expenses”) is run by a high-level VA lawyer who pays himself $65K a year from charity funds. The VA apparently sees no problem with this, since they also don’t mind felons and pedophiles as employees.
 From “History – Department of Veterans Affairs (VA)”, VA web site, 4-3-2016. http://www.va.gov/about_va/vahistory.asp
 “Trends in the Geographic Distribution
of VA Expenditures: FY2000 to FY2009,” Prepared by the National Center for Veterans Analysis and Statistics, December 2010.
The first review is in: by Elmer T. Jones, author of The Employment Game.Here’s the condensed version; view the entire review here.
Corporate HR Scrambles to Halt Publication of “Death by HR”
Nobody gets a job through HR. The purpose of HR is to protect their parent organization against lawsuits for running afoul of the government’s diversity extortion bureaus. HR kills companies by blanketing industry with onerous gender and race labor compliance rules and forcing companies to hire useless HR staff to process the associated paperwork… a tour de force… carefully explains to CEOs how HR poisons their companies and what steps they may take to marginalize this threat… It is time to turn the tide against this madness, and Death by HR is an important research tool… All CEOs should read this book. If you are a mere worker drone but care about your company, you should forward an anonymous copy to him.