Lately there’s been a lot of negative talk in the news about the U.S. Department of Veterans Administration (VA for short). Some of it is deserved. All of it was preventable. None of it is easy to explain.
While I may not be 100% happy with the VA 100% of the time, I do appreciate the efforts of the VA collective. Thousands of people make the system tick and I thank them whenever I get a chance. You see, I’m eligible for VA benefits. Since I am overseas, I don’t use the medical benefits but that’s a personal choice (I’m also a military dependent so I use military health care when needed). I fully appreciate that I can seek the care for my service connected disabilities if and when needed.
Why am I not as distressed about the news as others may be? I also know, as a retired military health care administrator, that the world of federal health care management is far from black and white. No news or data report can fully express how gray that world truly is and if they tried, they would lose readership. Counting peanuts is boring. Reading about counting peanuts is deathly boring. However, understanding the results is critical. Like when you’re making peanut butter. I don’t mean to equate each veteran to a peanut, but when you imagine how many peanuts it takes to make a jar of peanut butter, imagine how many veterans are eligible for medical care in the entire VA healthcare administration.
When bad news isn’t good enough Oftentimes in my career, I was a PowerPoint Ranger. I crunched numbers, ran reports, made power points, presented my reports, and made my boss look good. Anyone with decent tech skills can make bad numbers look well, less bad, on a graph without technically lying. I have also been on the receiving end after presenting a poorly received report. The data was good. The presentation went well. The results were not what the boss wanted to hear.
It’s human nature to want the pat on the back and not the kick in the rear on the way out the door. So I understand, I empathize with any sense of desperation felt by the worker bees and their administrative leaders far from the VA Headquarters in Washington, DC. I especially understand any desires to salvage their reports and essentially their hides. I don’t condone this behavior because in the end, honesty is the best policy, but it doesn’t mean I support the incredibly negative backlash I see in the news. The current negative spotlight is a terrific opportunity for the entire VA system to make right what’s wrong. It would not be an overnight fix but if it’s a systemic problem, as implied in recent news clips like this one and this, it’s a systemic fix.
This isn’t new information It’s old! Like nearly a decade old. VA gurus, dust off the 2005 Congressional Budget Office (CBO) report, and re-run the numbers. The title isn’t hard to find: “The Potential Cost of Meeting Demand for Veterans Health Care.” If you don’t have enough time to read the report in one sitting, jump to the parts of interest or straight to the summary. I found this closing statement particularly interesting.
“High anticipated growth in medical costs for the entire economy will play an important role in driving VA’s future medical costs regardless of the behavior of lower-priority veterans. But if VA’s appropriated budget does not grow at a rate consistent with health care cost growth, or if large numbers of currently unenrolled veterans decide to turn to VA for care, VA could again confront the decision of whether to freeze enrollment or to disenroll veterans who are currently using care within the VA system.”
Hello?! This hints at what could have happened in the next decade since 2005 but was far from predicting the as yet, unseen overall impact on the entire system. The demand for services grew but so far, disenrollment has not happened.
Who knew we would be in Iraq and Afghanistan for 9 more years, with wounded warriors and potential VA patients needing long term care for their service connected disabilities?
In 2012, the Huffington Post published the article Iraq, Afghanistan War Wounded Pass 50,000. It’s been nearly two years since and while it’s slowed, a good number probably have since transitioned out of the military. What percentage of those veterans now seek care within the VA system?
Doing more with less I’ve also been on the receiving end of nice, tied up with a pretty ribbon, reports and openly questioned data. While I am saddened by recent whistle blower news that certain Veterans Health Administration (VHA) facilities were falsifying data to higher headquarters and manually scheduling patient appointments in an effort to game the system, cook the books, and keep the true outrageously long patient waiting times out of the official reports… I am not surprised. The press is doing a great job keeping the focus on the care, on the veterans affected, and I, as a veteran, thank you.
However, the blame isn’t on just one person. Don’t make Secretary Shinseki the only fall guy when all is said and done. The VA is in full reaction mode, desperate to appease Congress since political leaders have constituents to appease. He’s just the easiest target and he wasn’t even in the VA leadership until 2009, well after the CBO report was published. He is a politically appointed leader of a huge bureaucratic institution that was charged to provide care for the largest veteran population in history with the largest budget of its kind in the world. That’s a pretty high fall from grace if he fails, considering that he himself is part of the veteran population.
The pressures on leadership to do what’s right and avoid negative publicity No one wants to be the bad guy. No one sets out in health care wanting to be the person who turns someone away because of a lack of resources. No one wants to tell their boss or worse, the public, that good care cannot be provided in a timely manner because of a lack of skilled manpower. No one wants to tell Congress that jobs cannot be quickly filled because all the qualified people with training and experience quit or retired after the last crazy fiscal year.
So what choices do federal health care workers have but to do more with less? Less time, less consumable resources, less appointment slots. What do they have more of? More paperwork, more reports, more patient population, more training requirements, more headaches.
Here’s a secret for Congress. Just because the worker bees can do more with less, does not mean they can sustain it for an undetermined length of time. Just because they have been able to do it for one year, two years, or even longer, does not mean that more resources are unnecessary. The system and its players will eventually give up from sheer and utter exhaustion. Sadly, patients who need them most may be lost in the battle.
More means more We have a VHA that’s been deluged for most of the last decade. Remember the article I mentioned a moment ago claiming more than 50,000 war wounded in both conflicts in Iraq and Afghanistan? Those are likely service connected disabilities, a key concept and requirement for VA benefits. You can surf the VA website and learn more about the other kinds of disabilities that are also covered by the VA.
We also have had all time highs in recruiting periodically in the last 20 years. One would hope that the budgetary gurus have allowed the VA budget to grow in direct proportion to the military’s growth, but it’s probably a lot slower than needed. Do you recall when the current administration pushed for and got a 30,000 troop increase for Afghanistan in 2009? Those troops, whether injured on the battlefield or while lifting weights on their forward operating base, are potential VA patients.
Here’s an example for the common man to mull over: If an individual left the military this year after 20 years of service at the age of 39 and is eligible for VA healthcare, he could be in the VA system for the next 42 years. (I used the Social Security Administration’s life expectancy calculator for this example)
He is not a drain on the VA system. The system was built for him and others like him.
Increased patient numbers, increased access required, increased cost of care The government has been responsible for the care of our disabled soldiers since the Pilgrims in 1636, but our current system has been in place since 1930. Since its official formation, the VA has flexed, grown, and changed with its beneficiaries, but like other huge bureaucracies, it is a slow-growth. The healthcare facilities cannot simply push back eligible patients when they seek care. It is truly a vicious cycle. They can possibly seek more funding if they show they have the need based on the number of patients they see. They can increase their patient load if they increase the number of available appointments. They can increase the number of available appointments if they have the providers. They can increase providers if they have the funds. Do you see the madness? I had a professor who once called this kind of thinking a “death spiral”… I tend to agree.
Guess what, America? Our greatest generation may be fewer in numbers because they are dying out and our veterans from the Korean and Vietnam eras may be fewer in numbers too. However those that hang on are living longer with more complex health issues thus requiring more and expensive resources. Did Congress think they funded the VA enough over recent years and hence the VHA to grow their resources so they could provide long term health care for our aging veterans as well as all the wounded warriors now in their system? Evidence is readily available that VA leaders have been asking for budgetary increases over the years. For instance, then Undersecretary for Health at the VHA, Dr. Robert Petzel, testified to the House Subcommittee on Health.
“During 2011, we expect to treat nearly 6.1 million unique patients, a 2.9 percent increase over 2010. Among this total are over 439,000 Veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom, an increase of almost 57,000 (or 14.8 percent) above the number of Veterans from these two campaigns that we anticipate will come to VA for health care in 2010.”
The VA did their part and shared their expectations for that fiscal year, 2011. My friends, that was nearly four years ago, and we are still at war.
Continuity of Healthcare from Department of Defense to the VA There are manpower experts, financial gurus, and planners who can calculate the expected cost of care per user within the military health care system. How many more steps would it take to translate the cost of that same veteran into the VHA? Do the two sides work well together to strategically translate the expected costs of a wounded warrior on the overall systems? If they didn’t in the past, they are working in that direction. After a couple of clicks on the internet, I found evidence that the General Accounting Office considers Continuity of Healthcare from the Department of Defense to the VA a key issue. What have the institutions done with this knowledge other than read the reports? By the way, the latest I could find was filed in 2012, so it’s likely that any real collaboration is relatively new and if it’s an early success, the VA ought to put it out in the press for all the world to read.
Perhaps that’s where the grassroot movements should also focus their anger and their efforts. Help the VA get the resources it needs to bring itself up from the near bottom of public eye barrel. Tell the leaders in Congress that they have the fiduciary responsibility to ensure the VA can operate effectively for the long haul and should no longer continue doing more with less. Provide moral support to those who work hard to provide access and care within the VA system. They will be under weeks and months of scrutiny by investigators, legislators, and the press.
There’s a light at the end of the tunnel.