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Time for a Dose of Reality

9:35 AM, Jun 19, 2014 • By KEVIN NICHOLSON
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In reality, the VA’s electronic record system is a hodge-podge of roughly 100 different software systems. The infrastructure of some of those systems dates back to the 1980s, and many components of the overall system are incompatible with others. Every veteran who visits the VA knows to bring with them a photocopy of their medical record, and knows that when they turn their record over to a doc, it will promptly disappear. (This is why well-prepared VA patients always keep an original paper copy of their record at home.)

Furthermore, the VA’s ability to produce superior health outcomes is dubious. A 2009 report by the Congressional Budget Office confirmed that it is difficult to gauge the quality of VA care against other providers, given that many veterans receive their health care from multiple sources. Of Medicare-eligible patients age 66 and older who had also been enrolled in the VA for one year or more, only about three percent chose to seek in-patient hospital care from only the VA.  Seventy-six percent avoided the VA completely, with 19 percent seeking care solely from Medicare, while roughly one percent sought care from both the VA and Medicare. Yet proponents of the VA as a model healthcare system have ignored this mix of providers in an attempt to ascribe all successful health outcomes to the VA.

I suppose that none of this really matters when you’re trying to win a political argument. A recent audit of 731 VA hospitals and outpatient clinics may have discovered that more than 57,000 veterans have been waiting more than 90 days for an initial appointment, while 64,000 veterans never even received an initial appointment after requesting one. But these numbers reflect more of those inconvenient horror stories that Krugman would prefer not to be bothered with. 

Why make the argument of the VA as a model system in the first case?  Because, to admit the VA’s many fatal flaws, is to admit that socialized medicine (to use Ezra Klein’s one-time description of the VA’s health care network) doesn’t work very well. And that’s an uncomfortable reality for the Obama administration and its supporters. If the VA can’t really provide better outcomes at reduced costs, what are we to think of the ACA’s chances of doing the same? 

In reality, the VA hospital system should likely be phased out and replaced with insurance coverage for qualified veterans.  Retirees and injured veterans, many of whom already have insurance coverage provided by the military known as TRICARE, should retain or gain that coverage. This coverage should then be made eligible for use at private hospitals across the country, and supplemented by a system of regional military-run trauma centers (specializing in providing the brain, burn, prosthetic, and psychological treatments required by many injured veterans). 

This is a practical and reality-based solution to a real problem that affects the health and well-being of Americans who have sacrificed a great deal for their country. It’s certainly not the only answer to the problem, and may not be the best.  But it’s an honest start in the right direction that doesn’t depend on an elaborate game of pretend.

A Convenient Excuse for a Bad Decision

What can you say about a White House that made the conscious decision to release five top-level Taliban commanders in exchange for an (at best) AWOL soldier under a scenario that will likely see those combatants return to the battlefield in one way, shape, or form?

The Obama administration and its supporters in the media have obviously received their talking points, and all are reciting the fact that the United States “leaves no one behind” on the battlefield. Ergo, anyone who disagrees with their decision to release five top-level Taliban commanders must not care about the welfare of Prisoners of War.  This trope has been shouted from the rooftop by the president and his supporters in the media with the hope that the argument closes the case.

To call this a hyperbolic response to a straw man is too kind.  The United States does not leave its own on the battlefield. Enough said. Those of us who have served in the military have lived this creed and do not need to hear it regurgitated by the likes of Susan Rice, the national security advisor and former United Nations ambassador. Rice’s further description of Bergdahl as having served the United States with “honor and distinction” – powerful words whose meaning apparently escape her – only underscores the disconnect between the administration and the rest of us.

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