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Another View: The need for a better VA

Published: Monday, June 2, 2014 7:38 p.m. CDT

The political fallout from a report confirming allegations that Department of Veterans Affairs administrators in Phoenix and possibly other facilities manipulated medical waiting lists to hide treatment delays prompted President Obama on Friday to accept the resignation of VA Secretary Eric K. Shinseki.

Shinseki, himself a veteran who suffered grievous wounds and who has been a champion for those who served their country, concluded he had become too much of a distraction to be effective. It is clear, though, from a reading of the report by the department’s Office of Inspector General – the 19th report issued since 2005 about delays and scheduling issues – that it will take more than a ritual resignation and the election-year posturing that accompanied it to resolve the systemic issues that have long plagued the VA.

The interim report is scathing in its assessment of how staff at the Phoenix VA understated wait times, possibly in a bid to burnish the evaluations of hospital personnel that are tied to raises and bonuses. It found 1,700 veterans not on the official wait list and in danger of being overlooked. The average waiting time to get an initial appointment was placed at 115 days, or almost five times as long as what had been reported. Whether any deaths resulted from the delays was not determined, but the investigation continues.

There is general agreement that the quality of care in the VA system is good, with the system outperforming the private sector and surveys of veterans consistently showing high patient satisfaction. The problem, one that has persisted for decades, has been access to care – the long waits to qualify for services and get an appointment. Indeed, the current scandal seems to have its roots in a guideline established by the VA to attack those delays, setting 14 days as the deadline to get care for non-urgent appointments.

Given the resources of the VA, the influx of wounded from two wars and the fact that the average wait to see a family physician in a major metropolitan area is 20 days, is that reasonable? Sam Foote, a doctor who worked at the Phoenix VA and blew the whistle on its scheduling scam, recently argued in the New York Times that the scheduling scandal is but a symptom of the more serious problem of a mismatch between the system’s mission and its resources. Phillip Longman, whose authoritative book “The Best Care Anywhere” examines the VA, has talked about an “ambivalence” about what vets are owed, in which the American public agrees that anyone hurt in the line of duty should be taken care of but is conflicted about whether everyone in the military should get free health care.

Congress, as Dr. Foote wrote, needs to decide whether to revert to a time when it took care only of patients’ service-connected conditions, along with a safety net for impoverished veterans, or try to re-establish a more universal program that builds on the current system’s strengths. Unfortunately, partisan divisions are already forming, with Republicans seemingly wanting to dismantle the system in favor of privatization while Democrats argue for more money. Abandoning a system that has provided quality care and that has developed specialized care for the unique injuries of the United States’ wounded doesn’t make sense. But neither does resisting proposals that give veterans – especially those in underserved areas – other options for treatment.

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