Tag Archives: VA hospitals

The Kochs engineer a “scandal” at the VA

19 Tuesday Apr 2016

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An article in the St. Louis Post-Dispatch (4/14) lamented the fact that the local VA hospital was having trouble finding anyone to take the facility’s medical director position. The article cited two main reasons for this situation.

First, was the issue of pay. The Post-Dispatch pointed out that while a similar position in the private sector would pay in the vicinity of $349,000 a year, directors at the the VA have a salary range of $121,956 to $183,300. I don’t know about you, but I’m pretty sure that a salary of about half the going rate isn’t going to get many takers. We all know, too, that those who are willing to work for less might not be quite the very best talent that can be found.

Second, the article pointed out that there has been lots of publicity about shortfalls in VA service over the past couple of years, resulting in lots of heated rhetoric and excessive political meddling in the VA’s management . Nobody wants an underpaid job where oversight means your efforts to succeed will undermined by demogogues and micromanagers who seem to be looking for reasons to cut funding essential VA funding.

It is not really surprising that administrators at the VA are underpaid relative to the market. One need only look at the spending cuts that congressional Republicans wrung out of the Obama administration since 2010 to understand that more than administrative pay may have been compromised by the indiscriminate GOP budget ax – and at a time when the VA system has had to accommodate a large influx of wounded veterans returning from Iraq and Afghanistan. The most recent Republican appropriation was $1.7 billion below the amount requested by the president.

Given the state of VA funding, more is at stake than administrative salaries; a corresponding slippage in service levels would not be surprising. And there have indeed been reports of long delays in receiving service which, if the stories are to be believed have in some cases resulted in the deaths of those on the waiting list.

Nevertheless, despite the prevalence of such horror stories in the media, a large majority of veterans respond positively (pdf) to surveys about their care in VA hospitals (see also here). A report by Alicia Mundy in the Washington Monthly, “The VA is not broken – yet,” quotes from several recent studies that find “the VA still generally outperforms or matches the rest of the health care system on most measures of quality.”

How do we explain the apparent contradiction between surveys that report high levels of patient satisfaction and the widely disseminated stories of VA failures? Is it possible that the VA horror stories might not be true? Mundy tells us unequivocally that this is indeed the case. Kevin Drum succinctly summarizes her findings:

There were some problems in Phoenix, where employees had gamed the system for recording wait times. However, there was no evidence that this problem was widespread; there was no evidence that it caused any deaths; and there was no evidence that care had been compromised.

Mundy assigns blame for the false accusations to free-market Republicans, who abhor the VA as a bastion of socialism, along with health-care businesses that hope to profit if the VA medical system is privatized. In particular, she singles out the Concerned Veterans for America (CVA), a creation of – who else – the Koch brothers, as an important player in the effort to create a false sense of crisis at the VA:

… Seldom, however, has one of their investments paid off so spectacularly well as it has on the issue of veterans’ health care. Working through the CVA, and in partnership with key Republicans and corporate medical interests, the Koch brothers’ web of affiliates has succeeded in manufacturing or vastly exaggerating “scandals” at the VA as part of a larger campaign to delegitimize publicly provided health care.

The CVA smear provides cover for GOP fellow-travelers so that they can face down the numerous veterans groups that have reacted with horror at the suggestion that VA medical services may be privatized. They have also managed to stampede some of the centrist, red or reddish state Democrats – like our own Senator Claire McCaskill – who are perpetually trying to prove to closed-minded conservative constituents that they are open-minded enough to entertain criticisms of liberal institutions. right wing fantasies.

Mcaskill was gung-ho when it came to 2014 legislation to “reform” the VA system which gave us the ill-considered and unsuccessful Choice Card that allows veterans to get private care on the VA dime, as well as setting up a commission to make recommendations about further “reform.” Many of the members of this commission have a partisan bias against the VA; they include members from health care industries that stand to profit from privatization of VA services and the CVA itself. The only groups not represented are veterans organizations that strongly support the VA.

Although McCaskill has been more than ready to endorse the “broken VA” storyline, her actual proposals seem to have been modest and fairly reasonable and, to my knowledge at least, she hasn’t indulged in privatization rhetoric. There’s reason to hope she’ll pick up on the GOP con and will have the courage to resist it even though it seems tailor-made for certain noisy Missouri constituencies. We’ll need her if the VA, one of our government’s success stories, is to survive this most recent, dishonest onslaught. As the saying goes, “if you’re not at the table, you’re on the menu.”

N.B. I would suggest that you read the Mundy Report, and Paul Glastris’ response to conservative criticisms of the Mundy report. They’re all relatively short. If you’re interested in the political process currently underway, this Boston Globe article will be of interest, along with this article from The American Prospect

Ann Wagner toes the GOP privatization line on VA hospital scandal

18 Wednesday Jun 2014

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The most recent email newsletter that I got from my Congresswoman, Rep. Ann Wagner (R-2), Ann’s Weekly Roundup, focused on the scandal attendant on the long waits that many veterans have to endure in order to get care at VA hospitals. Wagner, needless to say, wants us to know she’s utterly, utterly aghast – even though she had little or nothing to say in February when her GOP compatriots in the Senate blocked Bernie Sander’s bill, S. 1982, that would have not only expanded the range of care available to veterans, but would have helped to alleviate the situation at notably overtaxed VA hospitals by providing for 27 new medical faciliities, facilities that, in the wake of the Iraq and Afghanistan wars are desperately needed.

Instead of addressing the real issue and acknowledging its genesis, Wagner prefers to troll veterans looking for more horror stories to back up her spurious claim that “the American people cannot trust the VA to correctly identify and address all deficiencies plaguing this agency.”  In fact, as Danny Vinik cogently argues in TNR, it’s more likely that only the VA itself can address the real problems – provided the funds to do so are made available.

Of course Wagner, in line with the notably dishonest GOP thrust toward privatization, doesn’t want us to believe we can trust the VA so she notably fails to mention the great job it does once folks get past door, or  the fact that “the VA healthcare system has consistently out-performed the non-VA/private sector in quality of care and patient safety.” Not a word from Wagner that the waiting period to see a doctor is, in many cases as long in the private sector as it is at most VA hospitals.

No, Wagner wants to send veterans into the private sector. For Wagner, who shows every sign of wanting to climb the GOP’s leadership ladder, the important thing is that there’s a problem at the VA that can be exploited by the pro-privatization fanatics in the GOP. Consequently, Wagner’s touting her role as a co-sponsor of the Veterans Access to Care Act, “which would allow any Veteran forced to wait more than thirty days for an appointment, the option to receive private-sector care.” Like most in the GOP, she ignores the spectular failures of the private sector in delivering health care in our free enterprise Wild, Wild West. Nor does Wagner, again in common with the rest of her GOP cohorts,  seem to be aware that this solution lacks the support of many veteran service organizations that ” long have feared such moves as a step toward dismantling their prized, fully integrated VA health system.”

But there’s still another dimension to the VA scandal that is truly scandalous serious.  It seems that staff in the Phoenix VA falsified patient wait-time records. It’s likely they did so because the VA was not only under pressure to cut wait times to 14 days, an interval that, given the myriad pressures on the system, was totally unrealistic, but because financial incentives were offered for achieving this wait time. This serious lapse has, of course, gotten everyone justifiably worked up; but only Republicans have tried to exploit it to favor their anti-government ideology:

“(The) VA’s sordid bonus culture is a symptom of a much bigger organizational problem: The department’s extreme reluctance to hold employees and executives accountable for mismanagement that harms veterans,” said House Veterans’ Affairs Committee Chairman Jeff Miller, R-Fla.

Which leads me to point out that the use of financial incentives is not unique to the public sector, It is a motivational mechanism that the VA along with other nonprofits has borrowed from that GOP icon, the private sector, where it has an equally spotty record. Take for instance, the issue of bonuses paid out to business executives. The Economist reports on a study that concludes that, “of the largest companies in America (those in the S&P 100), CEO pay has no correlation with either performance or market capitalisation.” Does this bother those GOPers like Wagner who champion the supposedly greater efficiencies of the marketplace? It certainly didn’t in 2009 when the GOP came out swinging to protect the bonuses “owed” to the CEOs of bailed out banks.

The issue in both the public and private sector is not the use of incentives per se, but the degree to which they are tied to realistic, easily verifiable goals. Cheating at the VA is akin to that in the education field where we find schools where merit pay as well as the survival of the school itself depends on students’ test scores while, at the same time, the school district is without the wherewithal to enable it to address the complex issues that lead to low test performance. Since the stakes are high and there’s no way to succeed, sometimes they cheat. Same at the VA.  

It’s not surprising that people who have to meet unrealistic goals to avoid censure as well as to supplement their income will cheat when they think they can get away with it. It’s a sad fact, but it happens. It happens in the private and the public sector and the conditions that give rise to such cheating need to be addressed. And in the case of the VA, putting veterans into the private health care system does nothing to address the issues – although it will up the costs for the American taxpayer. According to Danny Vinik:

… the Congressional Budget Office reported that allowing certain veterans to seek care at non-VA facilities would cost $35 billion over the two-year program, as The New Republic’s Brian Beutler predicted. If made permanent, CBO estimates it could cost $50 billion a year. For comparison, the VA currently spends $44 billion a year on its health care system. CBO notes that its estimate is preliminary, but it still is much higher than the expected cost. And this is only for the partial privatization part of the bill.

While the potential for a new $50 billion a year program is worrisome, the bill would not even address the underlying problems at the VA.

It’s not surprising that Rep. Wagner is touting a bill that opens the VA door slightly to privatization, but it is tragic that so many Democrats have allowed themselves to be stampeded through that door by the media circus that folks like Wagner have ramped up. Do we really want to pay more to give our soldiers so-so care? Or do we want to fix the real problems at the VA where doctors specialize in the specific issues that affect those in the military? Two Republicans voted against the bill because of its cost – and for once they were right to do so, given the dubious nature of its main provision. Why, though, were there no Democrats willing to stand against what Vinik identifies as a privatization “trojan horse.”