No easy answers to fixing the VA health system

The current problems in the Dept. of Veterans Affairs’ hospital system seem insurmountable. We’ve all seen news reports of huge backlogs  and “double” lists of reported and actual wait times, some of which left some veterans to die while waiting for care at various VA hospitals across the country.

Yet politicians who breezily call for the resignation of VA Secretary Eric Shinseki don’t really understand why the system is the way it is or why the backlogs exist. Many pundits who say the system is a recent disgrace or scandal haven’t been paying attention. This isn’t a new problem for the VA, and it’s not one that’s going away anytime soon.

The $53 billion military health care program now consumes 10%  of the Pentagon’s nonwar budget. That’s a big number, but it’s one that doesn’t meet the health care needs of the military. In 2009, when President Obama took office, he allowed two new areas of coverage – military members with PTSD from serving in Iraq and Afghanistan and Vietnam veterans suffering a variety of ailments from being exposed to Agent Orange. Adding those extra veterans added about 300,000 extra military members to the rolls.

In must-watch TV on The Daily Show, Jon Stewart continued his slams against treatment of veterans, which goes back to the start of our country. He included the refusal of the Reagan administration to recognize the problems of Agent Orange; the refusal of the government to advance the bonus payments to unemployed World War I veterans in the “Bonus Army” that marched on Washington in 1932 (instead they were attacked by forces led by no less than Gens. Douglas MacArthur and George Patton); and the continued growth of the backlog of processing veterans’ requests for treatment and disabilities, which skyrocketed while the VA tried to handle the increased numbers of troops during the Bush administration and grew more when the Obama administration added those extra categories.

Of course, the same politicians calling for Shinseki’s removal aren’t blameless. Senate Republicans blocked extra funding for the VA in February. You can’t treat people if you don’t have the funds to do it. And the gigantic system grew up over decades. The Defense Dept. and the VA have different computer and processing systems. So when an active member of the military moves from the Defense Dept. system to the VA system, the whole process starts over, rather than using existing medical records. Meshing them is a monumental task.

So we have an underfunded system with problems of monumental growth, more serious health issues, and outdated and incompatible computer systems.

For a start, let’s look at the issue of funding.

Most of you reading this probably have a pretty good idea of what you pay for health insurance each month, whether you’re part of an employer health insurance plan, you’re on Medicaid or Medicare, or you have individual coverage. There’s a lot of variance, depending on where you live, what type of plan you have, whether you pay for individual or family coverage, how high your deductible is, etc. The U.S. average monthly premium for family coverage in an employer-sponsored plan in 2013 was $380, according to the Kaiser Family Foundation/Health Research & Educational Trust. Since 2003, health insurance premiums have increased 80%, nearly three times as fast as wages (31%) and inflation (27%).

Members of the military and their families, whether they are actively serving or are retired, get their health insurance a different way. They use TRICARE, the government program that lets families buy health insurance. And they pay less than the rest of us – a LOT less. Remember that “retired” in the military doesn’t mean you’re 65 years old, it means you’ve served the minimum number of years to retire with full military benefits. And that includes a pension and health insurance. For life.

TRICARE premiums for beneficiaries have not kept up with inflation and the overall increase in health care costs during the past two decades. Congress raised TRICARE Prime annual enrollment fees for retirees in 2011 — the first time the fees had gone up since 1995. Right now, TRICARE Prime retirees pay $273.84 annually for individual coverage and $547.68 per year for family coverage through Sept. 30, 2014.

Those are ANNUAL rates, not monthly rates. Remember, most of us pay an average of $380 per month through an employer for family health insurance. Military retirees pay less than $46 per month for family monthly coverage.

I’m all for honoring returning members of the military. I’m old enough to remember the shameful treatment veterans got when they returned from Vietnam. But if a military family is paying $46 per month for insurance, no wonder the VA health system doesn’t have enough money.

And despite all these problems, what do members of the military think of the care they get? Veterans consistently rate the care they get from the VA more highly than most other Americans rate their own health care. In a recent survey, 81% of veterans expressed satisfaction with their care from VA hospitals, compared with 77% satisfaction from Medicare and Medicaid patients. And we know that America’s seniors love Medicare.

So what are the answers? Pay for it. DON’T privatize it, as that will make the system even more dysfunctional and more expensive. And modernize the records systems and mesh them with those of the Defense Dept.

We might as well wave a magic wand.


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