Saturday, May 31, 2014

Selective Outrage on VA

There is bipartisan outrage over charges that veterans seeking health care at Veterans Health Administration clinics were forced to wait much longer than two weeks to be seen by physicians — and in some cases the delays may have been several months, all while some VA executives were collecting cash bonuses for their performance.

Timothy Noah of MSNBC reported May 24 that wait times for appointments may have been falsified at the Phoenix VA hospital and the department was investigating whether long wait times contributed to the deaths of 40 veterans at that facility. Similar complaints have been heard about other VA facilities. As Noah wrote, “This is a ghastly problem involving potentially criminal behavior.”

But, Noah added, while VA wait times for appointments are bad, private-sector wait times aren’t much better.

Conservatives have claimed that the scandal proves that the VA was never the model for excellence (and, by implication, the argument for socialized medicine) claimed by liberals like Paul Krugman, Ezra Klein and others, including Noah. “But the VA scandal does not raise questions about the quality of VA care, which continues to rank highly; it raises questions about the availability of VA care,” Noah added.

“To conclude from the VA scandal that VA hospital care was poor would be like concluding from Harvard’s 6% admission rate that Harvard did a lousy job educating students,” Noah noted. “The difference, of course, is that Harvard isn’t supposed to admit everybody, whereas the VA is supposed to book appointments for already-qualified veterans within 14 days. It isn’t doing that. News stories about the Phoenix VA and some other bad actors indicate the wait can be many months, but an internal VA estimate — one based on ‘hard’ time stamps and therefore less vulnerable to manipulation than the records allegedly falsified — puts the average wait at about 21 days.” (On May 28, acting Inspector General Richard J. Griffin said in an interim report that the average wait for a first appointment at the Phoenix hospital was 115 days and “inappropriate scheduling practices are systemic throughout” the nationwide VA health care system. The inspector general has not determined whether any veteran died as a result of delayed appointments and treatment.)

While directly comparable data for the private sector are unavailable, a recent survey of wait times to see private physicians found the average wait time for a Medicare or Medicaid patient to see a private specialist in 2013 was 18.5 days. Noah added that in Boston, which has a high concentration of top-quality private-sector hospitals, the average wait time was 45.4 days.

Republicans led the call for VA Secretary Eric Shinseki to resign before the department’s inspector general completed his review of the complaints. Some Democrats running for re-election also called for Shinseki’s resignation after release of the IG report. (This was published before Shinseki resigned Friday.)

Many of those same Republican senators who are critical of the VA backlog blocked a bill on Feb. 27 that would have improved veterans’ access to health care among other things but under Senate rules needed 60 votes to proceed. Only two Republicans, Sens. Dean Heller (R-Nev.) and Jerry Moran (R-Kan.), joined 54 Democrats and independents in voting for the $24 billion veterans benefits bill, despite endorsement by every major veterans organization, as 41 Republicans voted against it.

Sen. Bernie Sanders (I-Vt.), chairman of the Veterans Affairs Committee, who had sponsored the bill, said he would introduce another bill to increase accountability at the Department of Veterans Affairs and make another attempt to improve VA health care, education, job training and other benefits.

"In recent years, as a result of the wars in Iraq and Afghanistan, 1.5 million more veterans have entered the VA health care system,” Sanders said in a press release. “Congress must do everything possible to make certain that the VA has the financial resources and administrative accountability to provide the high-quality health care and timely access to care that our veterans earned and deserve.”

The new accountability measure that Sanders will introduce would grant VA secretaries the power to remove senior executives because of poor job performance, his office said. Under current law, officials in what the federal government calls the Senior Executive Service may be dismissed or demoted, with rare exception, only for misconduct.

Unlike a bill that the House passed May 22, the Sanders measure would avoid politicization of the VA by preventing any new administration from discharging hundreds of high-level civil servants without due process for political reasons.

If Republicans are outraged at the VA’s delay of health benefits for veterans, they also ought to share their concerns with Republican governors and legislators who are preventing the coverage of a quarter-million veterans who don’t qualify for VA care but could get care under the Affordable Care Act.

Ezra Klein of added, “It’s a relief to see so much outrage over poor access to government-provided health-care benefits. But it would be nice to see bipartisan outrage extend to another unfolding health-care scandal in this country: the 4.8 million people living under the poverty line who are eligible for Medicaid but won’t get it because their state has refused Obamacare’s Medicaid expansion.

“As appalling as the wait times are for VA care, the people living in states that refused the Medicaid expansion aren’t just waiting too long for care. They’re not getting it at all. They’re going completely uninsured when federal law grants them comprehensive coverage. Many of these people will get sick and find they can’t afford treatment and some of them will die. Many of the victims here, by the way, are also veterans.”

The Kaiser Family Foundation estimates that more than 7.5 million uninsured adults would be eligible for Medicaid but live in one of the 24 states that have refused the expansion. Of that group, 4.8 million who live below the poverty line would be ineligible for subsidies in the insurance exchanges. So they’re out of luck. And so are 258,600 uninsured veterans who the Urban Institute estimates would be eligible for Medicaid if their states accepted the expansion.

In Texas, for example, Medicaid expansion under the Affordable Care Act would provide 1,727,000 working-poor Texans with comprehensive health insurance, including 48,900 veterans. Without the medical care, which the federal government would pay for, as many as 3,000 uninsured Texans are expected to die, health-care experts at the Harvard Medical School and City University of New York have estimated. (The study found that as many as 17,000 people could die of premature and avoidable deaths in the 24 states that have rejected Medicaid expansion. Likewise, in Florida, Medicaid would cover 1,212,000 working poor, including 41,200 veterans, and 2,200 could die. In Georgia, Medicaid would cover 599,000 working poor, including 24,900 veterans, and 1,100 could die. In North Carolina, 511,000 working poor, including 23,300 veterans, and 1,100 could die. All state officials have to do is accept the federal money. Other states whose Republican leaders are intent on denying medical care to their working poor, including veterans, include Alabama, Alaska, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, Oklahoma, South Carolina, South Dakota, Tennesse, Utah, Virginia, Wisconsin and Wyoming. (Pennsylvania hasn’t moved forward yet, but its officials are negotiating with the Obama administration to do so.)

Republican who claims to be “pro-veteran” and “pro-life” but votes to deny VA benefits in Congress or Medicaid expansion at the state level is a hypocrite who is more to blame for the denial of health care and avoidable deaths of veterans than Eric Shinseki is on his worst day.

Republicans ought to be ashamed, but that notion seems quaint nowadays. — JMC

From The Progressive Populist, June 15, 2014
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