Medical Care for Our Vets is a Mess

The health system is failing our bravest and most deserving — but there are solutions

Our veterans are dying at the hands of the health care system meant to heal them. And what are our candidates talking about?

As we approach the third and final presidential debate, life-and-death issues should be on the table. Yet health care remains one of the least talked-about issues this election.

Our veterans far too often receive poor to mediocre care with no recourse.

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We have made formal promises to our veterans to provide them care after discharge. A recent report, however, shows that patients in the Phoenix VA Health Care System are still unable to get timely specialist appointments after “massive reform efforts.” Worse — the delayed care may be to blame for at least one more veteran’s death. Phoenix isn’t alone in its challenges.

Candidly, I am not surprised. During my internal medicine residency, I rotated through a well-regarded Veterans Affairs hospital in the mid-Atlantic. Even then, decades ago, the VA medical system was problematic.

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Our veterans often require more specialized care because of exposure to things like Agent Orange, as well as the physical and psychological trauma that often come from being a soldier. Yet there are 450,000 disability appeals claims backlogged with the system, long wait times to get an appointment, and appointments continually canceled for no reason. Our veterans far too often receive poor to mediocre care with no recourse — and to top it off, employees who don’t do their job or who don’t do their job well remain protected in their roles.

Take a good look — because this is the future of our health care system, should single payer be adopted on a wider scale.

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Medicare is already bankrupt, so “Medicare for all” needs further explaining. But Americans have an obligation to assist our vets in an effective, fiscally responsible way. Two suggestions:

1.) Medicare for All Veterans
Democrats in particular want Medicare for all. Let’s start, then, by giving it to all veterans regardless of age. Medicare is touted as this efficient system with low administrative cost. That belies the fact that the elderly use a lot of care relative to those under 65 years of age. We would see the true cost very quickly. Perhaps simply firing the VA would save money. Think of the government employees for whom taxpayers would no longer have to pay salaries and retirement benefits. The U.S. government could sell off the land, just as it has for unused U.S. post offices. It’s a win-win — but political considerations on a federal and local level likely would block this.

2.) Medicare for Veterans Over Age 65
Veterans over 65 represent a huge portion of the VA’s current problem. Vets who are eligible for Medicare should be given a special Medicare card. When a patient is unable to obtain a VA appointment within a specified period of time — 30 days for most procedures — he or she could use his special Medicare card to obtain the services of any participating provider in the U.S.

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If the matter were more urgent, such as depression or post-traumatic stress, the waiting period might be reduced to, say, seven days. And if a particular treatment could be readily deferred without substantial risk or discomfort to the patient, the waiting period might be somewhat longer. Finally, the standard deductible and copay for Medicare — normally collectible from the patient unless there is a specific policy in place — would be waived.

To activate the special Medicare card so that a Medicare provider could accept it, the veteran would be given a certificate from his or her local VA hospital, specifying the service for which an appointment could not be obtained within the maximum waiting period.

Critics worry Medicare reimbursement rates might exceed the VA’s actual service costs, but this would incentivize the government to improve efficiency.

In addition, in any system, a national hotline could be established to police those times (rare, one hopes) when patients were not provided either a timely appointment or the certificate. Veterans or their families could report such cases either by phone or online. Suitably scrubbed of patient identifying information, the list of recalcitrant VA hospitals or providers — and the dates and circumstances of the complaints — could be made public.

That way the media, the president, and members of Congress could not claim to be unaware of any problems.

Officials could also collect records of the number of certificates issued by each facility and the treatments for which they were provided, obviously scrubbed of patient identifying information. That would also be a warning of potential mismanagement or underfunding.

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Critics worry that Medicare reimbursement rates might exceed the VA’s actual service costs. But this would incentivize the government to improve the VA’s efficiency, or to obtain more resources from Congress.

By providing both choice and transparency, we would be able to determine after a period of time whether or not the VA has outlived its usefulness and whether it should be replaced. Whichever way the VA evolves, veterans themselves would no longer be hostage to the ideological or policy debate.

Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC and a regular contributor to LifeZette.

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