VA Mismanagement and Government-sponsored Health Plans
If the state of Medicare and Veteran’s Health Care is an example, of how the US Government runs medical service, the Uninsured American Public should be very afraid. If I had to choose between high priced arrogant profiteering insurance corporations and uninspired, underpaid, uninterested bureaucratic medical providers, I would hitchhike to Mexico or Canada. This is what Republicans, Health Insurance Conglomerates and ‘Big Pharma’ would like you to believe.
Obama does not describe this scenario, Republicans do. Obama will let the government act as your insurer, you will choose your provider as you normally would, but, like Medicare, the government would pay your doctor “at Medicare rates”. As much as I want to see universal coverage available to America’s Uninsured, government bureaucracy will be the same as Medicare, the only screw up will be those who use it fraudulently.
Obama has not restored government accountability to my satisfaction. I am part of Obama’s cheerleading squad, but there is practicality to contend with. Obama has a long way to go toward dismantling those little bureaucratic empires that permeate US Government Agencies. As long as those empires, kingdoms and fiefdoms exist in every agency the Congress creates, there will be no streamlined, reliable systems for the government to offer. Obama has a daunting task before him because, he has to satisfy all those contributers, political allies and lobbyists in order to get anything done. That is called the “Political Machine”. I was convinced Obama had a well lubricated machine to get those things done that he promised. What I see today is a Political Machine with so many monkey wrenches thrown at it, that it will be miraculous for anything to get done. Universal Health Care opponents use sneaky and vile ways to undermine getting this program on its feet. Because Republicans are grasping at straws, they throw the dirtiest, self serving rhetoric they can invent, to distort Obama’s Health agenda. They are bound and determined to take their revenge on Obama by screwing the American Public. Republican spokespersons have carefully promoted extremist behavior and lauded acting out by their less stabile, hateful minions. Hate mongers are having pep rallies everywhere and some are starting to act out destructively … domestic terrorism is part of their extremist agenda. Guantanamo should stay open to receive US Domestic Terrorists only.
Obama’s Health Care push is becoming watered down daily as he tries to satisfy the hundreds of special interests that are tied to his administration. Not unlike other Presidents that preceded him.
Health Care Reform, NYT
- President Obama took his health care overhaul proposal to one of its more skeptical audiences, telling doctors at the American Medical Association conference in Chicago that the United States is “not a nation that accepts nearly 46 million uninsured men, women and children.” June 15, 2009
- In closed-door talks, President Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul. June 14, 2009
- President Obama said he intends to pay for his health care overhaul partly with cuts in hospital payments. June 13, 2009
- President Obama, taking his case for a health care overhaul directly to the American people, vigorously defended his call for a government-sponsored health plan to compete with private insurers. June 12, 2009
- Opposition by the American Medical Association could be a hurdle for advocates of a government-sponsored insurance plan. June 11, 2009
- A study found that small businesses, already burdened by high health care costs, could save money under a mandate to purchase coverage for employees. June 11, 2009
Statement of Michael L. Shepherd, M.D., Senior Physician, Office of Healthcare Inspections, Office of Inspector General, Department of Veterans’ Affairs Before the Subcommittee on Health Committee on Veterans’ Affairs, United States House of Representatives Hearing on Charting the VA’s Progress on Meeting the Mental Health Needs of Our Veterans: Discussion of Funding, Mental Health Strategic Plan, and the Uniform Mental Health Services Handbook, April 30, 2009 [4/30/2009 PDF 57 KB]
Feb. 9: VA begins sending out notification letters to veterans who received colonoscopies offering free testing for HIV and hepatitis. About 6,800 patients at Murfreesboro and 1,070 at Augusta receive letters.
March: Improper cleaning procedure at Miami hospital discovered, affecting up to 2,400 veterans. Mail notifications begin to those veterans.
April 1: VA announces 11 Murfreesboro hospital patients have tested positive for hepatitis.
April 17: VA announces a Murfreesboro hospital patient tested positive for HIV.
May 18: VA records show about 8,000 of the 10,500 possibly affected patients have been notified of their follow-up blood test results.
May 21: VA officials give Congress a briefing, drawing criticism for not proceeding quickly enough with notifications.
June 8: VA reports that at Murfreesboro a total of 27 have tested positive for hepatitis, one for HIV. At Miami, 11 have tested positive for hepatitis, three for HIV. At Augusta, nine have tested positive for hepatitis, two for HIV.
June 16 and 24: Scheduled congressional hearings in Washington with the goal of looking into what caused the problems and what the VA has done to fix them.
Issue 1: PCT and PTSD Treatment Program Leadership
The complainant alleged that there is no full-time Medical Director of the PCT and that the program directors for the PCT and the PTSD Program are competent and concerned,but serve multiple roles as clinicians, researchers, and program directors. It was also alleged that their research responsibilities detracted from the time available for direction of the clinical program.
We substantiated that the designated Medical Director for the PCT and PTSD Program does not function as a full-time medical director. At the time of our review, the Medical Director, a psychiatrist, was only available for program management and clinical care 0.5 days per week and did not substantively participate in the operations of the PCT orthe PTSD Program.
Issue 2: Clinical Staffing and Access to Treatment
The complainant alleged that as a result of the absence of full-time clinic direction andstaff fragmentation, there was no consistent treatment plan or program for OIF/OEFveterans with PTSD. He stated that patientsare seen within the prescribed period of time by a psychiatrist somewhere in the system but that there is inadequate staffing to provide treatment programs, except for some formulaic, time-limited groups run by interns, and to provide real individual therapy.
Issue 3: OEF/OIFCase Management
VHA requires that each returning combat veteran seeking treatment at a VA facility be assigned a case manager and that an adequate number of case managers be designated based on the workload. A VHA handbook states that the standard caseload should be 25–30 patients per case manager.12 At the time of our review, 260 OEF/OIF veterans were identified as needing case management, and the OEF/OIF Care Management Program had only three case managers.
Issue 4: Prioritization of Clinical Care Versus Research
The complainant alleged that research has been given inappropriate priority over clinical PTSD care. VHA’s mission includes clinical care, teaching, and research, and there is an expectation that all three may be achieved concurrently. It is also expected that neither teaching nor research should be allowed to detract from clinical care, which is the foremost priority.
“I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs,” Mr. Obama said, in the keynote address at the A.M.A. annual meeting. “These are legitimate concerns, but ones, I believe, that can be overcome.”
Mr. Obama’s quick trip to Chicago to try to sell doctors on his health proposal is part of a wider White House effort to push what is a central tenet of Mr. Obama’s domestic policy program. He called health reform central to the American economy, and promised that he could enact his ambitious plan without burdening the budget deficit.