Usually, when you ask the question in the title of this post of any VA program, its failings are adequately explained by the organization’s deep-seated, ossified incompetence, and strange resistance to garbage-collecting the incompetents in its ranks.
But this might just be one time to embrace the power of “and”.
To start with, the VA began squandering money on the program at a ratio of administrative expenses to medical expenses of over ten to one.
The VA used nearly $165 million to implement the program during its first year, while spending only $16 million on medical care during the same time, the report states.
…and despite that expenditure, the VA seems to have used that system as another means to stall and delay appointments in its own dysfunctional system:
In many cases, veterans were sent back to the VA after waiting 48 days, on average, to get an appointment with a doctor in the private sector. About 98,200 veterans who were still holding out for an appointment in the private sector as of September 2015 were waiting an average of 72 days to be scheduled.
The VA blames the Third Party Administrator (a term with a specific meaning in health insurance) for the problem:
Through the Veterans Choice Program, a third-party administrator was responsible for scheduling appointments for veterans for private-sector care.
But who selected and hired that TPA? The VA, of course. And if it had been any other TPA, would the result be any different? Of course not. It’s the VA. They’d sooner shoot the vets, the patients they’re supposed to be working for, than accept responsibility.
“[T]he procedures used to authorize and schedule appointments under Choice… were cumbersome and required veterans to schedule their treatment without assistance from [the VA],” inspectors wrote. “These procedures placed a greater burden on veterans than seeking treatment at [VA] facilities.”
This “greater burden” was not accidental. The VA modeled Veterans’ Choice on the Jim Crow literacy test, the point of which was not to make sure voters could read, but to make sure the sons and grandsons of slaves didn’t vote. So VC (a fitting acronym) was not to make sure vets saw doctors, but to make sure the VA’s all-precious mangers and workers didn’t get disrupted or face competition.
There’s also the neat trick the VA pulled on vets who wanted to accelerate their care by seeing a private doctor: give ’em an appointment, but with the wrong-specialty barber, on the other side of the whole freaking continent.
Inspectors gave a few examples of how the system led to errors. In one case, the third party scheduled a primary care appointment in New York for a veteran living in Idaho. One veteran in Florida was given an appointment with a specialist in California. Another veteran in south Texas was scheduled with a specialist who couldn’t perform the surgery that he needed.
We’ll be looking into the OIG report(.pdf) later.
We don’t use the VA. They’ve assigned us to a facility hundreds of miles away in another state, but even if it was up the street, we wouldn’t go there unless indigent, and even then we’d probably roll the dice with Medicaid first.
The vast majority, over 98%, of the injuries and illnesses treated by the VA are injuries and illnesses that civilian hospitals treat all the time. Indeed, most serious VA hospitalizations are for the routine diseases of lifestyle and aging. Why do we need a massive DC and regional bureaucracy to treat these diseases in veterans? Why does it have to be one that crushes competent providers and shields incompetent and corrupt ones?
We have built a system that is nothing but welfare for the bad doctors, nurses and administrators; whilst making a pretty rotten workplace for the good ones. Is it time to disband this thing yet?