Thank you for the comments to my guest post about the Veterans’ Choice Plan and to Frank for the link to the Gazette editorial. I think that the Tricare idea has merit but are the benefits better or the same as the VA’s? There are a myriad of stupid and wasteful VHA practices but I can think of many reasons why it should not be privatized but rather become more veteran- inclusive, simplified, expanded (Choice Program) and improved.
For example, during the “Great Recession,” a 40-something moderate-income Navy veteran I know, lost his good-paying job and health insurance. During his period of unemployment he sought health care at the VA but was turned down because he owned a retirement 401K plan, lived in a mortgaged “upside down” house and owned a car. Six years in the service–including dangerous duty working on nuclear submarines–but the first time he really needed VA health care, he was turned away. What reasonable veteran wouldn’t be bitter about that? He is.
He was also ineligible for state insurance plans. Due to pre-existing health issues, high risk insurance pools were not affordable on unemployment checks. His COBRA plan was also not affordable and if he drained his 401K, he’d have to pay a tax penalty. He eventually landed another job 800 miles away, which offered good insurance and affordable premiums, before any medical disaster struck. But, like millions of other folks, he lost his home in foreclosure during the Wall Street economic debacle.
Consider the fates of very poor and low-income non-elderly veterans, without a qualifying child, in the 19 states which have not expanded Medicaid. Like states which tax FOOD, I call them the mean states. (These are also the states in which the majority of voters vote against their own self interest when it comes to health care.)
Many adult veterans living in these states will have no other viable option for health care if the VA doesn’t have facilities or Veterans’ Choice providers in their locale. Small businesses employ veterans but finding jobs with any health benefits can be hard because many small employers have been forced to drop health insurance or go out of business. Big employer/small employer, group insurance or none: vets earning “slave wages” can’t afford their portion of private insurance premiums anyway so the point is moot.
When veterans can’t access VA health care, what do their out-of-pocket costs look like? Consumer Reports received grant funding for their retail drug price research (LINK). Need insulin? Don’t ask.
Should veterans be subject to income or asset tests? No! No way! Veterans have earned this benefit yet only some can get medical help when they need it. Better-off insured vets? The VA bills their health insurance and collects needed income. Win-win. In rural areas that don’t have waiting lists, why not allow family members/widows with health insurance to access VA health care rather than close facilities? Help families and get paid.
The notion that fraud, waste, and medical incompetence can be eliminated by VA privatization is utopian because corrupt, egotistic and greedy leadership exists in the non-profit and for-profit worlds. It takes a lot to embarrass anyone these days. The big cheeses just say/do whatever they want, apologize, and wait for things to blow over.
Getting rich veterans into VA care might actually help a lot! Sen. McCain is probably eligible for VA care as a former POW (LINK) but I think we would all agree that he should be eligible for VA care regardless of his affluence or SC disabilities. If Sen. John McCain was a regular patient at the Phoenix VA I think the health outcomes for all veterans would improve markedly. Maybe ALL Congressional veterans should be required to receive VA health care, at least once a year, in their home states.
Veterans often have different health care needs from those of the civilian populations (Agent Orange. Burn pits? What’s that?); In our experience, many private doctors don’t even ask their patients if they ever served in the military much less understand the implications of who, what, where and when. My opinion is that we shouldn’t give up on the VHA yet.