Sunday, May 25, 2014

Perspective On The VA Scandal: Face It, We're Indifferent To Our Well Being

Now that the dust is beginning to settle around the Veterans Administration hospitals scheduling scandal, it is time to put an unwelcome perspective on things.  I say unwelcome because this scandal is merely the tip of an immense iceberg -- a profoundly dysfunctional American health care system that thrives on indifference, a reality that virtually no one wants to acknowledge, let alone address.
That perspective:
* The VA hospital system would be overworked and under-resourced even without the Bush Wars.
But the mission that it is trying to fulfill is impossible with the hundreds of thousands of additional patients from those wars -- as many as 700,000 by some estimates -- some merely needing routine care, but many requiring more intensive and time-consuming care, and in tragically too many cases, psychiatric care.

* These psychiatric disorders stem directly from those wars.
There was the unjustifiable war in Iraq with continuously shifting rationales that had nothing to do with the 9/11 attacks but was foisted on us by a neocon brain trust that relishes shooting and bombing anything that moves, and a justifiable war in Afghanistan that, just as it was making headway, foundered because it was bled for the fool's mission in Iraq.

* The root of the scandal is a profound mismatch.
Congress demands prompt, quality care for veterans but won't adequately fund it, resulting in a chasm between fulfilling that mission and the VA's resources, which has prompted administrators, aided and abetted by doctors and nurses, to resort to secret schedules at 26 hospitals, and perhaps more, which has left some patients to die while awaiting appointments.

* Under the Obama administration, the VA patient load has increased by over one million veterans.
While returning Iraq and Afghanistan war vets are a big part of that increase, the president made good on his campaign promise to expand access to the VA system for all vets, the inevitable result being an increase in waiting times for appointments.  Lost in the outrage is that waiting times have been shrinking from their high at the beginning of 2013, and backlogs today are less than half of what they were then.
* All that noted, the scandal erupted on Obama's watch. 
Never mind that Republicans have on the one hand sought to reduce veterans benefits and access to care for years while waving the American flag with the other hand and blah-blahing about supporting the troops.  While not on the scale of the recession, this is yet another Bush era mess that Obama has to clean up, and he'd better damned well do it.
* Trouble is, Obama shows little sign of doing much of anything beyond being photo op outraged. 
The scandal requires a full court press of an investigation by the Justice Department, which can impose criminal penalties, and not merely the internal inspection by the Veterans Integrated Service Network ordered by Secretary of Veterans Affairs Eric "I'm Mad As Hell About This" Shinseki.
* The scandal has prompted the usual suspects to opine that Obama was again out of the loop. 
Citing the fatal Benghazi attack and problems with the Affordable Care Act rollout, they say the president should have known about what was going on with secret scheduling at the Phoenix VA medical center before a recently-retired doctor and a local journalist blew the whistle and the scandal began to unfold.  Guilty as charged on the ACA mess; not guilty on other counts.
* The scandal begs the question of whether the VA should change the way it provides care.
Should it treat service-related only conditions, which it once did, or continue its so-called universal care system, which would require an enormous increase in funding to repair the deficiencies the scandal has laid bare in an era when Congress can agree on virtually nothing of consequence.

* Is the VA hospital system, as reliably conservative critics claim, too big to succeed? 
How to deal with the source of the scandal -- a 125-plus day backlog of nearly 300,000 disability claims?  What beyond sound-bite messaging about the problem would critics propose as the solution?  Universal health care?  No way.  Allowing vets in sparsely populated areas like the Southwest, where the scandal first broke, to get VA-reimbursed urgent and emergency care at any hospital?  Good idea, but critics aren't advocating that.
* * * * *
It is a sad commentary that the Veterans Administration, even with its substantial resource and funding shortfalls, and now the scheduling scandal, does a better job of caring for veterans than the rest of society.  No one, you see, is arguing in the heat of this particular moment that publicly- and privately-funded medical systems do a better job and should be models for the VA, and for good reason, because they do not.

In recent decades, America's standing has steadily eroded.  It is indisputably no longer a great country, ranking at or near the bottom among the 17 industrialized nations in quality-of-life and other social measures, and nowhere is this more glaring than in health care.

America is first by some measures, all of them negative: These include infant mortality, incarceration rates and anxiety disorders, as well as a gulf between the rich and everyone else that accelerated during the Bush Recession as the economy tanked and unemployment soared, but CEOs and their corporations pocketed record stock dividends and profits.  But by other measures, including life expectancy, as well as obesity, child poverty, commitment to infrastructure development, broadband access and arts funding, America ranks dead last or nearly so.

Full implementation of the Affordable Care Act still will leave millions of Americans uninsured and without access to decent health care.  And the ACA will only nibble at the underlying problems in the system, which has by far the highest per patient costs in the world.  No, the ACA will not solve those problems, which stem from the uniquely American notion -- at least among its industrialized peers -- that being healthy is not a right, nor is it in the best interests of society because even a semblance of universal care would fetter millionaire doctors, for-profit hospitals, insurers and Big Pharma.
It is bad enough that so many men and women have difficulty getting health care after they lay down their arms and return home.  The VA scheduling ruses are indeed a scandal.  But as scandals go it is hard to top our indifference to the well being of all our citizens.

1 comment:

Racer X said...

Frankly this post makes me feel embarrassed and rage any time a Republican tries to talk about healthcare.