In Miami, there is a VA Hospital literally across the street from the County’s major public health hospital, and another two more operated by the University of Miami.  Now, I can understand several hospitals being located in close proximity to one another; but, why does the Government have to be competing with the private sector?

This is also probably the case in a number of other major cities, especially where there is a large concentration of Veterans.  Selling portions of the VA Health Care System to hospital corporations might please both ends of the political spectrum.  The private corporations would expand their patient base, thus gaining economic gains based on their total patient base.  Republicans would have “privatized” the VA Hospital System, and Democrats would gain a single-payer system.  Single-payer does not mean single-provider.

VA patients could be covered under a separate health care program under Medicare.  Call it, for instance ,“VetCare” with a separate schedule for co-payments, if any.  Medicare beneficiaries seem to love their existing coverage–and do NOT wish it to be changed.  y Wife and I surely don’t!    And, Medicare participants can go to any doctor or health care facility that accepts Medicare (VetCare).

Veterans would certainly benefit from greater flexibility of provider choice and could go to one nearby, rather than have to drive across-town, or even long distances, to a VA facility.  This might also alleviate some of the problems that currently detract from VA health care services, such as;  the great influx of Senior Citizens from the Vietnam Era; more on-site psychiatric services to treat PTSD and other mental disorders of younger Vets; and, of course, the increased demand for OB/GYN services as more and more Women return from the War Zones.

There might still be an overall shortage of doctors, practicing in the required specialty fields, and who could provide health care to all Americans–both Veterans and otherwise.  Many new doctors have huge student loan burdens, which causes them to pursue the big-money specialties and gravitate toward the larger cities.  That’s why there might be a need for scholarship programs and/or student loan forgiveness schedules in return for a commitment to public health–or to practice in rural areas or small towns for a period of time.

The Government, health care industry, medical school deans, and the health care insurance industry jointly need to formulate a plan as to how to tackle this problem.  I believe that the coverage standards of the Affordable Health Care Act are a definite improvement in minimum health care services, however, there still needs to be more transparency regarding the expenses.  Having a difference of more than 100% for the same hospital procedure, in the same city, is unacceptable.  That needs to be changed!

Now, I have never personally been involved in providing health care; but, I have been a patient in both VA and private facilities.  So, my comments here are based on: business; organizational and, what I think are, common sense considerations.  Just like any merger–although privatizing the VA health care system would have to be done in segments–there should be many benefits: combining of staffs; expansion of services available; eliminating administrative duplication; more patient flexibility; shorter wait-times and, of course, the cost savings.

NOTE:  At the recommendation of several friends, I had several check-ups at a VA Clinic, perhaps eight years ago.  I found the primary care doctor and nurse were excellent.  The administrative nurse and receptionist, unfortunately, were quite authoritative–telling me, rather than listening to me.  I felt like I was back in the Army again–going through Boot Camp!  Everyone at the VA (and private hospitals too) needs to realize that their patients are the reason for the facility–and thus their jobs!

There are a number of categories as to which Vets can receive health care services.  Those who have been in a war zone are assigned to a higher category than those who had not.  Since I already had my employer-sponsored plan, however–I realized that the VA process might get quite complicated as more GIs returned from the Middle East.  So, I stuck with my company health care plan; however, I can always go back to the VA, if I chose.


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  1. #1 by Ralph Ware on June 1, 2014 - 11:57 AM

    I don’t pretend to be an expert on VA care nor even as well informed as I need to be. But, my father died in a VA hospital, my brother is a frequent user of their services, and I have several close relatives that have worked for the VA, one of whom made a career of it in a town where the VA is the largest employer.
    The reason for a separate medical care system for veterans is that the patient population is very different from usual hospital patients. Treating them requires (or so I came to believe) different expectations of the medical staff. The VA hospitals exist for different reasons than do for-profit hospitals.
    My father, combat veteran, went into the VA for end of life care so as not to bankrupt my mother in her old age. My brother, a non-combatant, short-term enlistee with mental health (as well as medical) issues, frequently checks into the VA when things on the outside aren’t working out. We, the tax payers, are committed to spending whatever amount of money and taking whatever time necessary to meet the needs of such veterans. This has been one of the incentives for young men to enlist in the military for the ultimate good of the country and we, the tax payers.
    Maybe the care of Veterans could and should be handled differently but I can’t imagine that the private healthcare industry would be able to accommodate some Veterans’ needs. For-profit hospitals need to limit the amount of care they provide to keep medical costs down. I don’t think that turning them into VA style facilities would be in anybody’s best interest.

  2. #2 by cheekos on June 1, 2014 - 2:08 PM

    Mr. Ware, thanks very much for sharing your comments–and Family story. As stated, I do not claim to be an expert in Health Care Administration either; however, there are two facts of life involved here:

    First, Congress seems to be partially defunding VA and intimidating it in order to do so. This happened late last year when the Senate voted to shift funds so that it could restore the funding taken from DoD. There was some nonsense about funding strategically-important needs.

    Second: the Demographics are changing. Life expectancies continue to rise; so, each Era’s Vets will live longer than the ones before them. With health care in the Middle East being better and closer to the Battlefield, Deaths have gone down; but, substantial injuries have skyrocketed. And, nowadays, more and more Women are assigned to War Zones. That certainly was’t the case when i was in Vietnam. So, has the VA been able to keep-up with the full demand for Female Needs: contraception; pre-natal; maternity; the occasional abortion (let’s not get into the religious/moral dilemma) and, quite importantly, who will provide pediatric care for the Newborn VA Enrollees.

    There should be a transition period. Let’s say that a private hospital purchases a VA hospital two miles away. Some specialties might transition more quickly, such as psychiatric and OB/GYN Care, while others might shift. Also, the greater number of nearby ER’s would be beneficial for Immediate Needs. For most Vets, there is no such thing as a realistic VA ER–not 30 miles away.

    When two businesses merge, the two components are generally operated independently initially and, then, over time they become fully-merged, but offering more locations. Perhaps even combining two underutilized health care facilities, or do we really need two burn units, cancer centers or open-heart OR’s? Generally, there are numerous inefficiencies and the cost-savings can re-place some of the funding that was always inadequate or later de-funded.

    Mr. Ware, I do appreciate your Comments and, as stated in the Blog Post, I do not have any experience whatsoever in the health care field. But, when you consider the changes in our society, medical specialty needs, locations and the cost-benefit potential, I believe that it is at least worth suggesting changes and, hopefully improvements. There might even be some advantages for the medical community in being involved in a broader range of health care needs–and a greater flexibility in proving coverage.

    I sincerely wish you and your Family well. Thanks again.

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