Some comments on the Veterans Hospital situation in May, 2014

I have a book somewhere in my library written in the late 70s that details how Vietnam vets got the same treatment as those complaining now at a New York Va. The problem was identical. That facility, however, had a huge number of injured and sick vets referred them from all over the area. They simply rationed so that no population of vets got more than others. They all got the same and there wasn’t enough for anyone.

I prefer not to think that these people are intentionally stiffing vets, although the woman head of the Phoenix VA is now showing signs that she did all this to “look efficient” to her bosses so she could climb the career ladder faster. I think they figured out ways to ration care and hide it from the media (for a while).

I “think” the problem is an overwhelming mass of returning vets with a ton of medical problems and a limited amount of resource to deal with them. There are more doctors than Carters has Liver Pills all over Iraq and certainly Afghanistan. None of these doctors can do much definitive care there but they can “patch up” and send them back to the USA alive but with disastrous issues they would have ordinarily died from. Then they require a ton of expensive care that isn’t available in the system.

This is especially true for neurosurgical injury. If a soldier got a serious neurosurgical injury in Vietnam they died. In fact, if s soldier got an injury that a paramedic couldn’t fix at the scene he still had a pretty good chance of dying. Now they get patched up by doctors at up-front field facilities and sent back to the USA for a lifetime of expensive care and many remain non-functional, requiring some form of welfare support. All this is incredibly expensive and the funds were never available.

Most of the Vietnam vets were sent back with relatively inexpensive health care issues and there was enough resources in the VA system to cover them. When I was a resident in both Indianapolis and New York City, I trained at the VA hospitals in both those cities and I was never impressed that their resources were stretched. I thought patients there got pretty good care and very good training of doctors. Now they’re coming back requiring a LOT of chronic care for injuries that should have killed them and the system is dramatically overloaded.  So what do you do when you have resources for 100 soldiers a week and you have 1000 pushing at the gate to get in?

The answer in a perfect world is you prioritize in some way so those requiring the more acute care get it first and the rest stand in line till their number comes up. But watch the “Wounded Warrior” commercials on TV. They’re all acute and they all need more expensive technical care, ICUs, neuro care, extensive rehab for blown off limbs.

In this country, allowing one group to cut in line on the basis of anything will get vociferous complaints of favoritism and discrimination. So I have little doubt that the VA simply found ways to thin out the demand for services by backing them all up into a barrel and turning the spigot open to allow a defined number of them into the system that could deal as effectively as possible. The rest just backed up waiting their turn. There are lots of ways to do that. What they did in Phoenix is one. Then the media got hold of it and the resulting feeding frenzy didn’t point out the fundamental problem of too many injured soldiers trying to get too few resources. It pointed out incompetence and stupidity which is much better copy.

So how to fix the fundamental problem.

As long as we’re resuscitating otherwise mortal injury in Afghanistan, we will continue to deal with them inadequately in the overheated VA system. Now that the toothpaste is out of the tube in the media, it won’t go away. We have several choices.

1.  Pour a ton of money into the VA system creating a “separate but equal” care system for acute injury and rehab.

2.  Close the VA system for acute injury and spread these patients out through the nearly overheated public health care system and pay for that care via a separate reimbursement provision that the military has in place anyway for veterans who for some reason cannot access a veterans facility.

I “think” that #2 is the logical way to deal with these patients most effectively. The VA system clearly cannot deal with them at all, much less effectively. It would cost a lot more to bring the VA system up to speed than to adjust the “private” system. At any rate, we better do something soon because there are a lot of soldiers out there who deserve better.

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