• What to do with the VA?

A recent article in the New England Journal of Medicine makes some excellent points about the VA system and it's future.  First of all, the number of veterans is declining, and will continue to decline.  Second, older veterans are already covered by Medicare.  So, why is the VA about to spend a ton of money and try to hire a bunch of new physicians?  Politics is the unfortunate answer.  The recent debacle within the VA system necessitated a response.  It got one.  It was a knee jerk response by both republicans and democrats to throw money at a problem, rather than coming up with a solution.  Some excellent recent articles have pointed out that many VA hospitals have so small volumes that the quality of care that they deliver is by necessity not up to speed.  

I trained in VA hospitals during my residency almost thirty years ago.  At the time, I was essentially in charge of caring for my patients, because on at least one occasion, my attending physician clearly had dementia (I am not kidding).  The staff weren't always the most dedicated.  Now, I know that much has changed, and that these were isolated observations, but it always bothered me.  These men and women had served our country in the highest degree possible.  How could they deserve this lack of respect?  The recent scandal is as much about disrespecting our veterans as it is poor management.  Hence, the knee jerk reaction from congress.

What should we do?  In the long run, having a separate health care system for a group of people doesn't make sense.  There is a caveat to that.  Trauma and PTSD are some areas where there is truly a need for specialty care that the VA should provide.  However, primary care services and other routine specialties, do not require the VA.  Over time, all primary care should be done outside the VA and only battle related medical conditions should be cared for at the VA.  This would lead to the closing down of many VA facilities.  If people are worried about jobs, they need not be.  By giving all veterans vouchers that are sufficient to cover the cost of health insurance, these veterans would end up in the regular health care system.  The added patient volume would lead to more jobs in the private health care sector.  

I actually have one major concern with my proposal.  The VA has developed many excellent geriatric centers of excellence.  What would we do with these?  Actually, the answer is simple and productive.  Movef the VA geriatric programs into the private sector. This way, not only veterans, but other citizens would have the opportunity to avail themselves of a type of care that is presently not readily available on the open market.  

Adding more doctors and nurses to an already broken system will not solve the problem.  The solution needs to be based on how to deliver the best and most readily available care to our nation's veterans.

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