Elder Body Image – Take 2
Skewed Blog Survey Report

A Healthcare Success Story

category_bug_politics.gif The Medicare prescription drug program, Part D, has enriched pharmaceutical companies beyond all reason while leaving poor elders choosing between drugs and food or cutting their pills in half. This is particularly so now that many are hitting the infamous “doughnut hole” during which time they must pay one hundred percent of their drug costs until they reach the magic expenditure total of $5100 when the program kicks in again.

Not counting Part D, Medicare works pretty well. For a government program. There are some important quibbles to be made which can be addressed in time, and something must be done about disallowing doctors to opt out of taking Medicare patients before 2011, when the leading edge of the baby boomer generation becomes eligible and swamps the program. For now, considering the inefficiency of bureaucracies (and not counting Part D), it is not a disaster and most people get the care they need when they need it.

But there is another government health program that not only beats Medicare in delivering higher quality care, lower mortality rates and much lower cost per patient, it also exceeds private sector healthcare in those benchmarks. It is the Veterans Administration.

Last week, Time magazine published an informative piece on how the VA transformed itself in the past decade from an operation so substandard that Congress nearly shut it down into a space-age, high-tech organization:

“Patient records were transferred to a system-wide computer network, which has made its way into only 3% of private hospitals. When a veteran is treated, the doctor has the vet’s complete medical history on a laptop. In the private sector, 20% of all lab tests are needlessly repeated because the doctor doesn’t have handy the results of the same test performed earlier…

“Another innovation at the VA was a bar-code system, as in the supermarket, for prescriptions. With a handheld laser reader, a nurse scans the bar code on a patient’s wristband, then the one on the bottle of pills. If the pills don’t match the prescription the doctor typed into the computer, the laptop alerts the nurse. The Institute of Medicine estimates that 1.5 million patients are harmed each year by medication errors, but computer records and bar-code scanners have virtually eliminated those problems in VA hospitals.”

Time, 4 September 2006
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The VA has also invested in heavier preventive care with 300 new community clinics which cuts down on hospital visits.

Time reports that as word of the improved service got around, more vets gave up private healthcare for the VA, overwhelming the new system. So instead of increasing funding, the Bush administration has limited care to the poorest vets and those with service-related injuries and illnesses.

From a social obligation point of view, that last item is shocking. One way America has traditionally honored those who have faced death and injury on the battlefield to protect our way of life is providing for their healthcare until they age into Medicare. It embarrasses me that a soldier or sailor is now required to have suffered a battlefield injury to receive this benefit.

According to Time, American Legion commander Tom Bock has what he describes as a “win-win-win" idea: let elder vets trade in the their Medicare coverage for VA benefits.

“Medicare, which pays more than $6,500 per patient annually for care by private doctors, could save with the VA’s less expensive care, which costs about $5,000.”

And how about this too? Take Mr. Bock’s suggestions and then expand the superior VA service not only to vets currently on Medicare, but to all Medicare recipients, and then to all Americans. But as Time explains, that is not an option in Congress or, rather, the current Congress:

“…conservatives fear [the tradeoff of Medicare for VA care for veterans] would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.”

Trojan horse? Wait a minute. It sounds to me - for lack of any other idea from this administration - like a good horse to ride. But of course, it’s politics as usual. And, the partisan objection falls apart when you consider that the “private sector” conservatives are so concerned with enriching would still be needed: pharmaceutical companies, laboratories, medical equipment and services, assisted living facilities, etc. Even for-profit hospitals for the extremely wealthy who could afford them.

Part of the VA’s success at cost containment is directly due to the fact that they negotiate drug prices with the pharmaceutical companies. When Congress enacted the legislation for Part D, they specifically prohibited Medicare from negotiating with the pharmas.

That’s your Congress at work for you…

Keep that in mind for the next two months. We are in high campaign season now for the November congressional elections and this is the first in a series of political posts from Time Goes By about issues we believe are worth thinking over as you consider your votes for your senators, representatives and governors.

Comments

I am so disgusted with how downhill the healthcare system has gone in the last 10 years. Now California has a chance to pass a single payer system and of course the governator is against. What really gets me mad is the guy I voted for in the primary - the progessive democrat - is also against it!

Perhaps EVERYONE should be on the same plan. If our elected officials were part of the same plan intended for all others, I suspect we would see sweeping change... very quickly.

Oh, how true! If our elected officials had to have the same health care - and pensions, etc - as the rest of us, there would be sweeping changes.

Sounds good until you talk to people who have to wait weeks to get a VA appointment - who have to put up with doctors who cant get a job in the real world and who sometimes can't get much needed health testing for months. Perhaps the VA program still needs a lot of work as well.

Here in New Mexico where one of incumbent Heather Wilson's ads brags that she helped pass Medicare Part D for the benefit of New Mexicans always makes me gag. I commented on what a farce it was to advertise on the "success" of Part D to my thirty-something son, but he had no idea what I was ranting about. My point is that we need to help the younger generation understand the problem if we expect to change the makeup of Congress in the next election.

Somehow, by some magic means, I fell through the cracks and qualified for free medical care via the VA. That was twenty years ago. They had just set up the first of the "Women's Clinics." The bottom line remained that the VA medical system was still set up to handle older male, alcoholic vets of the WWII and Korea eras.
Despite the VA systems many successes, my friends now report that the VA is still set up to deal with older male, alcoholic vets....now add those in the Vietnam era.

All I can say is...I'd really love to know where Time got it's research from! Certainly not in Florida! Where I've done nursing for 19 years...and the VA health care has only gotten progressively worse. It's a horror show and a very poor excuse for good health care.

One of my pet peeves - the abominal healthcare in this country. My dh and I are fortunate that he worked for 30+ years for a company that provides healthcare for us in retirement, but that is becoming extinct for most retirees. How are we going to deal with all those baby boomers - old, sick and no health insurance?

And I agree with your views on the VA and how they are failing those who have served our country.

I'm really concerned that veterans returning from Iraq and Afghanistan aren't going to be able to get access to the care they need. The Bush Administration has, through federal agencies, cut down on the amount of VA services National Guard soldiers can access -- during a war where 45% of those serving are in the Guard or Reserves.

This is especially important because of one good news/bad news scenario. Because of much better (and more rapid) battlefield medicine, many US soldiers are surviving battlefield injuries that would have killed them in any previous conflict. However, this means we have a returning population of veterans with very severe injuries. The New England Journal of Medicine, in addressing this issue, says that there are 6,000 returning veterans who have head injuries, partial or complete blindness, or are amputees.

These are injuries that are going to require expensive, lifelong care and rehabilitation services to let these people live their lives to their fullest ability. Are they going to get it? That's an unanswered question.

We had plenty of veterans of Vietnam on the streets begging because of a botched and callous national response to returning veterans with serious physical and psychological injuries. If we aren't committed, we'll have Iraq veterans on streetcorners in US cities, begging. Because we didn't ensure that they got what they needed.

(I've suggested that Jay Rosen's to-be-launched organization New Assignment partner with the Wounded Warrior Project to follow up on every amputee veteran of Iraq and ask one question of each of them: Did you get the best available prosthesis?)

I think Angelides saw some flaws in this bill and has his own plan. Angelides is set to announce his plan tomorrow:

SAN JOSE, Calif., Sept. 6 /PRNewswire/ -- This Friday, Senator John Edwards and Democratic Gubernatorial Candidate Phil Angelides will join hundreds of rank-and-file leaders from California's largest and fastest growing union as SEIU United Health Care Workers - West makes an announcement about their commitment to bring universal health care coverage to California by 2008 and make fundamental change in Washington D.C. and Sacramento.

The announcement will come as 2,000 healthcare workers from across the state convene at the 2nd Annual SEIU United Healthcare Workers - West (UHW) Leadership Conference. With polls showing healthcare among voters' top concerns, and Governor Schwarzenegger's refusal to sign SB 840, Senator Sheila Kuehl's universal health care legislation, as a backdrop, the union sees an opportunity to win health care coverage for all Californians -- not just their members.

I have been on my soapbox about this issue for years. As long as people believe that the Canadian and British plans are a failure they will defeat any type of single payer system. The facts are otherwise, but people continue to believe the misleading anecdotal stories about long waits for surgery, etc. It always reminds me of Reagan's welfare queen story, which turned out to be false.
Instead of the office help in the doctor's offices having to understnad, and fill out, the forms of 200 insurance companies and until an agency can buy prescription drugs in bulk, our health care system will continue to be the most expensive on Earth. Also that bogeyman, "Socialized Medicine" is an incorrect term. The V. A. does have socialized medecine because they hire their own doctors. That would not be true under a national health plan. But with the clout in Washington that the pharmacutical companies and the insurance companies have, nothing worthwhile will be done.
It is so frustrating to know that thousands in this country have no health insurance and that it isn't necessary. Only until "We the People" rise up in anger will things change.

My sister, a Marine in the early 70's, has had to have the VA for her medical coverage. They did treat her kidney cancer although it took 3 months of tests and appointments before they did the surgery. This year she had to have a hysterectomy that they referred her to a local hospital for. The RN at the Women's clinic mishandled the follow-up prescriptions so that my sister did not get the patch for 3 weeks.

I agree with the poster who said the VA is set up for aged male veterans. The wait for service is horrendous. For all their vaunted efficiency people are not being treated as people but as cogs in a machine.

I am so thankful for the medical care we are getting in a medium sized city in the midwest from an HMO. Thanks to my husbands public service in state government we don't have to worry about good medical care on a more or less timely basis.

The healthcare system in this country is a travesty. Ohio has a system called HCap for poverty level patients without insurance. The trouble is, it only covers doctor's visits. No physical therapy, no specialists, no ER visits, I am in debt for money I cannot pay. AND I couldn't/can't have the neurological exam my doctor ordered -- a test came back with a matter of concern -- because I haven't insurance. The neurologist refuses to see me without cash upfront. So much for the Hippocratic oath! For all I know I'm walking around with a time bomb within me. Am I scared? Hell, yes! Am I worried? You betcha. However, all I can do is soldier on in an unforgiving world. I've come to the conclusion that there's an 8th Deadly Sin: Poverty

I have for many years wholeheartedly supported the idea some of the commenters here made, that our congressional leaders, and government administrators, should have to have the same kind of insurance they foist off on the American people.

I hope this piece on VA medical care receives a lot more comment for consideration by those of us who may not have direct information from friends and loved ones as to exactly how well the revamped VA program is working, especially in the hospitals.

Just today I recevied first hand information from a vet and his family that they have been extremely pleased with the outpatient service they've received from the VA after leaving their very prominent HMO.

I would like to hear more about inpatient reactions and their family members assessments of the VA care delivered to a loved one during hospitalization.

Unfortunately there are as many hiden plans as it`s needed, no one who has power to decide won`t be in the common plan

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