Hiring Freeze And Obamacare Repeal Could Clobber Veterans Affairs

As promised, President Trump has moved to dismantle the Affordable Care Act. It's a concern for those who might be left without health insurance — and especially for the Department of Veterans Affairs, which may have to pick up some of the slack.

Carrie Farmer, a health policy researcher at the Rand Corp., says 3 million vets who are enrolled in the VA usually get their health care elsewhere — from their employer, or maybe from Obamacare exchanges. If those options go away, she has no idea just how many of those 3 million veterans will move over to the VA.

"I would expect that the number of veterans using VA health care will increase, which will only provide a further challenge for VA to provide timely and accessible care," Farmer says.

The VA has already seen a surge in usage in the past year, straining what has long been an overtaxed system.

That could get worse if the agency can't fill vacancies. Trump signed a federal hiring freeze this week, and while national security is supposed to be exempt, the VA is not. White House spokesman Sean Spicer called it a "broken" system.

"The VA in particular, if you look at the problems that have plagued people, hiring more people isn't the answer. It's hiring the right people," Spicer told reporters on Tuesday.

Just hours after the White House emphasized that there would be no exemption for the VA from the hiring freeze, the acting secretary of the agency, Robert Snyder, seemed to issue a contradiction.
"The Department of Veterans Affairs intends to exempt anyone it deems necessary for public safety, including front-line caregivers," he said in a statement.

David Shulkin, Trump's nominee to lead the VA, in the past has stressed an urgent need to hire more caregivers. Shulkin has run the VA's health administration for the past two years, and he told NPR this past fall that negative attention to VA caused a 78 percent drop in applications there.

"We have 45,000 job openings. That's too many," Shulkin said. "I need to fill every one of those openings in order to make sure that we're doing the very best for our veterans."

Shulkin said the VA performs as well or better than private health care systems, but he said that long before he was asked to join the Trump administration.

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Over 2,200 veterans died in 2008 due to lack of health insurance

A research team at Harvard Medical School estimates 2,266 U.S. military veterans under the age of 65 died last year because they lacked health insurance and thus had reduced access to care. That figure is more than 14 times the number of deaths (155) suffered by U.S. troops in Afghanistan in 2008, and more than twice as many as have died (911 as of Oct. 31) since the war began in 2001.

The researchers, who released their analysis today [Tuesday], pointedly say the health reform legislation pending in the House and Senate will not significantly affect this grim picture.
The Harvard group analyzed data from the U.S. Census Bureau’s March 2009 Current Population Survey, which surveyed Americans about their insurance coverage and veteran status, and found that 1,461,615 veterans between the ages of 18 and 64 were uninsured in 2008. Veterans were only classified as uninsured if they neither had health insurance nor received ongoing care at Veterans Health Administration (VA) hospitals or clinics.

Using their recently published findings in the American Journal of Public Health that show being uninsured raises an individual’s odds of dying by 40 percent (causing 44,798 deaths in the United States annually among those aged 17 to 64), they arrived at their estimate of 2,266 preventable deaths of non-elderly veterans in 2008. (See table.)


“Like other uninsured Americans, most uninsured vets are working people - too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,” said Dr. Steffie Woolhandler, a professor at Harvard Medical School who testified before Congress about uninsured veterans in 2007 and carried out the analysis released today [Tuesday]. “As a result, veterans go without the care they need every day in the U.S., and thousands die each year. It’s a disgrace.”

Dr. David Himmelstein, the co-author of the analysis and associate professor of medicine at Harvard, commented, “On this Veterans Day we should not only honor the nearly 500 soldiers who have died this year in Iraq and Afghanistan, but also the more than 2,200 veterans who were killed by our broken health insurance system. That’s six preventable deaths a day.”

He continued: “These unnecessary deaths will continue under the legislation now before the House and Senate. Those bills would do virtually nothing for the uninsured until 2013, and leave at least 17 million uninsured over the long run. We need a solution that works for all veterans - and for all Americans - single-payer national health insurance.”

While many Americans believe that all veterans can get care from the VA, even combat veterans may not be able to obtain VA care, Woolhandler said. As a rule, VA facilities provide care for any veteran who is disabled by a condition connected to his or her military service and care for specific medical conditions acquired during military service.

Woolhandler said veterans who pass a means test are eligible for care in VA facilities, but have lower priority status (Priority 5 or 7, depending upon income level). Veterans with higher incomes are classified in the lowest priority group and are not eligible for VA enrollment.

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Veterans rally for better health care

Veterans and health care workers rallied in Camp Hill today to demand better health care for war veterans.

Organizers said the Veteran's Administration has long provided high quality health care for veterans. But they said the VA is "woefully underfunded" at a time when many injured veterans of the war in Iraq are returning home and needing medical care. They say the VA is short staffed and veterans encounter delays in obtaining medical care.

The rally was organized by SEIU Healthcare, a labor union that often rallies in support of affordable health care.

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Healthcare for vets - and all others

EVEN AS our government puts members of our armed services in harm's way, it is failing to care for them once they return home. Soldiers get excellent acute care when injured on active duty, but as revelations of poor conditions for soldiers receiving ongoing outpatient care at the Walter Reed Army Medical Center highlighted, service members often have trouble getting the care they need once active duty ends.

According to a study by some of my colleagues at Harvard Medical School, to be published in next month's American Journal of Public Health, nearly 1.8 million veterans had no health insurance in 2004, up 290,000 since 2000. An additional 3.8 million members of their households were also uninsured and ineligible for care at hospitals and clinics run by the Veterans Health Administration of the Department of Veterans Affairs. The 2006 data released this year show little change in these numbers.

Many uninsured veterans are barred from VA care because of a 2003 Bush administration order that halted enrollment of most middle-income veterans. Others are unable to obtain VA care because of unaffordable copayments for VA specialty care, waiting lists at some facilities or the lack of VA facilities in their communities. Almost two-thirds of uninsured veterans were employed, and nearly 9 out of 10 had worked within the past year. Most uninsured veterans were in working families. Many earned too little to afford health insurance, but too much to qualify for free care under Medicaid or VA rules.

The problems with veterans' healthcare offer further evidence of why the US healthcare system needs to be reformed. Because we pay for healthcare through a patchwork of private insurance companies, nearly one-third of our health spending goes to administration. Replacing private insurers with national health insurance would recover money currently squandered on billing, marketing, underwriting, and other activities. Eliminating this waste has been estimated to save $350 billion per year. Combined with what we're already spending, this is enough to provide comprehensive coverage for everyone.

Iraq veteran healthcare could top $650b

Doctors group warns possible crisis looming

WASHINGTON - A group of noted physicians predicted yesterday that healthcare for Iraq veterans could top $650 billion, another warning of a looming social crisis as thousands of veterans struggle with mental and physical disabilities and other disruptions to family life.
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The study by Physicians for Social Responsibility, titled "Shock and Awe Hits Home," marked the first attempt to isolate the financial costs of "the wide-ranging traumatic mental and social effects of the Iraq war."

The liberal group, which shared the 1985 Nobel Peace Prize, estimated that the long-term financial burden to care for a new generation of veterans will far outstrip the amount of money spent on combat operations in Iraq.

"Providing medical care and disability benefits to veterans will cost far more than is generally being acknowledged," according to the study, overseen by Dr. Evan Kanter, a psychiatrist and neuroscientist at the University of Washington and a staff physician for the Department of Veterans Affairs.

"As physicians and healthcare professionals, we are acutely aware of the actual price we are paying in human terms, and we are compelled to bring this to the attention of the Congress and the American people," the report added.

The estimate was derived by analyzing the current costs of treating debilitating health problems of troops in Iraq, including blast injuries to arms and legs from improvised explosive devices; the historically high instances of traumatic brain injuries; and post-traumatic stress disorder, which the VA believes affects at least one-third of soldiers serving there.

Since the 2003 US-led invasion of Iraq, at least 60,000 US service members have been wounded or become mentally ill from their battlefield experiences.

American Healthcare: An Oxymoron

American healthcare is an oxymoron and the system represents the country's biggest competitive disadvantage going forward. And yet it is the 800-pound gorilla in the room that’s ignored during these Presidential election primaries and run-offs. Nobody touches the fact that this is a huge business and economic issue besides a socio-political one.

Canadians are lucky on this one. We may have line-ups and our newspapers may occasionally publish horror stories about someone left in a gurney for hours outside an emergency room.

But the U.S. system is the worst-executed in the world and its private sector interests have convinced the government to insure the riskiest people – namely veterans, indigents and seniors – while leaving the gravy to private-sector insurers.

Government in the U.S. provides medical care for more than half of the population, in these high-risk sub-groups. But if government covered all the population, younger and healthier, the cost per capita would decline because these would be spread over a less expensive population of clients.

So the private sector gets to do what it wishes which is to cover those that maximize its profits and the governments are drubbed for the costs of Medicare, Medicaid and other programs for the needy or risky.

So the U.S. has two medical systems: One private-sector for the well-off where insurance companies simply pass along costs, rather than wrestle with them, as do privately-owned hospitals, clinics, labs and physician practices. And another that takes care of the old, disabled, impoverished or militarily wounded.

Suffering

It’s hard to imagine the human suffering that has resulted from this situation. Canadians don’t have the anxiety about healthcare that underlies American existence. People there don’t leave jobs, don’t start new ones or businesses because they fear losing insurance benefits.

Insurance companies, according to Congressional testimony by one physician, pay doctors bonuses based on how many claims for medical care they refuse.
And yet, most of the Presidential candidates duck the issue whenever possible, although it’s becoming harder now that Michael Moore’s documentary “Sicko” has done a good job exposing the system.

But the economic problem is overlooked by everybody. The United States is spending 15.3% of his GNP on medicine and that doesn’t include the cost of litigation over medical bills.

The Inadequacies

-- 49 million people without any insurance. The same number inadequately insured.
-- Despite that shortfall, the U.S. spends about $5,700 per capital compared with Canada's $2,900 and has worse results by measures such as lifespan or infant mortality.
-- Costs are high, even though the system is so poorly executed, because the rich are over-serviced and pampered and the poor under-serviced or ignored.
-- Some estimate is that half of the personal bankruptcies in the U.S. are because of high medical bills due to a catastrophic illness.
-- Congress does nothing. The Republicans and Democrats do nothing. All are co-opted by pharmaceutical giants, the American Medical Association (the country’s most powerful trade labor union), insurance companies and ambulance chasing lawyers. See my blog sources (financialpost.com/dianefrancis) for more information.

A recent Congressional report cited the fact that the U.S. spends more money on healthcare than any other country in the Organization for Economic Cooperation and Development and double the average spent by the 30 member countries.

Medical professionals are paid much higher salaries and fees than elsewhere in the world which has resulted in a serious brain drain of personnel from Canada and Europe. Some 9,000 Canadian doctors now practice south of the border and at least that many nurses or other professionals.

For that and many other reasons, Canadians should hope the Americans do some major surgery.

Study Finds 1.8 Million Veterans Are Uninsured

"Supporting Our Troops" means that when they return home we provide the care they need, the care they were promised. This may also be an indication of the danger of putting healthcare in the hands of our federal government. It's just not a job for our inept, greedy leadership.

As the nation struggles to improve medical and mental health care for military personnel returning from Afghanistan and Iraq, about 1.8 million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found. "The data is showing that many veterans have no coverage and they're sick and need care and can't get it." (source: Washington Post)