Bury the current VA system and start over?

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As old soldiers die, should the Veterans Health Administration fade away?

Andrew Exum, a fellow at the Center for a New American Security, suggested just that over at Foreign Policy. A counterinsurgency expert and quite possibly out of his depth, Exum reaped the whirlwind and his suggestion sparked an interesting conversation about the future of the VA.

What Exum suggested was that as vets from World War II, Korea and Vietnam head to the hearafter, it could make sense to overhaul the VA for OIF/OEF vets who “might need less care in terms of quantity but more specialized care.”

He proposed opening privatized health care to vets, ditching the “brick-and-mortar VA of the 20th Century” in favor of “something more akin to an HMO.”

Exum, on his blog Abu Muqawama, found himself on the pointy end of some angry comments. And a run-and-gun Twitter battle ensued between Exum and Alex  Horton, who blogs at VAntage Point.

Here’s a selection:

AlexHortonVA: @abumuqawama “How should we care for vets?” means dumping them in a private system not well versed in TBI/PTSD treatments and tech?

abumuqawama: @AlexHortonVA If at some point you have less than 10m veterans spread out over 3.7m sq. mi., then a brick-and-mortar system makes less sense

AlexHortonVA: @abumuqawama Private health care is simply not up to the task of treating them. If VA needs to be reduced, so be it, but dismantled?

abumuqawama: @AlexHortonVA “Private health care is simply not up to the task of treating them.” Evidence?

AlexHortonVA: @abumuqawama Observational. Ever try to find a private practice that deals with war-related PTSD? Nightmare. VA has stand alone bldgs for it

abumuqawama: @AlexHortonVA The VA is a kind of sacred cow. But even it will have to defend its structure budget against other available options.

AlexHortonVA: @abumuqawama For update 3: “In 2051 we will be providing care for an unknown # of Iraq, Afghan and unknown conflicts unforeseen in 2011.”

And commenters at Abu Muqawama stuck up for the VHA. One linked to a 2007 article by Phillip Longman, whp praises the VA’s turnaround in his book “Best Care Anywhere: Why VA Healthcare is Better Than Yours.”

Consider what vets themselves think. Sure, it’s not hard to find vets who complain about difficulties in establishing eligibility. Many are outraged that the Bush administration has decided to deny previously promised health-care benefits to veterans who don’t have service-related illnesses or who can’t meet a strict means test. Yet these grievances are about access to the system, not about the quality of care received by those who get in. Veterans groups tenaciously defend the VHA and applaud its turnaround. “The quality of care is outstanding,” says Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion. In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients.

Amid Exum’s vociferous critics, a few commenters seemed to meet him halfway:

Look, today’s VA provides *fantastic* care to the ~23m veterans in the U.S.

But tomorrow’s population of veterans will look different from today’s population of veterans. The future veterans population will be smaller, more diverse, more diffuse, and more likely to place increased demands on the VA. How does tomorrow’s VA meet the needs of this population?

So the question is how the VA should adapt its 20th Century infrastructure for the 21st Century — and beyond. One way is to continue embracing Community-Based Outpatient Clinics. Another is to revamp its hospitals, mirroring innovation in the private healthcare sector, to embrace outpatient and specialty care, and push primary care out to centers like the CBOCs. A third is to continue innovating in the benefits and records areas, including the new joint DoD-VA medical record. A fourth is to streamline and improve the ways VA allows care in the private sector, especially to help veterans who don’t live near a VA facility. And there are many other ways the VA can and should continue to innovate.

The end state should be a VA that serves the needs of veterans (and their families). But to do that successfully, tomorrow’s VA can’t rest on the laurels of today. It needs to aggressively question its assumptions, structure, and model, and figure out the best way to continue caring for those who have borne the nation’s battles.

We’d like to hear your thoughts on the VA system and how to overhaul it, if at all.

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  1. I know, our history is important. Look back to WW1 when National Guard Units were activated or other times Soldiers have helped our Country, which is all the time. That is one reason I am unsure who implemented alot of the new rules. I was very shocked after being a Reservist for 3 years, I could not goto the Vetrans Administration Hospital at Duke University where I live. I was basically just turned away. I am believeing a lot of these rulers were made by civilians, and I don’t see the implications if Soldiers in need of a Doctor use this or why they discriminate between Soldiers that have gone overseas, and Soldiers that serve in the United States. I had lost my Health Care and needed some help. Unfortunately this is what I found out.

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