Encouraging vets on Medicare to use civilian care instead of Veterans Affairs’ could cut the patient backlog at the VA by as much as half, solving a national crisis.
Almost half of vets are older than 65, and nearly all vets using the VA have Medicare coverage. Often, they’d be better off getting their bypass surgeries and cancer operations at civilian hospitals that do higher volumes of these age-related procedures and have better survival rates, instead of sticking with the VA. But the VA fails to tell them. The culprit is the American Federation of Government Employees, the union that dominates the VA. For AFGE, the VA is a jobs program. The union wants more patients, bigger VA budgets, and more staff, never mind what ailing vets need.
Nine months ago, the VA rolled out a $9.3 billion program to refer vets needing specialists to civilian medical centers, if the wait at their VA is too long or if they live too far away. AFGE is fighting the program, even accusing VA executives of deliberately causing the backlog. “Create a Crisis and then out-source the work. They will dismantle the VA Healthcare System a brick at a time,” charges the union’s newsletter.
AFGE President J. David Cox Sr. insists the only remedy is more VA staff. “Chronic understaffing,” is the problem, he says. It’s hard to fathom how Cox can make that claim. VA hospitals have no clue how many staff they need. A 2012 audit by the VA’s own inspector general found that hospitals lacked any method for calculating staffing needs, in part because of resistance to measuring worker productivity.
The union opposes outsourcing. Worse, vets are being discouraged from accessing civilian care, even when they are desperate and have insurance to pay for it. The VA’s health care budget is based on how many vets enroll and how much care they use. For the unions, the bigger that budget the better. Even if it means letting vets with Medicare, who could get timely civilian treatment for their cancer or heart disease, die in line instead.
RAND Corporation researchers cite data showing vets often have a better chance of surviving high-risk heart and cancer surgeries at civilian hospitals that perform them frequently (the exception is the Houston VA). Long waits at VAs increase the risk of needless death. Boston VA researchers found patients aged 70-74 who wait more than 31 days for treatment face a 9 percent increased risk of stroke.
African-Americans and low-income seniors are most likely to stick with the VA. One reason is that out-of-pocket costs are lower there than with Medicare. But that can be rectified easily, a change that RAND researchers recommend. Vets could be issued a special Medicare card that eliminates the Part B premium and reduces Part B copays and deductibles to the small fees the VA charges ($15 for a primary care visit, $9 for 30 days of medications, $50 for specialist visits).
One million vets who seek care at the VA are covered by Medicare Advantage, the private plans the federal government purchases for seniors. Astoundingly, the VA spends 10 percent of its medical care budget treating seniors who have Medicare Advantage, even though the federal government also pays over $3 billion a year to Medicare Advantage insurers to cover the same people. Paying for the same care twice: what a waste.
As long as AFGE dominates the VA, the inefficiencies and corruption won’t be fixed. The union’s contract is filled with mind-numbing rules to prevent workers from being given a new task, changing shifts or being disciplined for shoddy work. The place is run for workers, not patients. Shockingly, many VA facilities don’t give vets a reminder call a day or two before their appointments, a practice standard in civilian medical offices. The result is that no-show rates are as high as 45 percent, tragic when vets are waiting for an opening.
All the more reason to help waiting vets get civilian care. But be prepared for a battle with the VA’s self-serving unions and their ally, the Democratic Party.
Betsy McCaughey is a former lieutenant governor of New York and the author of “Beating Obamacare.”