[quote=@The Harbinger of Ferocity]

I will pose a contrary question then. Can you name one positive statistic overall from the Department of Veteran's Affairs' medical coverage, other than the fact it at all exists? I mean something consistent and measurable that does [i]not[/i] fall into this story of loathing? I have [i]never[/i], not once in my life, met a veteran or service member who did not encounter tremendous difficulty - notably waiting times and quality of care - with the Department of Veteran's Affairs. I have instead heard many stories of them living purposefully outside of coverage by the hospital so they are [i]forced[/i] to get referrals to practitioners who are private sector in order to get better care.

[/quote]

I've never had anything to do with the VA. I'm willing to take your word for it that the system dosen't work as currently constituted.



Ok just got home and haven’t had a chance to do any research but I’m going to go ahead and assume that everything you have told me and everything I’ve heard in the media is true. Also the goal of this is to fix the VA rather than provide true universal healthcare for non veterans. For the sake of simplicity im going to use veterans as a catchall rather than continually differentiating for dependents, tri care, ect.
 




Step 1: Hire me at a cost of 0.1 F35s a year.

Step 2: Transmute VA benefits/Tricare into the equivalent of full coverage private insurance at 100% reimbursement and no co pay. Reimburse this in the same way as private insurance rather than the medicare model, I understand why medicare works the way it does, but it is going to be counterproductive in this particular interest. In the short term this will lead to over-billing but the primary goal is to make veterans a preferred class of patient. In addition to traditional reimbursement attach a bonus to all care provided to veterans. It need not necessarily be a huge bonus in absolute terms.

Step 3: Remove all restrictions on where VA insurance can be used and give the patient absolute freedom to seek care where it makes sense for them to do so. America has a strength in the private healthcare sector and that should be leveraged. There is no reason that ancillary services such as blood work, imaging ect need to be done at va facilities and many therapies and procedures will make more sense to administer through existing private or state facilities rather than at dedicated VA sites. Private/State providers and facilities would collect the aforementioned bonus. If a veteran had the work done at a VA facility it could be returned to them, perhaps via a tax credit. This means it is in the veterans interest to use the VA when it makes sense and it encourages private providers to take on veterans.

Step 4: Establish additional federal incentives (again perhaps tax incentives) to take part in voluntary Federal programs for providers who service large (in relative terms) numbers of VA insured patients. This would also require additional federal oversight to ensure the absence of fraud and the quality of service and patient outcomes.

Step 5: Gut the existing VA establishment. As I understand it the President has given authority to terminate senior VA officials with cause. This should be expanded and they should go through with a hatchet and clean out the incompetent. Those who did stuff like falsify wait times and neglect patients should be punished to the full extent of the law. There is no excuse for the sorts criminal negligence I have heard reported. I’m not assigning guilt but sunlight is the best disinfectant and examples need to be made where deliberate neglect or malpractice exists.

Step 6: Restructure actual VA facilities to be more closely focused on the types of procedures which existing providers are ill equipped to handle but are needed by VA patients in disproportionate volume. Physical therapy for battle injuries, PTSD treatment ect ect.  Existing facilities should function better once the private and state system takes of some of the burden.

Step 7: Replace federal employees with contractors and enforce oversight. As I understand it it is way easier to remove a contractor than a traditional federal employee. Set clear and achievable goals for categories such as patient care standards/weight times ect.

Step 8: Give broad policy direction responsibility to regional and/or facility directors to address the specific demands of given regions. Obviously coordinating care in Alaska presents different challenges to doing so in the Boston Metro and doctors and administrators should have the freedom to address them. They would also be operating within clear metrics and subject to review and eventual removal if they aren’t able to deliver. 

Step 9: Plan for the future. Build new hospitals. Improve scholarships for veterans and perhaps others who are willing to commit to long return of service obligations for the VA. Set up a reviewing body with the explicit goal of ensuring that admin costs are held in check and that resources are focused on patient/caregiver interaction, rather than pushing paper.

In overall terms this will shift current VA patients into the private system. That will make private medical providers happy and shouldn’t threaten the medical insurance lobby as it dosen’t take money directly from their pockets (not yet anyway). It will hopefully clear the current glut of patients and allow the current facilities to function well enough to allow restructuring. It should be palatable enough to the states as it would be proposed by a Republican administration and there is a wellspring of political capital to be gained in both aiding veterans and in addressing the VA scandal that can be pinned on the previous administration. There is a question as to whether putting so many veterans into the public system will stress capacity. I don’t personally believe so but that isn’t exactly my area of expertise.