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Author Topic: How efficient is the VA really?  (Read 1079 times)

MTK20

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How efficient is the VA really?
« on: November 12, 2016, 09:06:46 PM »
Hey gang, I've got a question about something that I need to be educated on. While I'm normally quite skilled in debate, I encountered something from one of my professors today that I wasn't prepared for.

So seeing as I am trying to present their argument, I will try my absolute best to present it as they did in class today. After all, I want to do it justice.

It was about healthcare and the "evils" of privitisation.

They were saying that the VA hospital is one of the most efficient hospitals ever known. That 95% of funding goes directly to patient care, while only 5% goes to administration funding. This is in stark contrast to most every other hospital where typically 20-30% of funding goes to administration and the remaining goes towards the patient. They continued to say that America has a bad habit of when we have a war happen, everyone talks about cutting money for the war effort and the number one place we go to is to cut funding from the VA. They said that the reason this happens is because the VA is so efficient in taking care of our vets that it is one of the few places that can still manage to stay afloat after such funding cuts. They said that it is preposterous that we have a war to fight, so we cut funding from the one place expected to care for our vets and that we have no forethought to if they will need medical or psychological care when they come back. My professor said that we have continued this political line of thought as recently as 2003 when we did the last big funding cut from our VA.

Then my professor went on to criticise legislation. I am not sure which senate bill, but they said there is a misleading bill named the "care for our vets" bill or something that wishes to cut funding from our VA hospitals under the ruse of helping the vets, and will only seek to line the pockets of the 1% of private practice offices and private physicians.

In summary they were saying that private healthcare providers would not reduce wait times, cost, nor improve the care that our veterans get and that to think so was faulty ideology.

The bill they referenced might have been this one, but I am not sure:

http://www.mccain.senate.gov/public/index.cfm/2016/4/senators-mccain-ayotte-cornyn-cruz-ernst-flake-graham-tillis-introduce-the-care-veterans-deserve-act

Give me your opinion on this matter.

Although I ask one thing of you:

Ground rules for this thread:

I want to know if you are a veteran or if you work in healthcare (especially if you have ever worked in a VA hospital), in addition to your opinion on the VA. I want to know how you are tied to the VA. While I am not a veteran, I have friends and family who work in VA hospitals and so I will most likely get their input on this as well.


Thanks for your input, guys! And for those of you who have served and who work in healthcare, I appreciate you!  :cool
Texas
Do we forget that cops were primarily still using 6 Shot Revolvers well through the mid 80's? It wasn't until after 1986 that most departments then relented and went to autos.
Capacity wasn't really an issue then... and honestly really it's not even an issue now.
Ray Chapman, used to say that the 125-grain Magnum load’s almost magical stopping power was the only reason to load .357 instead of .38 Special +P ammunition into a fighting revolver chambered for the Magnum round. I agree. - Massad Ayoob

Paradoxically it is those who strive for self-reliance, who remain vigilant and ready to help others.

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    JesseL

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    Re: How efficient is the VA really?
    « Reply #1 on: November 12, 2016, 09:14:07 PM »
    You might want to send a message to ping louis the lumberjack about this thread.
    Arizona

    MTK20

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    Re: How efficient is the VA really?
    « Reply #2 on: November 12, 2016, 09:17:46 PM »
    You might want to send a message to ping louis the lumberjack about this thread.

    Sent him a quick PM.
    Texas
    Do we forget that cops were primarily still using 6 Shot Revolvers well through the mid 80's? It wasn't until after 1986 that most departments then relented and went to autos.
    Capacity wasn't really an issue then... and honestly really it's not even an issue now.
    Ray Chapman, used to say that the 125-grain Magnum load’s almost magical stopping power was the only reason to load .357 instead of .38 Special +P ammunition into a fighting revolver chambered for the Magnum round. I agree. - Massad Ayoob

    Paradoxically it is those who strive for self-reliance, who remain vigilant and ready to help others.

    Bud

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    Re: How efficient is the VA really?
    « Reply #3 on: November 12, 2016, 11:42:12 PM »
    I retired from the US Department of Veterans Affairs, Veterans Benefit Administration (VBA)as a GS12 Veterans Rating Specialist in 2007. A rating specialist is the person who actually makes a decision on a veteran's claim for benefits be it service connected compensation or veteran's pension.There are three components to the VA; the Veterans Benefit Administration which decides the award or denial of any and all benefits. the Veterans Health Administration which is the hospitals, out-patient treatment centers, etc and the National Cemetery Administration which administers all US National Cemeteries with exception of Arlington National Cemetery which is administered by the US Army.

    I am also a 100% service connected disabled Army retiree. I was medically retired from the US Army on May 30, 1999 and I was rated at 100% service connected by the VA with an effective date of May 31, 1999.

    I should state that I "retired" from the VA in total disgust with the VBA in March, 2007 after working there for eight years. I retired because before I left, I paid the equivalent of 16 years of my total active duty military time into the Federal retirement system (FERS)  a bit just over $10K. I could do that because Federal law prevented my from receiving my Army pension because I was receiving VA service connected compensation, the so called dual compensation law.

    I also use the VA health system as a patient but only to the extent that I receive my medications from them and I allow them to conduct non-invasive lab tests which I provide to private care health practitioners. I have absolutely ZERO respect for the VA healthcare system and will not ever allow them to perform any type of procedure on me.

    Anybody that says the VA healthcare system could provide better service to veterans is a non informed statist who has absolutely no idea he(or she) is talking about.

    As a rating specialist, I rated dozens of claims by veterans of mistreatment and malpractice by VA healthcare "professionals".

    To demonstrate to whoever gave you this information, ask them in which State all VA healthcare professional are required to be professionally licensed in. Odds are, they won't know because it is a little known fact that VA Healthcare professionals are not required to be licensed in any State because they are working in a Federal healthcare facility. VA healthcare professionals do not have to carry malpractice because under Federal tort law, they cannot be sued. You can sue the VA but not the individual.

    Most VA patients are already treated by private practice MDs. By that i mean, every VA hospital is co-located with a private medical school and all of the physicians caring for vets in the hospitals are students. They are interns or residents but they are students still attending school.

    I am and have been very ill every since i got out the Army.But with the exception of meds, I pay 100% of my medical from my private med insurance or out of my pocket. That's because I want to go living for as long as possible and the VA could care less whether I do or not.

    So as the most senior of all the veterans claims examiners (A rating specialist is the top of the heap) and as a seriously ill and injured patient I can state categorically no omne should be forced to accept VA healthcare.
    MissouriBud
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    MTK20

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    Re: How efficient is the VA really?
    « Reply #4 on: November 13, 2016, 12:08:55 AM »
    I retired from the US Department of Veterans Affairs, Veterans Benefit Administration (VBA)as a GS12 Veterans Rating Specialist in 2007. A rating specialist is the person who actually makes a decision on a veteran's claim for benefits be it service connected compensation or veteran's pension.There are three components to the VA; the Veterans Benefit Administration which decides the award or denial of any and all benefits. the Veterans Health Administration which is the hospitals, out-patient treatment centers, etc and the National Cemetery Administration which administers all US National Cemeteries with exception of Arlington National Cemetery which is administered by the US Army.

    I am also a 100% service connected disabled Army retiree. I was medically retired from the US Army on May 30, 1999 and I was rated at 100% service connected by the VA with an effective date of May 31, 1999.

    I should state that I "retired" from the VA in total disgust with the VBA in March, 2007 after working there for eight years. I retired because before I left, I paid the equivalent of 16 years of my total active duty military time into the Federal retirement system (FERS)  a bit just over $10K. I could do that because Federal law prevented my from receiving my Army pension because I was receiving VA service connected compensation, the so called dual compensation law.

    I also use the VA health system as a patient but only to the extent that I receive my medications from them and I allow them to conduct non-invasive lab tests which I provide to private care health practitioners. I have absolutely ZERO respect for the VA healthcare system and will not ever allow them to perform any type of procedure on me.

    Anybody that says the VA healthcare system could provide better service to veterans is a non informed statist who has absolutely no idea he(or she) is talking about.

    As a rating specialist, I rated dozens of claims by veterans of mistreatment and malpractice by VA healthcare "professionals".

    To demonstrate to whoever gave you this information, ask them in which State all VA healthcare professional are required to be professionally licensed in. Odds are, they won't know because it is a little known fact that VA Healthcare professionals are not required to be licensed in any State because they are working in a Federal healthcare facility. VA healthcare professionals do not have to carry malpractice because under Federal tort law, they cannot be sued. You can sue the VA but not the individual.

    Most VA patients are already treated by private practice MDs. By that i mean, every VA hospital is co-located with a private medical school and all of the physicians caring for vets in the hospitals are students. They are interns or residents but they are students still attending school.

    I am and have been very ill every since i got out the Army.But with the exception of meds, I pay 100% of my medical from my private med insurance or out of my pocket. That's because I want to go living for as long as possible and the VA could care less whether I do or not.

    So as the most senior of all the veterans claims examiners (A rating specialist is the top of the heap) and as a seriously ill and injured patient I can state categorically no omne should be forced to accept VA healthcare.

    Thank you very much for sharing your story Bud! I can tell that you have had years of experience with the VA and its workings from both sides.

    Without me trying to show my hand too much, I felt that you hit the nail on the head when you stated "a non informed statist who has absolutely no idea he(or she) is talking about". This professor in question is extremely intelligent, a Doctor (not medical though, I believe they are a doctor in psychology) with many published works. That being said, I haven't had to talk with them for very long to realise that the answer to every question (given their world view) is that the more government intervention, the better. During the original story/rant today, they were saying that the VA is superior to private practice because in the private sector it is all about "business and making profit", when with the Government there is not profit to be gained  :facepalm.

    That's kind of the beautiful thing about capitalism though. If you are a s___ Doctor, then no one goes to you, and you don't get payed. In order for you to make that evil thing called "profit" you have to be high in demand, and for that to happen you have to be pretty good at what you do.

    I never knew that VA employees had certain immunity from being sued and that they didn't even have to hold a license  :shocked.
    Texas
    Do we forget that cops were primarily still using 6 Shot Revolvers well through the mid 80's? It wasn't until after 1986 that most departments then relented and went to autos.
    Capacity wasn't really an issue then... and honestly really it's not even an issue now.
    Ray Chapman, used to say that the 125-grain Magnum load’s almost magical stopping power was the only reason to load .357 instead of .38 Special +P ammunition into a fighting revolver chambered for the Magnum round. I agree. - Massad Ayoob

    Paradoxically it is those who strive for self-reliance, who remain vigilant and ready to help others.

    ksuguy

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    Re: How efficient is the VA really?
    « Reply #5 on: November 13, 2016, 01:05:05 AM »
    Every vet I've ever met only goes there as a last resort if they have no other options.   
    Kansas

    louie the lumberjack

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    Re: How efficient is the VA really?
    « Reply #6 on: November 16, 2016, 10:30:32 PM »
    Sorry, I spent the long weekend in Mexico and I haven't had much time to screw around online.  I'm going to take this piece by piece.  My role at the Phoenix VA officially is in healthcare compliance (GS-11), however I am currently detailed to another position in NonVA Care (GS-12).  Both roles are administrative in nature.

    They were saying that the VA hospital is one of the most efficient hospitals ever known. That 95% of funding goes directly to patient care, while only 5% goes to administration funding.

    What? First off, this argument requires definitions. Define efficiency, administration, patient care and which VAMC?  There are only around 140 of them and no two are exactly alike.  All serve a population of varying size, demographic, region and complexity.  Once we get a baseline on this, we can really talk, but for now lets assume he is going by layman's definitions.  I am not a clinician and neither are the 47 people that work for me so it might be safe to say that 100% of our time is administrative.  My current role however is to oversee the processing of authorizations for patient care from local private providers.  My supervisor on the other hand, is a board certified, primary care physician.  He is supposed to have a small panel of patients that theoretically take up half his time.  He has seen exactly zero patients in the past year.  His time is split between helping me run my section, as I often require a doctor to talk to another doctor to get things done, and authorizing urgent consults.  Essentially, he goes to meetings, reads and signs consults for 12 hours a day, but paid for 8.  This is why I immediately object to the 95% number.  While my role and my boss' are objectively administrative, both directly affect patient care.  Similarly, most VA doctors spend several hours a day documenting their clinical interactions.  In the private sector this is also done but it is used to drive billing. This is non-clinical work but without it patient care can be affected.  Unless he has some sort of citation to these numbers, I call bulls___.  There is never black or white in government, only gray.

    This is in stark contrast to most every other hospital where typically 20-30% of funding goes to administration and the remaining goes towards the patient.

    True.  There are numerous studies that suggest part of the reason Americans pay more for healthcare is the administrative structure thats in place in private hospitals.  This administration however, is mostly due to regulatory compliance, coding, billing--in essence legally getting paid for services rendered.  In a European-style system there is exactly one source of funding, the state.  With exactly one process, as defined by the state, to get paid; therefore fewer administrative professionals are required to specialize in this process.  Here in America there are dozens of government and private payers, each with its own process and its own documentation requirements.  Thanks to HIPPA, they at least all use the same forms.

    The administrative burden to adapt to multiple payers is reflected in the overall cost of doing business.  This is similar to an airline's cost for fuel being baked in to the cost of your ticket.  If the ticket doesn't have enough value to justify the cost you will find another airline, or just drive.  The airline will either adapt, or go under.  Southwest, Jet Blue, FEDEX and the US Air Force all pay the same for fuel, and all can transport passengers in varying degrees of comfort.

    The VA by the way, also bills private insurers for copays for non-service connected care but most VA hospitals aren't very good at it.

    They continued to say that America has a bad habit of when we have a war happen, everyone talks about cutting money for the war effort and the number one place we go to is to cut funding from the VA.

    I think your professor may be conflating the VA with DOD, but I'll assume he knows the difference.  I'd point out the VA has congressional liaisons whose job it is to provide estimates on the potential costs for our foreign policy adventures.  Potential VA costs have also been used as consideration for several DOD programs, many of which are public health related (smoking cessation programs for example).  I would argue that Congress at least recently has been smart enough to see the causal link between the two departments.

    They said that the reason this happens is because the VA is so efficient in taking care of our vets that it is one of the few places that can still manage to stay afloat after such funding cuts.

    Congress also provides us the criteria which we can pick and choose our patients based on service connection.  I will defer to Bud to elaborate on that.  I would argue that this "fiscal solvency" in the past has been the result in political decision making.  For example, the VA by law will provide care for any WW1 Veteran, any alive that is, for any condition at no cost to them or their families.  That has been on the books for nearly a century.  Contrast this with the decades it took to recognize Agent Orange exposure or Camp Lejune, etc.

    A year of chemotherapy for many of these Veterans costs an average of six figures in a VAMC.  Double that number if I have to authorize it under the Choice act.  Imagine how much we would have saved if Congress recognized it back in the 80s and we were able to treat these guys sooner.

    Plus, the VA is not affected by EMTALA, something no private health system can avoid.

    They said that it is preposterous that we have a war to fight, so we cut funding from the one place expected to care for our vets and that we have no forethought to if they will need medical or psychological care when they come back.

    Damn straight. That is preposterous.

    My professor said that we have continued this political line of thought as recently as 2003 when we did the last big funding cut from our VA.

    Any chance this guy ever heard of the Veteran's Choice Act?  https://veterans.house.gov/the-veterans-access-choice-and-accountability-act-of-2014-highlights
    Or is he aware that OIF/OEF are eligible for care for five years past their date of separation regardless of Service Connection?
    http://www.oefoif.va.gov/healthcare.asp
    We're throwing plenty of money at VA, we're aren't any good at spending it.

    Oh, and as recently as 2003? Over a decade and seven elections ago? I love people like this.  They always pick the sweetest cherries.

    Then my professor went on to criticise legislation. I am not sure which senate bill, but they said there is a misleading bill named the "care for our vets" bill or something that wishes to cut funding from our VA hospitals under the ruse of helping the vets, and will only seek to line the pockets of the 1% of private practice offices and private physicians.
    In summary they were saying that private healthcare providers would not reduce wait times, cost, nor improve the care that our veterans get and that to think so was faulty ideology
    .

    Wait times?  This assumes evidence not in existence.  No, seriously.  The only reason the VA measures such things is because we have to.  Private hospitals typically don't.  Why?  Paying for the cost of operations requires treating patients.  If they can't get patients into beds, they go under--kind of like when airlines have no passengers.

    The cost of healthcare by the way, is driven independently of the VA, private hospitals and those evil monocle wearing capitalists at insurance companies.  It is driven primarily by CMS and the AMA in the form of Medicare Reimbursement rates (price floor).  Surely, a college professor would understand how that works and wouldn't need it explained.

    The bill they referenced might have been this one, but I am not sure:

    http://www.mccain.senate.gov/public/index.cfm/2016/4/senators-mccain-ayotte-cornyn-cruz-ernst-flake-graham-tillis-introduce-the-care-veterans-deserve-act

    Pass it first. Then we'll talk.

    louie the lumberjack

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    MTK20

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    Re: How efficient is the VA really?
    « Reply #7 on: November 16, 2016, 10:42:13 PM »
     :thumbup2

    Thanks Louie!

    If I knew I wouldn't get academically and professionally destroyed for merely having the "wrong opinion", I would love to show this to my professor.

    Too bad that there are grave consequences for students who think differently. One would think that differing ideas and opinions would be welcome in a place of higher learning.
    Texas
    Do we forget that cops were primarily still using 6 Shot Revolvers well through the mid 80's? It wasn't until after 1986 that most departments then relented and went to autos.
    Capacity wasn't really an issue then... and honestly really it's not even an issue now.
    Ray Chapman, used to say that the 125-grain Magnum load’s almost magical stopping power was the only reason to load .357 instead of .38 Special +P ammunition into a fighting revolver chambered for the Magnum round. I agree. - Massad Ayoob

    Paradoxically it is those who strive for self-reliance, who remain vigilant and ready to help others.

    Chief45

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    Re: How efficient is the VA really?
    « Reply #8 on: November 17, 2016, 08:44:02 AM »
    fascinating discussion.  Thanks guys.   :thumbup1
    KansasUN-Retired LEO.

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    Re: How efficient is the VA really?
    « Reply #9 on: November 19, 2016, 01:23:40 AM »
    Agreed.  It shows how much of a political football this whole thing has become.  If there is one group that should never, ever be subjected to such treatment it is our veterans.  Get them the medical attention they were promised, pay the bill and stand ready to repeat as necessary. Period.  :scrutiny
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    Re: How efficient is the VA really?
    « Reply #10 on: November 19, 2016, 06:21:56 PM »
    The nearest VA hospital is pretty good.  They got my dad hooked up with hearing aids (he was a cannon-cocker in Korea, during their late North-South Unpleasantness) and a 30% disability pension.  And they've taken good care of my son-in-law, who was medically discharged from the Navy on 100% disability.

    That said, I'd go to my veterinarian before I'd go there with anything more serious than a hangnail.  But I feel that way about most of the private doctors in this area, too.
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    Re: How efficient is the VA really?
    « Reply #11 on: November 19, 2016, 09:31:26 PM »


    That said, I'd go to my veterinarian before I'd go there with anything more serious than a hangnail.  But I feel that way about most of the private doctors in this area, too.


    This. 

    I'm fortunate enough to have a decent HSA plan from work, that I never thought twice about dumping Tricare.  I won't go anywhere near the VA unless something really awful happens to my finances.
    USMC 0621 vet.  Yeoman farmer.  All around hillbilly.

    MTK20

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    Re: How efficient is the VA really?
    « Reply #12 on: December 12, 2016, 04:47:17 PM »
    SB 841

    Was the name of that Bill, btw.

    I just found out today.
    Texas
    Do we forget that cops were primarily still using 6 Shot Revolvers well through the mid 80's? It wasn't until after 1986 that most departments then relented and went to autos.
    Capacity wasn't really an issue then... and honestly really it's not even an issue now.
    Ray Chapman, used to say that the 125-grain Magnum load’s almost magical stopping power was the only reason to load .357 instead of .38 Special +P ammunition into a fighting revolver chambered for the Magnum round. I agree. - Massad Ayoob

    Paradoxically it is those who strive for self-reliance, who remain vigilant and ready to help others.

    sqlbullet

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    Re: How efficient is the VA really?
    « Reply #13 on: December 12, 2016, 07:03:31 PM »
    Not a vet, no exposure to VA hospitals.  Relatives who qualified never went there.  I didn't ask why and they are dead now.  On to my real comment.

    I get so tired of people saying healthcare today shows that capitalism doesn't work.  Health care in the US has not been capitalism for nearly a hundred years.  And it is pretty simple.

    I the basic free market, the consumer trades money to a business or individual for goods or services.  I go the grocery store and I pick out the goods I want, and give them money and leave.  There is a provider and a consumer.  The consumer is defined as the person that uses AND PAYS for the good our service.

    Compare that to the typical American's health care experience.  I go to the doctor.  I receive a service.  But I don't pay the doctor.  My insurance pays the doctor.  And because they pay him, they also have a relatively large say in picking the doctor.  I am not a capitalist consumer of healthcare in the US.  I am the recipient of healthcare, with little or no control on my destiny.

    What is worse is I am also not the consumer of insurance.  My employer picks my insurer and they pay them on my behalf.  I tolerate this because there is a huge tax incentive for this arrangement.  But if I am dissatisfied with the insurance provider I have little to no realistic ability to choose something different.

    Medicine in the US is fully socialized.  All of my choices have been taken from me and are decided based on the demographics of my social group, as determined by my profession and employer.  However, the social system is not controlled by the government.

    If we want to fix healthcare we need to make a couple of changes.

    First, I can have my insurance premium paid to a health insurance concern of my choice, pre tax.  My employer easily and gladly divides my paycheck up among several different bank accounts; checking, savings, HSA.  Surely one more account will be no problem.

    Next, employers cannot form the foundation of a "group" healthcare plan.  I don't need a group plan for my car insurance, or my home insurance. No reason I need one for my healthcare insurance.

    Finally, I have to review and apply for insurance companies to remit payments to healthcare providers myself.  For small items I may make payment and then seek reimbursement.  Larger items I may choose to have the insurance remit directly.  The key part is that the consumer needs to get the bill and own getting it to the insurance company. 

    These seem pretty common sense to me.
    Utah

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    Re: How efficient is the VA really?
    « Reply #14 on: December 12, 2016, 07:20:04 PM »
    I would modify your proposal by eliminating the state rules that limit the healthcare "insurance" companies to those approved by an elitist state board with an agenda.  Let every company that does business in the USA compete in each state.  Enforce the Interstate Commerce Clause to actually do what it was intended to do, which is keep states from erecting barriers to businesses from other states.


    I will say, since we have gone to a high deductible plan, I now get to see how much we are actually charged vs. the services we get, and I just wish we got that up front to inform our healthcare decisions, rather than after the bill is presented.
    Arizona

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    Re: How efficient is the VA really?
    « Reply #15 on: December 12, 2016, 08:25:29 PM »
    Efficiency is in the eye of the beholder.  When I got out of the Army in '92, I enrolled at Carl T. Hayden VA Hospital in Phoenix.  The service was mediocre at best.  When I moved north, to Yavapai County, I transferred to NAVAHCS (Bob Stump).  To give an example, at Hayden, it took me 10 yrs. to get them to do an MRI on my knees.  When I started having problems with my neck last year I had x-rays scheduled that day, and when I started having problems picking up a cup of coffee, because my hands started going numb, I had an appointment scheduled within a week with a neurologist.  Just last Friday, I got a notification from UPS (there's an app) that a delivery was scheduled for today from the pharmacy.  My reaction?  "WTF? I didn't order anything!"  Coincidentally, I had my six month follow up today.  My Primary Care Provider was getting ahead of the game because of the upcoming holidays, and sent out my pain meds. 

    Either I lucked out with my care team, or there's a vast chasm that exists between the different facilities.  Not just on a national level, but on the state level as well.
    ArizonaStupidity cannot be cured with money, or through education or by legislation.  Stupidity is not a sin, the victim can't help being stupid.  But stupidity is the only universal capital crime; the sentence is death, there is no appeal, and execution is carried out automatically and without pity.  RAH

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    Re: How efficient is the VA really?
    « Reply #16 on: December 13, 2016, 05:11:09 AM »


    I would modify your proposal by eliminating the state rules that limit the healthcare "insurance" companies to those approved by an elitist state board with an agenda.  Let every company that does business in the USA compete in each state.  Enforce the Interstate Commerce Clause to actually do what it was intended to do, which is keep states from erecting barriers to businesses from other states.

    I will say, since we have gone to a high deductible plan, I now get to see how much we are actually charged vs. the services we get, and I just wish we got that up front to inform our healthcare decisions, rather than after the bill is presented.

    Eliminate any CON laws--do we limit the number of garages or fast food outlets based on the number already existing?
    Require upfront fee schedules and estimates from providers---allow consumers to shop around, like they do for everything else


    https://market-ticker.org/akcs-www?post=212359 ideas to lower health costs overall













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