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Fund and Fix is the Right Cure for VA

Published Thursday, June 12, 2014 12:10 am
Dennis_Maley_Image

As a veteran, I am appalled by the idea that those who have served our country and sacrificed themselves physically in doing so would have received anything less than adequate health care through the VA. As a recipient of that care, however, I can attest that I have never experienced anything but competent and professional treatment from skilled and dedicated employees and physicians. VA treatment is held to an incredibly high standard that is incomparable to the private sector. If it's not fulfilling its stated mission, then let's focus on making sure the resources are in place to do so and that investment and performance expectations are sensibly aligned.

It's easy to look at the headlines surrounding the VA scheduling scandal and infer a very negative image as to what goes on in VA health care centers. However, it's also important to put the data into perspective. The VA serves almost 9 million veterans every year, an important number to remember anytime you hear a statistic in the tens of thousands. They also serve a uniquely challenging demographic in terms of age and ailments and in doing so, have created standard of care metrics that are far higher than almost any you are going to find in the private sector – which, by and large, has many more dollars per patient and on average, employs much more expensive providers.

As more information comes to light, it is beginning to become clear that there have been many administrators and other employees who, unable to meet the agency's self-imposed mandates, engaged in dishonest practices to the detriment of those served. If in fact, parts of that massive health care system did not have the resources to meet those metrics, or the goals were unrealistic, failing to do so should have sent the signal that a closer look at goals, best practices and available resources were warranted. Hiding that failure and creating the impression that the current system of resources, practices and standards are effectively meeting the mission only allows the problem to get worse.

Fortunately, a whistle blower was able to bring systemic problems to light, though it is unfortunate that the problem had to fester for so long before that was the case. Part of the current goal should be to determine whether a climate exists in which bringing challenges and problems to the forefront is welcome. Anyone who has worked for a very large corporation knows that monolithic bureaucracies can stunt reform, and that is not a dynamic unique to the public sector.

In fact, much of what I am learning about the VA scheduling scandal reminds me of things I saw in my time as a banker for a very large corporation. People at the top would create metrics based wholly on data and objectives without regard for what actually happens on the ground. They would look at products that made the banks money, decide how much more money they'd like to make and then plot goals based on those increases with little to no input from the people who marketed the products.

Debit cards are highly profitable and “sticky” products that make it less likely someone will leave the bank, so don't open an account without a debit card. If 85 percent of your new accounts don't have debit cards, you're failing. Never mind the fact that for various reasons, many accounts wouldn't reasonably have a debit card issued for them. During the real estate collapse many banks still had unrealistic mortgage quotas, regardless of the fact that banks had a de facto moratorium on many of the products that might be used to achieve them. Remember, it's more important than ever to make good loans, but hit that quota or else.

Deposits were desperately needed to improve reserves, so bankers were instructed to try and get any and all monies, despite interest rates that barely produced a return. At the same time, that desire for sticky products kept the pressure on to open a checking account with every CD client, get them to dump some more in a money market account and how about a credit card while they're here – deepen that relationship young man.

There would usually be a carrot and stick approach – contests and bonuses for having the highest percentage of “relationships” and extra (unpaid) hours on nights and weekends “dialing for dollars” if you didn't. The result was always the same: lots of cheating, little accountability. Debit cards were ordered and then chopped up, checking accounts were opened with a few cents and illegally marketed as “required” for the promotional CD rate, etc.

Too often, the people committing the fraud were doing so to avoid the stick, not to get the carrot. They wanted to be free of evening call time in order to attend their daughter's recital, or not come in on the weekend for cold calls so that they wouldn't have to miss another one of their son's soccer games. The carrot, however, made it easy to vilify them, while insulating the million-dollar executives much further up the line, who were always shocked to learn that “a few bad apples” had let their greed get the better of them.

Did those at the very top know what was happening? It was hard to tell, though they seemed so disconnected from what actually occurred within their branches that it's hard to imagine any of it was more than statistics, data and dollars in their eyes. Part of me thinks that's a lot of what happened with the VA, and we should keep that in mind when crafting reforms.

If there is justice to be had, those who knowingly gamed the system to their own benefit will be punished, and we will spend as much time examining whether the VA, with its thousands of old and dilapidated facilities, along with its extremely challenged pool of patients, has the necessary resources to reach the admirable and lofty expectations that have been set, as we do looking for people to blame.

It's easy to politicize this problem. There are certainly many special interests who would benefit from telling this story as one of big-government failure, and use it as another opportunity to privatize the resources in a way that is sure to line pockets and fatten bottom lines. But I'll leave you with this; last year I was sent to Bay Pines Medical Center for a routine skin biopsy and received an appointment less than two weeks from the time my primary physician at the Bradenton clinic had referred me. I had an 8:20 appointment, for which I arrived only 10 minutes early. By 8:35, I had checked in, been seen, biopsied and was back in my car.

 

I can honestly say that was pretty typical of the VA care I've received, though I've never felt rushed out the door. Despite the quick efficiency I have enjoyed, I've always had physicians and nurses who took the time to explain procedures, answer questions, smile and thank me for my service. I can't say the same about any experience I have ever had in the world of for-profit medicine, where the care was never as effective, and I've usually felt like herded cattle being milked for my insurance company's dough.

Let's fix the problems in the VA and make sure it has the proper resources to care for all of our veterans to the highest standard possible. Let's make sure that mandates are realistic and a system is in place to communicate breakdowns in such levels of treatments and most importantly, let's not forget all of the great work that the thousands of dedicated and qualified professionals in that organization are already doing in providing care for this nation's veterans every day. Calls to privatize care, bring in state agencies and other radical fixes are dubious at best. This is one baby we don't want to throw out with the bath water.

 

Dennis Maley's column appears every Thursday and Sunday in The Bradenton Times. He can be reached at dennis.maley@thebradentontimes.com. Click here to visit his column archive. Click here to go to his bio page. You can also follow Dennis on Facebook.

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