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June 6, 2014 | Posted By Bruce D. White, DO, JD

The ongoing VA scandal is indeed unfortunate and sad. In a speech on May 30, 2014, in Washington, DC, Eric K. Shinseki apologized for the “systemic, totally unacceptable lack of integrity” shown by some administrators in managing the Veterans Administration health care system hospitals and clinics. Within hours of the apology, Secretary Shinseki resigned.

It is clear that the trouble within the VA has been brewing for some time. The fuse that set off this latest explosion may have been whistleblower claims that managers at the Phoenix VA Medical Center were keeping two sets of books which logged wait times for veterans seeking primary care appointments. There are allegations that some of the delays resulted in veteran deaths. Acting VA Inspector General Richard J. Griffin issued a preliminary report confirming that Phoenix VA administrators had manipulated wait times possibly to assure more favorable annual performance reviews and higher bonuses and compensation for staff.  The unethical behavior by those entrusted with the care of our veterans is inexcusable.

So, the question again: Does America really need a separate VA Health System to properly care for veterans? It may be a far-fetched idea, particularly since we’ve had a stand-alone health system for veterans in America since World War I. To some it may even sound unpatriotic and disrespectful. It’s not meant to be. But, it’s a very practical question given the America today as compared to the US of 75 years ago when the Veterans’ Bureau (as the VA was called then) was first established. After World War I, the federal government was not in the health care delivery business to any great degree.  The VA hospital system was created to provide care to veterans who otherwise would have gone without. Now, with Medicare, Medicaid, and the health insurance exchanges under the Affordable Care Act, health care is a major component of the federal government. Medicare and Medicaid programs alone account for about one-third of this year’s federal budget expenditures

Also, the question implies that veterans should be properly cared for. It is their due from a grateful nation. It is the right and fair thing to do for our country to care for those who have borne the battle. But can we properly care for them without having to have a freestanding VA health system? Why not mainstream veterans and provide for their health care in a manner similar to Medicare? In fact, why not allow them to enroll in Medicare rather than maintain a health care delivery model that is plagued with its own problems?  With one uniform administrative system under Medicare, the monies currently used to fund much of the present VA health system could be funneled into existing delivery channels.

Of course, for the recently returned veterans, more may be necessary to provide them with quality health care. In addition to allowing veterans to enroll in Medicare, the Congress could create centers of excellence for orthopedic and reconstructive surgeries and rehabilitation medicine, and for mental health treatments (particularly for post-traumatic stress syndrome), at academic medical centers around the country to complement the Medicare coverage for these special needs

Without question the Nation should properly care for its veterans, but with the present scandal perhaps we should rethink how we do it? Which by the way is a lesson from history: the very first director of the Veterans’ Bureau – Col. Charles R. Forbes – was relieved after two years on the job. He later was convicted on charges of conspiring to defraud the government on hospital contracts and was sentenced to a prison term. 

With what’s going on now, justice requires our immediate deliberate action to protect those who have protected the Nation.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

2 comments | Topics: Bioethics and the Law, Distributive Justice, Fraud

Comments

Howard Cain

Howard Cain wrote on 06/15/14 11:18 PM

I don't suppose anything we ever do will eliminate fraud and mismanagement. However, I agree that we may have an excellent chance to save quite a bit of money here and obtain a more just distribution of available resources.
With an annual budget well over $100b annually and scores of VA medical centers across the country along with multitudes of clinics fiscal responsibility requires this question be asked. The suggestion of integrating veterans' health care into the Medicare system is definitely one possibility. We should also realize that our current medical billing systems and personnel handle the peculiarities of Medicare, Medicaid, and myriad private insurance policies without requiring standalone hospitals and clinics to service the patients involved. These veterans could possibly be cared for by the general health care delivery system. This would not only save money by eliminating duplication of service, but also would give the government the opportunity to sell the assets involved like buildings and equipment. This could generate tremendous revenue. Our tertiary care centers are capable of treating the most serious injuries and conditions. I doubt that quality of care would suffer. There is, of course, the issue of lost jobs. However, health care professionals are in high demand. The ill and injured still need to be treated. They would only have to be treated in the general system as opposed to the VA system. All those jobs won't be lost.
It is uncertain whether either an integration of VA health care into Medicare or a VA benefit package handled by medical billing personnel would work, but I think it is irresponsible to ignore the possibility when we are faced with mounting public debt and budgetary shortfalls.
James Finnerty

James Finnerty wrote on 06/17/14 4:57 PM

When will the folks who govern this wonderful nation of ours come to accept the fact that we, like most of the rest of the world, need a system of UNIVERSAL HEALTH CARE for all?
James Finnerty, M.D., M.A.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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