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An Open Letter to Our Next President
on How to Fix Veteran’s Healthcare

by Paul David Pruitt

If there’s anything our government is good at its redundancy. The US Federal Government is the world’s largest provider of healthcare and they deliver these services though a massive and costly web of overlapping infrastructures. The Veterans Health Administration (VA) and the Department of Defense (DoD) both operate independent and often incompatible healthcare systems. Of these the VA is the most massive, operating over 100 hospitals in the US and her possessions. The largest is the James A. Haley Medical Center located in Tampa and the second largest is Bay Pines VA Medical Center in St. Petersburg. Simply maintaining the bricks and mortar of these hospitals is an astronomical expense to taxpayers. The 150 acres of intercoastal waterfront that Bay Pines sets on is one example of the pristine real estate dedicated to these facilities. The San Francisco VA sets on an even more valuable piece of property. http://www1.va.gov/directory/guide/facility.asp?ID=152

In the coming months we are going to see and influx of war veterans returning to this country unlike anything since World War II.  The current VA was built to accommodate the over four million G.I’s that started coming back from WWII in 1945. Well, times have changed. Today’s VA was built for a healthcare community that delivered its services on an inpatient basis. That has not been true for decades. Most care, including surgeries, is done in an outpatient setting. Private sector healthcare has bed space that is no where near capacity. Having the VA add to that bed surplus makes no financial sense, unless of course your costs are underwritten by the taxpayers. On top of this mountain of cash being burned daily, we read horror story after horror story about inadequate treatment for our veterans and active duty service members. VA medical centers are all too often monuments to inefficiency.

The Centers for Medicare/Medicaid (CMS) is a government healthcare service others can learn from. Here the government acts as insurer for our seniors and those who cannot otherwise afford healthcare. Veterans over 65 are Medicare beneficiaries the same as non-veterans. Administering programs is Washington’s strong suit, delivering them is not. The VA has recently created the Veteran’s Identification Card (VIC). It was designed to make it easier for veterans to use VA hospitals nationwide as opposed to only being treated where their medical records are maintained. This card contains valuable medical information that is assessable to any facility where the veteran seeks treatment. This could easily be converted to be used at private sector hospitals the same as a Medicare card. For many years now the VA has offered a program known as “fee basis”. Fee basis is primarily for veterans who live in a geographic are where it is not practical for them to go to a VA hospital for care. It is normally a distance issue but can also apply when the veteran has a condition that their closest VA does not have the resources to treat. Under fee basis, the veteran receives care from a local physician and the VA acts as the insurance company. Veterans who are aware of the program want to be on it. Vision for the future; armed with a VIC card, the veteran chooses his own local doctor who in turn bills the VA. Payment is based on the veteran’s level of service connected disability and determines the amount of co-pay, if any. When the veteran is able to choose his doctor and be referred to private hospitals that are convenient to his home, free standing VA hospitals are no longer needed. Billons of tax dollars would be saved and that money could then be spent on healthcare instead of keeping the lights turned on in outdated buildings. The Joint Commission, an independent organization that oversees health care facilities accreditation, speaks of “one level of care”. Multiple systems make one level of care very difficult. Giving our veterans a choice of doctors in their communities would go a long way toward one level of care and a better level of care.  Our veterans service organizations such as the VFW, DVA and American Legion do a magnificent job of advocating for our veterans would most likely oppose shutting down any VA facility. I would ask them one question, given the opportunity, would you not jump on the chance to be placed on fee basis?  If it’s good enough for you, why not all your fellow veterans?

The DoD maintains separate healthcare services for the Army, Navy and Air Force. The Marines as a Corps of the Navy receive their care at Naval facilities.  Some times two services have hospitals within the same zip code, with both going underutilized. Combining these competing delivery systems into a single entity is not a new idea. It has been purposed many times, only to be shot down by petty infighting and territorialism amongst the uniformed services. You and I pay for their vanity. A strong Commander in Chief can make this must needed change by forming an independent medical corps from existing resources all under the command of a military Surgeon General. We must have a uniformed medical corps as civilian healthcare workers are not going to be placed in a war zone.  By incorporating the best practices of each service, the Mobile Army Surgeon’s Hospitals (M*A*S*H Units, that’s right, it’s not just a 1980’s sitcom), Naval hospital ships (floating state of the art medical centers that are deployable world wide), and the Air Force Aeromedical Evacuation System, (these flying trama centers can have a wounded solider back stateside in a matter of hours), commanders would have seamless medical support for their troops. The backbone of military medical services is the field medic. These brave men and women are deployed with combat units and provide emergency medical service in the battle zone. Their role is to stabilize for transport or return to duty.  The military should maintain hospitals in strategic locations around the globe, but military medical services here in the USA are unnecessary.

Fortunately all active duty service members have TRICARE health insurance to use for civilian healthcare. TRICARE insurance is free of charge to all active duty military and their dependents. Military retirees and their families are also TRICARE eligible. For an annual fee, retirees enjoy the same benefits as active duty. DoD is moving toward closing all stateside medical facilities, but they are doing so in stealth mode to avoid the outcry of the surrounding retiree community. Military hospitals do not charge co-pay for either active duty or retirees. TRICARE pays 80% for outpatient services and 100% for inpatient hospitalization. By cutting the overhead of maintaining base hospitals, the military would be able to fund TRICARE to pay 100% across the board. No active duty service member should have to pay for healthcare, we owe them that.

Anytime the government looks to end a program it raise concerns about displacing government employees. This is a legitimate concern, but realistically doesn’t apply here. Physicians are normally already on staff at multiple hospitals, both public and private. The nursing shortage in this country is at critical mass. Nurses and nurse’s aides returning to private hospitals would be a boon to our national healthcare system. Medical technologist, administrators and billing and coding specialist all mainly use government hospitals as a training ground before moving on to more lucrative positions in the private sector.

Every four years voters get beaten about the head and shoulders with the “change” mantra. And then the only thing that changes is the face.  We’re long over due some real, positive change.  Change that both saves billions of tax dollars and gives those who have served in our military affordable access to the same quality healthcare we expect for ourselves and our loved ones. Let me recant that, we’re not giving them anything. They have earned it. They paid for it with their blood in the sand.



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