Dear Secretary General Shinseki [doesn't that title have a nice ring to it?],
Deputy Secretaries Tammy Duckworth and Scott Gould:
Here is a bottom-up look at the Veterans Administration. I'm a routine patient with no unusual medical problems. I love and respect my VA doctors, nurses, technicians and clerks - most of the time. I had 10 years of care as a Chicago-based patient, and for the last 10 years, as a "rural-based" patient.
This is not a litany of all that is wrong at VA. That would be a series too daunting for even jimstaro, testvet, or any of the other diary writers who focus on veteran’s issues – there is simply too much that is wrong. Instead, I am going to provide some basic background information about the VA that regular readers of Daily Kos might not know, and relate my personal experience about just one average appointment at the Veterans Administration.
BACKGROUND & HISTORY:
Harry Truman did it right. So can Barack Obama. Back in 1945 Harry decided that the Veterans Administration needed to be totally made over. World War II veterans were about to sink the existing organization with demands for health care.
On August 15, 1945, President Harry Truman appointed General Omar Bradley to direct the Veterans Administration (VA). Almost immediately Bradley set out to modernize and restructure the organization. Under his leadership VA hospitals were built where they could provide the most benefit to the most veterans, rather than where politicians wanted them located. Medical care at those hospitals was greatly improved as well. Bradley revised and extended the educational benefits of the G.I. Bill, arranged for jobs and job training programs for veterans, established a program of loans for veterans, and administered a massive growth in veterans insurance and disability pensions. He remained at the helm of the VA until December 1947.
all graphics by OPOL
General Bradley created an all-new Veterans Administration in two years BC [Before Computers] 65 years ago. General Eric Shenseki, the new Secretary of Veterans Affairs, is facing many of the same problems Bradley faced and I'm going to show you only part of those problems - the Veterans Healthcare Administration.
The Amazing Size of the VA Healthcare System
Patients Unlimited
According to the Department of Veterans Affairs, there are about 23,800,000 living Veterans. That is close to the population of Texas. In addition, there are about 37,000,000 spouses and dependent children of those Veterans all of whom, by a contract [Enlistment Papers] and law, have the right to get care from the VA. Add them up and you are looking at close to 20% of the total population of the United States. Of those, in 2008, according to the VA, 5,500,000 showed up at VA hospitals and clinics for a staggering 60,000,000 appointments. Last year VA inpatient facilities treated 773,600 patients.
Facilities To Handle the Hoard
The VA Health Administration has 153 hospitals, over 735 community-based outpatient clinics, 232 readjustment counseling centers (Vet Centers) and 47 domiciliaries (dormitories for single veterans most of whom are getting outpatient care from a VA hospital located on the grounds) and 135 nursing homes. Including everyone from nurses aids up to the director of the VA Health Administration there are 247,113 employees.
Taking Care of Our Own
Indispensable to providing America’s veterans with quality medical care are nearly 127,000 active volunteers in VA’s Voluntary Service who donated more than 11 million hours in 2008 to bring companionship and care to hospitalized veterans. These hours equate to 5,519 full time employee-equivalent positions. For their volunteer service, they get to park within walking distance of most facilities.
Source: VA Fact Sheet
ONE AVERAGE APPOINTMENT AT VA
Do You Need Care? Your Time is Required.
I live exactly 90 miles away from Hines VA, 100 miles from Chicago's Jesse Brown where I go, 100 miles from Madison where my father goes, and 100 miles from Cedar Rapids, IA where a lot of other Dixon, IL veterans go. For making that trip to my one appointment, VA pays me $42.00 for gas. Then, at the Lakeside Clinic where I see my Primary Care Physician, parking is $24.00 - paid by VA.
After seeing the doctor, I need to drive across town to Jesse Brown to pick up meds if there is a change in prescriptions [there are lots of changes - I'm diabetic]. Parking there is only $11.00 also paid by the VA.
In the course of seeing my doctor for just 1 appointment, I have taken up a lot of other people's time.
- the time for a clerk to in-process me,
- the time for a nurse to take vitals,
- the time for another clerk to prepare paper work for travel pay,
- the time - usually 15 minutes - to see the doctor
- the time for a clerk at Jesse Brown to authorize payment for travel,
- the time for the cashier to pay me for the travel,
- the time for a pharmacist to check out the new prescription, and fill old ones if need be,
- the time for a second pharmacist to fill the prescriptions,
- and the time for a third pharmacist's clerk to hand me the prescription.
My time for all that:
- 2 1/2 hours driving in, parking, and walking 2 blocks to the Lakeside Clinic.
- 1 1/2 hours to see the doctor, nurse, and 2 clerks at Lakeside
- 30 minutes walking to the parking garage, driving from Lakeside to Jesse Brown, parking and walking to the appointment
- 1 hour to get through the clerks dealing with travel pay and the 1st pharmacist
- 1 hour to wait for the prescriptions to be filled.
- On a good day 3 1/2 hours driving home through Evening Prime Time traffic extending from the hospital all the way to the west side of Aurora.
That's 10 hours for just one 20 minute routine appointment. Do you see why I press to get in more than one appointment per visit?
Last year, for me it was rinse and repeat 18 times for 26 appointments.
When things go awry:
Usually all my medications are shipped but not always. On Wednesday, preceding President’s Day, I had three days of insulin left. Thursday morning I called VA and found out no one at the pharmacy has sent them. I still had enough insulin for two days.
Friday afternoon I got a message that insulin had been Fed-Exed and I should get it Saturday. I live in a small town 100 miles away. Fed-Ex does not routinely deliver on Saturdays. Friday night I took the last of the insulin. Saturday, if Fed-Ed didn't deliver by 1:00PM, I would have to drive all the way to Chicago to pick them up at my own expense. This time, at 10AM I got the insulin. What that cost VA, I don't have a clue. Last time, I had to make the trip. Gas was over $4.00 a gallon. It's about 205 miles roundtrip. My nearest pharmacy is 1.1 miles and 5 minutes when the roads are icy.
My real name is Richard B. Pierce. I'm 64 years old, have been retired for 10 years, and work as a volunteer to get veterans into the VA clinics for help that they need right now. I know the system, I know the nuances, and I have the time. I'm getting Social Security and a small Disability Pension.
ACKNOWLEDGEMENTS
The recognition that VA needs to be re-invented came from Mike Bowman. His testimony 14 months ago before the House Committee on Veterans Affairs included the plea that VA needs to be there to meet our returning Vets when they get off the bus. I think VA needs to be prepared to provide effective help. I hope to cover those ideas in the comments.
This diary has been the product of the great help from OPOL [One Pissed Off Liberal] with additional help from testvet and Bruce Richardson from Illinois VietNow. I will answer those questions I can, but if I disappear it means one of the guys with whom I'm working needs immediate help.
I defer all questions about Veteran's benefits to testvet. Trust me on this: he knows his stuff.