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Senator-elect Bernie Sanders (I-VT) is interviewed by a Reuters reporter at Sanders' office in Burlington, Vermont November 28, 2006. Sanders, a 16-year veteran of the House of Representatives who swept 65 percent of the vote in Vermont running as an inde
Senate Veterans' Affairs Committee Chair Bernie Sanders (I-VT)
Eric Shinseki is out at the Department of Veterans Affairs and now ... there are still a lot of complicated questions about how to fix the VA. Because it turns out that's not as simple as just getting rid of one guy at the top of an agency that has faced enormous influxes of people to care for and serve without having been scaled up in a thoughtful way to meet that challenge. A slew of bills have been or will be introduced in Congress, falling along predictable lines: Democrats want to fund better care in the VA system and Republicans want to privatize it; all concerned want to make it easier to fire or demote senior officials, but one party is interested in due process and the other isn't.
On Sunday, Senate Veterans' Affairs Committee Chairman Bernard Sanders (I-Vt.) introduced a far-reaching proposal to overhaul health care for veterans. The Restoring Veterans' Trust Act would give the VA secretary the authority to remove senior officials based on poor job performance; grant VA expedited hiring authority for nurses and doctors; authorize the department to lease 27 new facilities in 18 states and Puerto Rico; mandate a software upgrade for the department's patient scheduling system by March 2016; and expand opportunities for eligible veterans to seek outside care if VA facilities are unavailable.
Senate Republicans already filibustered many of these proposals back in February, but maybe they'll rethink that now that more people are paying attention. House Republicans have already passed a bill making it easier for the VA secretary to fire officials, but Bernie Sanders has concerns about the specifics:
"The nightmare could be under the current bill that passed the House that a new president comes in and they fire hundreds of high-ranking VA officials without due process or particular reason," Sanders said. "I think you cannot run a health-care system the size of the VA like that. You want to be able to get rid of people at the VA who are incompetent in a very rapid way, but you have to have due process."
This is a concern that will be hard to discount for anyone who ever paid attention to anything the Bush administration did—except for the people who were cheerleading Bush on in making federal agencies as partisan as possible, which is most congressional Republicans.

In other words, Shinseki's resignation only set the stage for the next round of fighting and Republican posturing.

Originally posted to Laura Clawson on Mon Jun 02, 2014 at 07:17 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Is 'Congress' even INTERESTED in fixing the VA? (18+ / 0-)

    I say 'Congress' because I expect many Democrats in the Senate and House would work to solve the problems, but as everyone knows, for the past 6 years or so Republican Congresscritters have zero interest in governing or improving anything. They actually prefer and consciously work to make things WORSE, to fit into the much more important part of their agenda; doing everything possible to show government doesn't work, and that the Muslim Kenyan Usurper is a failed President.

    Oh, and to create sound bites for ads and fundraising. Nothing else.

    "Just because we have the best hammer does not mean that every problem is a nail." - My President

    by Fordmandalay on Mon Jun 02, 2014 at 07:39:06 AM PDT

  •  VA wont begin to get 'fixed' until the military (4+ / 0-)

    pulls its head out of its ass and acknowledges PTSD as real.

    it is kicking their collective ass DAILY and they stand there like deer in the headlights.

    Mostly because they do not want to acknowledge the reality of PTSD.

    Legal means "good".
    [41984 | Feb 4, 2005]

    by xxdr zombiexx on Mon Jun 02, 2014 at 07:43:40 AM PDT

  •  So... (14+ / 0-)

    our government can press people into military service (the draft), and while serving, our men and women are government property covered by the Uniform Code of Military Justice and not the U.S. Constitution (the Marine captain that swore me in who looked exactly like Frank Sinatra Jr.), and the government sends them where it will, feeds, clothes them, and sees to their medical needs but when they are too injured or ill to serve or are released having served their hitches, we turn them over via privatization to for-profit health care entities?

    Use 'em up and toss 'em out? Let someone make money off of them?

    Yeah. That sounds ethical.

    Lead with love. Forgive as a reflex.

    by Gentle Giant on Mon Jun 02, 2014 at 07:43:55 AM PDT

    •  ^^^THIS.^^^ I was thinking about (8+ / 0-)

      that when the privatization meme came up. Why is it supposedly a great idea to have the VA run privately when it's the federal government that send people to war?  Why shouldn't the federal government be responsible for the veterans IT creates?

    •  So.. only the VA can provide medical care? (3+ / 0-)
      Recommended by:
      zootsuit, Gentle Giant, WillR

      Gimme a break.. the VA is good at war-related injuries, but by no means are they the only good source of medical care.

      Vets have to wait weeks, sometimes months (115 days average in the case of Phoenix VA system), for an appointment for simple routine non-injury related illnesses.  And sometime they must travel hours to get that care.

      If they were provided a card that paid for care locally for non war-related illnesses, I believe most vets would not have a gripe about that, and probably welcome it.

      Let's change the VA to do what it does best - rehab for injuries, prosthetic centers, PTSD research and treatment facilities, etc.

      And let's give Vets a plan they can use in any hospital in any state when other illnesses befall them.

      •  And How Would This Privatization Work (5+ / 0-)

        I'm a disabled vet and get all my medical care through VA.  And how much is my co-pay?  Zero.  And what is my catastrophic cap?  Again, zero.  And how much is my prescription co-pay?  You got it - zero.  As a disabled vet, the VA is free, universal healthcare.  So if it gets privatized, will the care and prescriptions still be no-cost to the Vet.
        So I guess I'm just this scum-sucking, moocher and taker, just waiting for all this socialism to wind up in my mail box.  I wore that uniform for 42 years.  Countless deployments, months (even years of family separation), intense anxiety during periods of action, and finally numerous injuries and conditions that now impair my health.  Do I feel entitled?  NO - I feel I did a duty on behalf of the American people to ensure our liberties and freedom is never marginalized.  I answered a call to be part of the band of brothers to stand up and say, "Send me."  As Sen Sanders says time and time again, we should not send our nations youth to fight in wars if we will not take care of them when they come home.  I'm a lucky one - I came home.
        The VA motto is “To care for him who shall have borne the battle and for his widow, and his orphan...”  That's from Lincoln's Second Inaugural Address affirming the government’s obligation to care for those injured during the war and to provide for the families of those who perished on the battlefield.  It is no less true today than it was in the 1860s.

        •  Thanks for your service (1+ / 0-)
          Recommended by:
          Gentle Giant

          And to answer your questions..

          Everything would still be zero cost to you as a disabled vet.

          You would simply be able to schedule and receive your care locally - or optionally at a VA facility as you do now.

          What is wrong with having an option?

          Not everyone is close enough to a VA facility to receive timely care like you.  Would you deny them local access to health care at no extra cost?

          Having this option would relieve the VA of some part of the burden they are experiencing, without having to invest tens of billions of dollars in new infrastructure.

          •  As long as the VA hospitals remained an (1+ / 0-)
            Recommended by:
            JJ In Illinois

            option, I'm not against a card for local care that would defer payment to the VA. But I am against privatizing the VA hospitals as that essentially eliminates the option for the care, free of cost, our military personnel were promised when they signed up.

            Lead with love. Forgive as a reflex.

            by Gentle Giant on Mon Jun 02, 2014 at 10:58:17 AM PDT

            [ Parent ]

          •  Options Are Good (1+ / 0-)
            Recommended by:
            shornby

            I think you might be a bit confused on the point I way trying to make.  It seems to me most people talking about privatization are focusing on equivalence of care.  My concern is not that - my concern is equivalence of COST.

            If we give vets the option to use private facilities we need to do it in a way where all the vet needs is his VA id card.  That single card gives him 100% coverage of medical care, hospital, medications, and doctors.  To do it any other way seems to me to be heading for another train wreck.

            Buy a plan on the exchange (if the vet is under 65)?  How would you get a plan that covers 100% of everything and the government pays 100% of the premium?  I don't think there is a mechanism to do that.

            Use Medicare (if 65 or over and on Medicare)?  Is Medicare rules going to change for disabled vets giving them 100% of coverage and no drug co-pay?  There is nothing like that in Medicare today.  I also have Medicare and I have yet to use it.  About 1 1/2 years ago had a hernia repair operation at the VA.  I paid no co-pay for the medical center costs, no co-pay for the dr's fees, and no co-pay for any of the pain medication I was prescribed.  Had I used Medicare, 20% of the hospital bill would have been mine and there would have been a co-pay on the drugs.

            Give disabled vouchers?  How would that work?  I only see a voucher working if it said, "The bearer of this voucher is entitled to free medical care and medications one demand."  

            All I'm saying is that there are things that could be taken to private health care facilities for disabled vets.  We need to be sure that we have invested the intellectual capital in how that mechanism will  work so that disabled vets are again burdened with costs they otherwise would not have entailed.    

            •  Medicare supplemental plans pay 100% (0+ / 0-)

              Simply purchase a Medicare supplemental plan for all vets that has zero out-of-pocket costs to the vet.

              My wife is on Medicare.  She has a supplemental plan that costs about $160 per month.  Zero costs to her for any procedure and/or office visit.  She never pays one cent.

              Drugs are a separate Part D plan, but there are costs associated with that.

              I could see vets continuing their drug plan through the VA at current rates.  Or, the government could fund a supplemental drug plan for Vets only (Part Z?) that pays the VA equivalence - but you could get your prescrips through Walgreens, CVS or whatever.

              This type of thing is not that difficult to do, technically.  We just need the political will to do it.

    •  Better care (1+ / 0-)
      Recommended by:
      Gentle Giant

      I'm not a fan of health care for profit, but the civilian health care system has already acknowledged the maladies that veterans suffer and developed treatments for them (PTSD, pesticide and radiation poisoning, etc.), while the VA barely recognizes them, let alone treats them. And the civilian health care system is distributed far more widely than VA hospitals. So I think vets would be much better served if they were simply enrolled in premium health insurance programs through the ACA. Let the dysfunctional VA dry up and blow away.

  •  Just don't let them privatize it. (12+ / 0-)

    I'm a vet for whom the VA is working and we should keep it and improve it. Hire extra staff now, get rid of the backlog, and get some new energy.

    The Republicans will wreck this system and do to it what they would have done to Obamacare. Some asshole now is probably planning to put forward "Vet Healthcare Savings Accounts" or "Vetvouchers."

    "The soil under the grass is dreaming of a young forest, and under the pavement the soil is dreaming of grass."--Wendell Berry

    by Wildthumb on Mon Jun 02, 2014 at 07:44:25 AM PDT

  •  The Key Is IMPROVEMENT (8+ / 0-)

    On any VA proposal offered the question that must be asked is:

    Does it improve the timing and/or quality of health care for our Veterans?
    For example, making it easier to fire people, while necessary in some cases, will do little to improve the timing/quality of care.  While expediting the hiring of new Doctors and Nurses as well as additional facilities will do a lot to improve the timing/quality of care.

    I know Republicans will hate to hear this, but an essential part of a REAL solution to the VA problem is more funding directed at the flaws in the system.  

    "Some men see things as they are and ask, 'Why?' I dream of things that never were and ask, 'Why not?"

    by Doctor Who on Mon Jun 02, 2014 at 07:46:25 AM PDT

  •  One thing that neither side is willing to do (3+ / 0-)
    Recommended by:
    a2nite, claude, Sybil Liberty

    to help the situation is to quit putting our troops into situations where they get harmed (physically and/or mentally) - which only increases the strain in the VA. Nope, both sides are just fine with expanding our use of gunboat "diplomacy."

    "Americans have a strong devotion to afflicting the afflicted and comforting the comfortable. They have a hard time contemplating any meaningful overhaul of the rules of their political system" -- Alec Baldwin

    by Sagebrush Bob on Mon Jun 02, 2014 at 07:47:14 AM PDT

  •  I agree with Saunders (7+ / 0-)

    in that Shinseki's resignation was not necessary.  I wish he would have stayed on, but that ship has sailed.  Now to keep up the fight to not only save the VA, but to enhance it for the future.  I personally use the VA as a disabled veteran have so since 1971 when discharged.  I have to go see specialists now that are outside of the VA but all my operations and care are done by VA hospitals.   As we now have some 2 million more new veterans and counting that have come from the latest wars, we need more funding and more facilities to take care of the damage that has been done.

    Oh, something else here too.  John McCain wants to have Tom Coburn as the next VA head, that would be a total disaster.  Look at where he came from in Oklahoma and his love for veterans there, the dude is a menace.  John has past his prime and just needs to go to the old soldiers home.

  •  In a way this seems like "Public Education Sucks" (2+ / 0-)
    Recommended by:
    annieli, mjd in florida

    part 2.

    Insofar as most vets give high ratings to VA medical care and this all seems like a massive RW effort to demonize the entire kit and kaboodle (presumably to lead to some good old fashioned "shock doctrine" type privatization or some such thing).

    It's kinda sad IMHO that many at this site are either actively buying into that meme, or at least passively accepting it)

  •  If we had rational health care, we could shrink (4+ / 0-)
    Recommended by:
    JJ In Illinois, Yonit, zootsuit, indres

    the VA to a fraction of its current size.

    We will always need specialists who understand the trauma of war and military service, but a rational health care system could take care of most needs.

    Hmmm.  Good health care.  Starts to look cheaper every time you turn around.  ACA proved we  could do something about it.  Next act? Let's do something good.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Mon Jun 02, 2014 at 08:02:50 AM PDT

    •  Create a special subsidy for vets on the exchanges (2+ / 0-)
      Recommended by:
      dinotrac, zootsuit

      Agree with you 100%.

      Subsidize their premiums at the same level their care is subsidized in the VA.

      Let them buy a Cadillac plan (Platinum?) with low out-of-pocket costs for a minimal or zero premium.

      Bingo.  Done.

      This isn't rocket science.

      Vet shouldn't need to wait months to see a VA doc for a respiratory infection, or to get cancer diagnoses, etc.

      Keep regional facilities open for war-related injuries, rehab, prosthetics, PTSD, etc.

      Done.  

      •  Yup. (3+ / 0-)
        Recommended by:
        JJ In Illinois, Yonit, zootsuit

        I'm amazed that more people don't see the need for programs like Medicaid and Medicare as symptoms of an underlying problem.  You don't need special programs for elderly, low-income or other folks if there is good health care for all.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Mon Jun 02, 2014 at 08:59:57 AM PDT

        [ Parent ]

      •  Please Remember This (0+ / 0-)

        We didn't pay for a VA plan.  With the level disability above 50% there is no PAY.  So those of us with VA disability entitled to full VA care, would we get this Platinum plan at no cost?  And what about using that Medicare instead of VA?  Would you change Medicare from 80% coverage to 100%?  Bottom line is anything that smells of privatization will hit disabled vets in their wallet.

  •  Throwing Shinseki under the bus was disgraceful. (1+ / 0-)
    Recommended by:
    Sybil Liberty

    More inept  "negotiating"?  No, thanks...

    don't always believe what you think

    by claude on Mon Jun 02, 2014 at 08:07:13 AM PDT

    •  exactly right (0+ / 0-)

      the administration should have stood its ground and forced Congress to its knees for past actions.

      We know damned well who's accountable.

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Mon Jun 02, 2014 at 08:19:54 AM PDT

      [ Parent ]

  •  If you're going to have a revolving door (3+ / 0-)
    Recommended by:
    Sybil Liberty, mjd in florida, indres

    Not just for administrators and officials but for doctors, nurses, and caregivers, services will never improve. Dumping an extra nine million users into the private HC market is an insane idea.

    Like it or not, as long as service providers and caregivers are compensated at below-market rates, absent some kind of perks (i.e., student debt forgiveness, Federal Income Tax exemptions, etc.) nothing is going to change.

    It is going to take money. Propose a "Veteran's Care Tax" to be paid by those who benefit the most from their sacrifice, i.e., those at the top of the food chain. Let the Republicans make the argument that it's not a good idea.

    •  Their budget has tripled in (2+ / 0-)
      Recommended by:
      zootsuit, indres

      the last fifteen years or so, but their in-patient admissions have gone up by 50%, and out patient visits have less than doubled.

      Pouring more money on them isn't helping, they just blow it on fancy conference rooms and consultants, and yet more administrators.

      Resident physicians and others who rotate to VA hospitals get frustrated with a number of things that impede care. You hear of doctors being written up because they ask that an operating room be cleaned soon after a surgery, so that another surgery can be performed. There is a prohibition on doctors rounding on their patients after 3PM, if records are missing, doctors can be reprimanded for insisting that they be found.

      If a patient needs a drug that is not in the VA formulary, they are simply out of luck.... they can't get it.

      The list goes on ad nauseum. The worst part is that under the current system, these things are unfixable, and the bureaucracy is unaccountable.

      … the NSA takes significant care to prevent any abuses and that there is a substantial oversight system in place,” Sen. Dianne Feinstein (D-California), said August 23.

      by mosesfreeman on Mon Jun 02, 2014 at 08:55:37 AM PDT

      [ Parent ]

  •  tie #Bergdahlzi to VA care.... have the WH nominee (0+ / 0-)

    follow Bergdahl's care closely.... and this time nominate a woman for VA Secretary

    Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "If we appear to seek the unattainable, then let it be known that we do so to avoid the unimaginable." (@eState4Column5)

    by annieli on Mon Jun 02, 2014 at 08:17:21 AM PDT

    •  Duckworth for VA Sec. (0+ / 0-)
      Shawn Gibson's name was one of several being mentioned as a possible permanent replacement, a move that would require Senate confirmation. Former Sen. Jim Webb (D-Va.), who served on the Senate Committee of Veterans Affairs, seemed to be gaining attention as a potential candidate for the role as well. Even before Shinseki's announcement, Webb received endorsements for the position from a newspaper in Staunton, Va., and a columnist with Bloomberg View.

      Other possible nominees being mentioned in published reports include Army Gen. Peter Chiarelli, Rep. Tammy Duckworth (D-Ill.), and Army Chief of Staff Ray Odierno.

      Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "If we appear to seek the unattainable, then let it be known that we do so to avoid the unimaginable." (@eState4Column5)

      by annieli on Mon Jun 02, 2014 at 11:10:34 AM PDT

      [ Parent ]

  •  Bernie's expression says to one and all, (3+ / 0-)
    Recommended by:
    mjd in florida, Palafox, Yonit

    "Let's get down to business."

    He's in the right place at the right time. The U.S. is fortunate to have this senator in a position of leadership.

  •  Here's my experience (1+ / 0-)
    Recommended by:
    Yonit

    I've never worked for the VA but have worked for something similar.

    The main guy in charge of it all of any big gov't organization does not really know much about what is going on at the local level.  He MAY be told about it by people under him but he's mainly a figurehead.

    In general most agencies are loaded down with additional mandates by congress or economic or other situations (like multiple wars) in this case but at the same time they are expected keep up with the same or only slightly more people. Also at this time of austerity nobody is getting any raises, and the salaries are getting lower as time goes by and it is increasingly hard to find or retain qualified people.

    Your guys in charge of the local offices want to look good by keeping up with everything while cutting costs to the point of maybe pushing people so hard that it leads to more attrition which makes the people there who stay work even harder.

    If you are LUCKY the local guy in charge will work to get the top to appropriate more money to get enough people to do the job. Then you have to HOPE that this percolates up thru the chain of command.

    When we started these wars I thought the big cost of them was going to be treating the people that were in them, not the cost of running them.

    I mean we are still spending tons of money and Vietnam Vets are still fighting for more treatment and We've essentially fought 2 Vietnams and will be paying for vets who want compensated and want care for 30 years on.

    You know how that congress wants to give the defense dept more money than they even ask for??? That's what needs to be done to the VA. They probably also want to up the physicians salary to at or above private levels to attract some more.

    I'm not a veteran but most of the ones I know would sort of resist privatizing, because the ones I know like the moral support of being around other veterans. Also I think the VA does  better job on some stuff than private where they tend to blow peoples complaints off a lot.

    I understand the GOP would like to voucherize the VA so then they could possibly garner campaign cash off the private businesses that got the money but not sure that many vets would be for that and I'm guessing that they would cut back and cut back on the vouchers to the point the vets would be seeing physicians assistants and stuff rather than doctors due to the cost.

    It's weird.

  •  Please Help (0+ / 0-)

    Please help us and tell Governor (of Alabama) Bentley to expand Medicaid.  Here’s his contact number 334-242-7100 or fax 334-353-0004.

  •  Can we clone Bernie? (1+ / 0-)
    Recommended by:
    Yonit

    I'd put him in charge, if we didn't need him far more in the Senate ...

    The thing about quotes on the internet is you cannot confirm their validity. ~Abraham Lincoln

    by raboof on Mon Jun 02, 2014 at 09:07:05 AM PDT

  •  The mantra for this issue should be: (1+ / 0-)
    Recommended by:
    indres

    Don't listen to what Republicans say. Watch what Republicans DO.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Mon Jun 02, 2014 at 09:53:24 AM PDT

  •  VA - move into hospitals closed because states (0+ / 0-)

    controlled by TeaParty/GOP refused to extend Medicaid. "We don't want none of your stinkin' free money."

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