I have an opinion on the delivery of healthcare through the current VA medical system. This is based on the several years of direct patient care at a VA hospital during training and subsequent frequent direct experiences as a private ED physician. My experiences were mostly negative. Let me explain.
First, I would like to state my unequivocal support for the promise of lifetime health benefits made to the veterans when they enlisted. This contract between the veteran and the US government is a sacred and just promise. It should be fulfilled. This is where my real world experience with the current VA medical system begins to tell me that something is very wrong.
The current system requires that the veteran have all of his physical checkups and prescription refills performed at an existing VA medical center. The problem occurs when the veteran lives many miles away and must travel, every several months, often many miles, to see a strange physician and be examined.
If the veteran requires admission, then his family must also travel many miles and arrange for lodging in an unfamiliar city.
Continuing with my list of complaints, there is the situation that arises if the veteran is at home and thinks that he may have an emergency. The ambulance is appropriately called and asked to take the veteran to the nearest VA hospital. Unfortunately, this is often many miles away. If the paramedics become concerned about their patient’s health, then by law they must stop for an evaluation at the nearest hospital. After examining the patient and determining that they are indeed able to make the journey safely, the ER physician, by law, must then call the VA medical center for permission to transport the veteran. In my experience, too many times the receiving VA will neither accept the transfer, nor will they deny it. In this manner they avoid any financial obligations that may arise. In the meantime, the veteran may indeed have an evolving emergency. If his condition deteriorates while waiting, then the private physician will have to accept him and provide any necessary treatment to help the veteran. The VA has escaped financial obligation because they never actually denied transport, nor would they accept. In my view, this represents a breach of contract, not to mention that it is plain wrong. The veteran has no idea what is happening, only that he or she needs help.
This scenario, as well as the previous one, could be avoided by providing the veteran with some sort of VA medical card that would allow them to obtain any needed health care and prescriptions, and then having these expenses paid for by the government as promised to them during the enlistment process. These problems and others, as well as proposed solutions, are detailed in my recent book “A License to Heal”.