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Post by lar on Jan 30, 2019 16:34:50 GMT -5
The VA is once again trying to get some of it's problems fixed. Here's a link to a story in Stars and Stripes about the new proposal: VA Private Sector Care ProposalThis, of course, is in the wake of the well-publicized problems the VA has experienced. I don't know if this is the answer but it sure does raise some questions. The gist of the whole thing is that veterans who live more than 30 minutes from their VA care provider or have to wait more than 20 days for an appointment would be able to seek care from a private-sector provider. The most interesting thing I found in the article was this statement: "Wednesday’s announcement came after numerous criticisms from Democratic and Republican lawmakers, as well as major veterans organizations, who believe the VA should’ve worked with them more closely to establish the rules." It kind of ties in with the discussion that's happening in the "An end to the shutdown" thread. I wonder. How much input should legislators or veterans groups have when it comes to regulations such as this? What about input from veterans themselves? Who would be more qualified to solve problems than the "experts" inside the system? Because I like a good argument as much as the next guy I'll start by throwing this bucket of gasoline on the fire; the VA employs lots of experienced people. Are they experts on veterans affairs or are they people with experience in how the VA bureaucracy works? How many are one or the other, or both? In my view, experience and expertise are two sides of the same coin. I'll add this to the conflagration; some, but not all, of the criticism of the VA is well deserved. Some of the VA facilities have done a terrible job. All of the facilities, good and bad, are run by the VA. Yet in spite of all of the people who work for the VA and their experience and expertise, the problems were not identified or resolved until they reached crisis level. Arguments in the other thread about the value, indeed the necessity, of having people who know the system seem to be misplaced in this instance. The Stars and Stripes article also says that a group of senators has raised questions about the cost of the proposal. At one meeting the senators were told that it would be $21.4 billion over 5 years. At another meeting they were told $1 billion for 1 year. The new proposal did not include a cost estimate. Some have raised concerns that the cost of the new regulation might strip resources from the VA system. I have no experience in government. None. I have lots of experience in business. In a case like this my first sense is to fix a system that is broken and not to create another parallel system that's supposed to do what the first system was supposed to do. There are a lot of vets that do not live in close proximity to a VA facility. Yes, those people need better access and the private sector may be a good solution. However, fixing the issue of wait times by sending patients to the private sector ignores the fact that there has been a failure inside the VA. Sending patients to private sector care givers won't solve that. With regard to the cost of the proposed regulation, the VA ought to have at least a ball park estimate of what the regulation will cost and where the funds are going to come from. But that thought is coming from a business person. I realize that ignores the opposing thought that business people with no experience in government shouldn't seek public office because they don't know how government works. I would argue that at lease some of what is contained in the proposed regulation is good reason for at least some upset of the bureaucratic apple cart. I wish Doug was here to comment on this.
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Post by brucemacneill on Jan 30, 2019 17:05:00 GMT -5
Because I live 100 miles from the nearest VA facility they sent me a "Veterans Choice" card that allows me to go to a private system and the VA gets the bill. I have no service related problems beyond a bad attitude so having Medicare, I just use that. Having a VA card does qualify for being insured under the ACA but Medicare covers it too. I have friends who have used the VA system and had no issues with it so location must make a big difference. I don't now if being in an area with a lot of vets helps or hurts response times. IMHO though, the VA is probably a good test case for a government run system and its overall reputation isn't good so I'm glad I have an option and I hope the VA system will get better or eliminated whichever better serves the vets with no options now.
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Post by lar on Jan 30, 2019 17:15:47 GMT -5
My experience with the VA is limited to the last 6 months of 2018. We have a large VA hospital here in town. It's about 10 minutes from my house so it's very convenient.
From the end of May through mid-December I visited the emergency department 6 or 7 times, had probably 25 or 30 appointments with various physicians, and experienced 6 stays in the hospital ranging from 2 to 5 days. All of this was accompanied by tests, the number of which I can't even calculate. My care was exemplary. The staff from nurses to the volunteers who move patients from place to place was uniformly cheerful and friendly.
I was confident in the care I got from doctors and residents alike.
Due to the general reputation of the VA I was a little apprehensive about going there. But I had no choice. If all of the facilities were run like the one in Milwaukee the VA wouldn't have the problems it does. Unfortunately, that's not the case nation wide.
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Post by jdd2 on Jan 30, 2019 18:41:35 GMT -5
It sounds like both Medicare and the VA can be good examples of government run medical programs.
I know an old high school buddy who had a hip replacement done in Milwaukee, and he really liked their work and service.
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Post by brucemacneill on Jan 30, 2019 19:00:48 GMT -5
It sounds like both Medicare and the VA can be good examples of government run medical programs. I know an old high school buddy who had a hip replacement done in Milwaukee, and he really liked their work and service. Medicare is great but I pay $1000/mo to make it that way above what I paid all my working career. I see the Medicare Advantage plans now offer free rides to doctor appointments. I wonder how they'd feel about taking Mary 75 miles north, waiting 3 hours for tests etc. and then bringing her back.
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Post by jdd2 on Jan 30, 2019 21:01:28 GMT -5
Well, maybe not everyone's top priority, but I've heard that when some people relocate for retirement, convenient access to healthcare can be an important consideration.
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Post by TKennedy on Jan 31, 2019 0:27:12 GMT -5
I had probably four to four and a half years of solid VA patient care experience during medical school, internship, and orthopedic residency. Both were university affiliated teaching hospitals in Omaha and Minneapolis. 1969-1977. A long time ago but I have good friends that were in academic medicine that worked at the Minneapolis facility until fairly recently.
In those hospitals I thought the care was excellent and state of the art at the time. At the Minneapolis VA I know that continues, at least in Orthopedics.
In non-university affiliated VA's I think one has to be a little more careful in checking out the practitioners and I think the same would hold true on private outsourcing. I am not sure how good the vetting process is.
That is about all I can contribute to this discussion.
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Post by t-bob on Jan 31, 2019 0:47:46 GMT -5
I’m not a veteran I live in the private sector
But the government Medicare is okay I had about eight surgeries and tremendous infections I didn’t have any money. I do have a Social Security check. And have a little pittance.... work And I had a freebie for stopped my HepC. My pills were $1000 each for 90 days.
That’s all for now
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Dub
Administrator
I'm gettin' so the past is the only thing I can remember.
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Post by Dub on Jan 31, 2019 1:53:41 GMT -5
Fiddlerina gets her care through the VA Medical Center in Iowa City. It’s affiliated with the Univ. of Iowa Hospitals and Clinics which is also a major research hospital. The care she gets there seems to be excellent for the most part. She’s been to VA hospitals all over the country and says Iowa City is the best she’s seen.
Still, the VA moves doctors around. They had a podiatrist for a while who had to redo a lot of the work her predecessor had botched. Fiddlerina was able to get her foot surgery done while the respected doctor was there. I think the podiatrist there now is of somewhat lesser caliber. The PCP that Fiddlerina is assigned to changes too. The one she has now is sometimes unresponsive or slow to get her assigned to specialists who actually do stuff. Fortunately Fiddlerina knows enough professionals there now that she can find ways to grease the skids if the PCP is a holdup.
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Post by brucemacneill on Jan 31, 2019 5:48:07 GMT -5
Well, maybe not everyone's top priority, but I've heard that when some people relocate for retirement, convenient access to healthcare can be an important consideration. It was. The hospital and cancer center was 4 miles from our house but it's gone 20 miles north now and is still in financial trouble and having trouble getting doctors especially specialists to work there.
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Post by theevan on Jan 31, 2019 6:27:30 GMT -5
I have no service related problems beyond a bad attitude
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Post by Hobson on Jan 31, 2019 15:38:47 GMT -5
Lar, glad you got good care. Sad that you needed so much of it. Glad there will be more choice.
Bruce, damn, that's a lot for Medicare + supplement + drug plan. For the two of us our monthly total is $665 and we have a Plan F (high end) supplement. I was paying almost $1,000 just for my ACA coverage before I turned 65. As you pointed out, you paid into Medicare during your working career. So did your employer.
When we moved from Phoenix to rural SE Arizona 14 years ago, we chose a place not far from a hospital and doctors. What we didn't know is that the hospital and many of the doctors aren't very good. Plus we have more need for specialists now and have a 160 mile round trip to see them. Hence our search for a new home in Tucson.
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Post by brucemacneill on Jan 31, 2019 15:58:04 GMT -5
Lar, glad you got good care. Sad that you needed so much of it. Glad there will be more choice. Bruce, damn, that's a lot for Medicare + supplement + drug plan. For the two of us our monthly total is $665 and we have a Plan F (high end) supplement. I was paying almost $1,000 just for my ACA coverage before I turned 65. As you pointed out, you paid into Medicare during your working career. So did your employer. When we moved from Phoenix to rural SE Arizona 14 years ago, we chose a place not far from a hospital and doctors. What we didn't know is that the hospital and many of the doctors aren't very good. Plus we have more need for specialists now and have a 160 mile round trip to see them. Hence our search for a new home in Tucson. I threw in the co-pays and dental. We have Plan-F and a Plan D with no deductibles. I just have a couple of generics I use but Mary has some high-price drugs. The VA/Metlife dental plan is $120/mo for both of us but it covers 4 cleanings/yr which I need and has no upper limit on other charges. I had about $3000 bucks of dental including a denture one year and I paid less than $600.
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Post by timfarney on Jan 31, 2019 17:36:50 GMT -5
My son in law has a plethora of health issues as a result of 3 tours in Iraq. The VA, for the most part, has been good to him, but sometimes you have to work to get the most out of the system, and I think it may Not be as good for vets who have no one to advocate for them and lack the mental health or energy to advocate for themselves. I think the VA’s legendary problems have quite a bit to do with location, a lot more to do with most of the attention going to the isolated problems that do exist. Good, solid service from a government-run agency doesn’t make for good press or politics.
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Post by patrick on Feb 1, 2019 22:51:00 GMT -5
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Post by Deleted on Feb 2, 2019 6:11:15 GMT -5
I'm in the VA system, but haven't used it yet. As I work on Fort Leavenworth, I still use a doc on post as my primary care physician. We do have a VA clinic right here in Platte City and a full VA hospital in Leavenworth proper. There is another VA hospital in KC. We have a large number of retirees and vets in the area.
I can say the folks at the VA that processed my medical retirement paperwork seemed pretty good, to include the doc the cataloged all of my brokenness for the medical board. That said, my doc on post is a good doc and a good guy, so I have no compelling urge to change. He's also very responsive when I need a referral out to the civilian system for a specialist.
Location matters. Some VA hospitals are not nearly as good as we have out here in Flatlandia.
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Post by Rob Hanesworth on Feb 2, 2019 10:45:03 GMT -5
Bruce, you frequently cite your high Medicare costs and I totally believe you are accurately reporting your experience in your location.
However, my experience here in central Indiana is much different. My Medicare Advantage plan covers all my drugs. I pay $10 to see my primary care physician, $45 to see my cardiologist or other specialist. Only monthly charge is the Part B premium of $136. My plan also includes access to an exercise facility and money for over the counter supplies.
So, while your experience is true, it is not universal.
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Post by brucemacneill on Feb 2, 2019 13:53:34 GMT -5
Bruce, you frequently cite your high Medicare costs and I totally believe you are accurately reporting your experience in your location. However, my experience here in central Indiana is much different. My Medicare Advantage plan covers all my drugs. I pay $10 to see my primary care physician, $45 to see my cardiologist or other specialist. Only monthly charge is the Part B premium of $136. My plan also includes access to an exercise facility and money for over the counter supplies. So, while your experience is true, it is not universal. Glad you got a good deal. I don't know if it's location or what but there weren't any costless Medicare Advantage programs here. I think you've mentioned having part B and Medicare Advantage. That wasn't an option I ever heard of. Supposedly Medicare advantage is in lieu of Plan B, you can't have both. Maybe I got you wrong. Mine didn't give me money for OTC stuff stuff and had co-pays for drugs and office visits. They were lower than Plan D plans but still co-pays. I see advertisements for Medicare Advantage plans saying "Low or in some places no additional costs" but you mus be in one of those no cost places and we're not.
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Post by Rob Hanesworth on Feb 2, 2019 19:05:57 GMT -5
As a condition of my Medicare Advantage plan, I have to continue paying my Part B premium. Does that mean I have both? I don't know. Maybe I don't. But whatever, I feel like I have a good plan.
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Post by brucemacneill on Feb 3, 2019 8:55:27 GMT -5
As a condition of my Medicare Advantage plan, I have to continue paying my Part B premium. Does that mean I have both? I don't know. Maybe I don't. But whatever, I feel like I have a good plan. Yeah, I think your plan-B money goes to your plan-C company so you don't really have plan-B. If your plan-C company can live with what plan-B costs, you're set. Mine had an additional cost of about $70/mo. There was only one plan-C offered here and it still had co-pays. The dental part only paid for one yearly cleaning and only one dentist here accepted the plan because it was slow to pay so when the VA plan, which costs too, paid 4 cleanings/yr which I need I went with the VA and it's Metlife which pays within a week so dentists like that. In any case, everybody going on Medicare needs to look at the available options and take what's best for them in their area.
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