Injured military veterans and private insurance
 

http://www.cnn.com/2009/POLITICS/03/...lth.insurance/

Can someone explain to me why this would be a good idea?

Is it a short term issue of getting the costs off the VA or a long term issue of making a federal health care plan more attractive by making more private insurers less profitable?

It just baffles me. How can the cost of health care from wounds during active duty be rightly shifted onto later coverage providers?

Who has more insight or information?

I'm baffled by this too and haven't found any thorough information on the logic of the changes. I know the VA has a lot a failings, but i think private insurance has just as many.

I'd love to hear an analysis of this.

I think the VA system has more failings than private insurance, but that's just been my experience. Most veterans I know who can pick and choose what they have their VA doctor treat and what they have their civilian doctor address. I know not everyone has the privilege of private health care or a great doctor who can walk you through the things that the VA physicians can't, but there you go.

Truth.

Both Tricare and VA has always treated our family well...but we never had relatives who suffered combat-related injuries. I have been extremely happy with the care at NNMC and WRAMC for all our issues.

This was shot down within the last day or so.

I can't believe it didn't make a bigger stink. I mean, here BO is trying the royally screw over the men and women risking life and limb...and there is hardly a whisper from the MSM.

Honestly? That makes all the difference. If you've spent the better part of your post-military adult life dealing with private insurance, the shift to the VA--I can't speak for Tricare--is a jolt to say the least.

I have only had military medical care for over 2 decades. There are some hassles but overall the care for our family has been quite good.

I know Vietnam vets with combat related injuries who got awful care through the VA system. Not to mention, a lot of VA hospitals have closed so they have to travel pretty far for their care as well.

And I believe Munchkin grew up in a military household (Munchkin: correct me if I'm wrong), so she probably also knows what she's talking about. Just because you've had good experiences with this doesn't mean that there aren't issues with the VA system.

Whoa, turn it down a notch. Note that I said I couldn't speak for Tricare, but that the VA is more problematic than most of your typical private insurers. You said yourself that you weren't familiar with how the VA works for those with service-related illnesses and injuries.

My father has combat-related injuries. He has private insurance from his civilian life, but since his illnesses are related to his service, he has access to the VA hospitals which are supposed to treat those specific injuries and illnesses. Sometimes he goes to the VA clinic, but for most of the big ones--including cancer--he has chosen to be treated by his own doctor and pay for it with private insurance, even though the VA would be free. VA clinics are woefully understaffed and often treat many, many people over a large geographic area. If you had the choice between going to a doctor in an office close to your home, and driving at least an hour to go to a crowded clinic to see a doctor (or more likely a physician's assistant) for 15 minutes, which would you pick?

It's not right that it's come to this. My dad can do this because he has private insurance. Many others in his siutation don't have that luxury.

From what the clinicians told me is there is just not enough trained and licensed staff at the VA to treat the array of combat-related injuries. There are more privately trained and licensed clinicians to treat the series of injuries.

This sounds like a case of HMO's trying to get into the game. But I am sorry, Kaiser does not have triage care that VA is accustomed to. Since you have to be military to be a part of the VA, then the number of people paying into the system is not as high as say an mass HMO system like Kaiser, Regence Blue Shield, etc.

While I do think ALL service personnel EARNED appropriate medical care and we should pay for it, the question is how? There just are not enough studies as to how this will work--the aftercare, etc. I do know there is a study are few years ago that was published in NEJM of how triage care improved in Iraq and how the clinicians trained for it from LA County Hospital, but, I have not seen the progression course of aftercare for combat-related injuries outside of intention to treat SOP's...

My guess, if the injury is not loss of limb, and starts with PTSD, if minimally treated like HMO's do, the stress becomes overwhelming to the point that something in the body actually does become afflicted early than later--assuming combat duty is an inexplicable, unexplainable overwhelming trauma...

I would like to see what the IAVA has to say about it.

This issue is not who is treating the combat injured vets: it's who is paying for it. I agree that the VA system has problems, but I'm not that shifting the cost of care to the private insurers is the way to go.

Apparently, in some instances, the VA treats the vets and then bill the private insurers for say, flu shots or some other non combat related issue. (Quote from linked article: "Currently, veterans' private insurance is charged only when they receive health care from the VA for medical issues that are not related to service injuries, like getting the flu.")

The proposal, which now I'm pretty sure was dead, was that the VA was going to bill the private insurers for the cost of treating issues related to combat injuries as well.

So the Vets would get all the crappy care associated with the VA, but private insurers would pay for it. If we were talking about getting private care and private insurance paid for it, it might still create problems for vets with serious injuries seeking private insurance (pre-existing conditions and all that crap), but it makes some sort of sense. Getting VA treatment for combat injuries and billing a private insurer makes zero sense to me.

It seems to be a total lose-lose to me.

When you don't have enough licensed trained clinicians, how many patients are treated per day? If less patients are treated, less pay is in returned. The way health insurance is done these days is by patient volume. However, the quality of care goes down precipitously...

The clinicians at the VA is are really good, there is just not enough of them to treat all the personnel that need to be seen in due course...

Private or civilian clinics are more abundant and could be reimbursed for treatment options. But, people have varying views. Sure, someone will get seen at the VA, but that may be awhile, opposed to a high volume location that sees a constant barrage of patients daily...

It's not like I am for this bill, I just question the feasibility of one plan over another.

I was only speaking from personal experience so that's why I qualified my statements both times by writing "our family" in my posts.

We do choose to use an MTF that is about 45-90 minutes away depending on traffic. Recently I had to go there on a daily basis during rush hour for about 6 weeks. We could go on the economy to our various doctors and specialists but having all our medical needs addressed at one facility where the specialists work together AND not having to deal with insurance paperwork.co-payments, etc was and is the ideal decision for our family.

That all being said, I do not believe that all VA Hospitals are of equal caliber and I absolutely do believe that not all servicemembers are receiving the care they deserve ie the WRAMC expose.

But the thing is, as I understand it, the proposal didn't really address private treatment, just who would get billed for who the VA treated.

It wouldn't do anything to address the number of clinicians or the quality of care they could provide.

ETA: I grew up as a military dependent and my experiences and those of my family are the principle reason that I don't think a single payer system or even a heavily governmentally run system will result in a net gain in the area of health care for most people. I think we may need to subsidize care for more people at the bottom end of income, and we may need to pass laws that require private insurers to cover more people or laws that require people to purchase insurance, a la Romney. But we don't need a general private system that functions like the military system. (Or like the English system if you saw the news reports this week about one of their facilities that patients described as "third world".)

If the Obama policy had instead said that the VA would pay for private treatment of combat injuries, I probably would have entirely celebrated that.

I agree that the VA has a many shortcomings, but I think it can also provide health care opportunities that many vets don't have with private insurance.

I live minutes away from the second largest VA hospital complex in the country and I have many friends and family who have either worked there or received care of the years. My grandmother was a charge nurse there for over 30 years. Many families move down here for the care offered at the facility.
They have struggled since the start of the Iraq War to keep up with the demand for clinical psychologists who can treat trauma injuries, but they have seen progress.
One of my sister's friends had an older brother come back from the war who could not even speak or function due to things he had seen, and the doctors at Bay Pines have helped him to re-build his life although he still has social difficulty.

I just have a strong belief that the government should care for its vets, no matter the price. It is important to note though that some vets already use private insruance, my grandfather does....

Yes, I agree that it's a fundamental government responsibility to provide for the medical care of veterans wounded during their service. It's just one of the costs of providing for a common defense.

I think that the government should also honor the committments that it made to those who served to provide health care according to the terms that were in place when the person served. It's pretty interesting to compare the current level of service older veterans may be getting vs. what they were told them could expect, just in terms of general care.

I have seen Public Health research papers to corroborate your observation of VA vs. civilian insurance. Most of the clinicians are military trained. And while they themselves might be suffering from military issues themselves, they somehow find away to be superior clinicians...

The other issue is the VA has not been well funded for the last upteen years. To find that funding, is owed and due to all veterans and their families. I think most people agree with that.

As far as the psychologists, I know for a fact mental health care is just plan missing at most VA. The IAVA has some really good ideas how to help veterans with some issues. There is just not enough licensed clinicians to see clients, intake them, keep up the appointments, steer them to one on one or groups, and possibly prescribe appropriate affordable meds, if needed. Then there is the issue of patient adherence. Most of the vets I speak to are waiting until there is a mental emergency before they actually see someone. By the time it gets to that point, there are so many layers that have to be honed through, that full psychiatric hospitalization is required, but cannot be enforced until a law is broken... Which is sadly, the case... :(


So, my suspicion, from the vets I know who have told me what is happening, is that the course of most PTSD cases from a medical pathology perspective, eventually turns into a Panic disorder that really feels like a heart attack. It does really register like one, like the EKG is fine and unfortunately it is not an "instant" kind of thing, it can occur years later, when some patients fit into the age risk of having a heart attack... When it happens, the first instinct is to go to the ER and get treated. When the clinicians there say, "whoop, no problem with your EKG" if the patients are veterans (which actually takes an an astute clinician team to know this these days), the actual psych work up, by both psychiatrist and psychologist is pretty much long... If you have a nonadherent patient who is also a veteran, they leave untreated for the real pathology affecting them, all to be solved by meds and behavioral therapy...

I am saying all veterans and their families DESERVE the best treatment. The fact is what does that treatment look like these days?

My uncle went to Vietnam twice in the Marines. Now while he smoked probably to quell "the nightmares", he did get mesothelioma that looks like it came from the Agent Orange use. This occurred some 30 years later... Now while he could have pursued the VA, the amount of benefit they were giving for treatment, was piss poor compared to Emory's plan... This is outrageous!

I am sure we all have anecdotal stories of loved one or ourselves who are maneuvering through this health care system and but, when a health incident occurs, I personally think Veterans deserves to choose wherever they can get the best care.

Your dad and mine sound like they are in a very similar position. My dad was in Vietnam and has had combat-related injuries since. He's been pushed around the VA system for years, and still hasn't gotten the treatment he needs for Agent Orange. A few years ago he FINALLY was able to get his back & neck surgery he desperately needed (he was a paratrooper and suffered severe nerve and bone damage). Now he's suffering complications from those surgeries, but everytime he gets an appointment at VA, it either gets cancelled or postponed (and it's always scheduled 6 months or longer away).

My dad does get private insurance from his job, but he doesn't want to use just when he gets "VA benefits" and now he's finally starting to realize that VA is crap.

IDK if this is VA or just veteran's benefits in general, but anyone who has family that are recently retired (or about to be retired) need to make sure that the gov't/VA (i'll have to ask my dad which one it is) acknowledges your marriage, and acknowledges your children (and whether or not they are in college). My mom & dad got married when I was 5....and not until this year has VA acknowledged their marriage. Not only that, but they never acknowledged that I was in college, thus my dad never got the benefits he gets for having children in college. My dad had been hounding them EVERY year I was in college and it wasn't until I graduated that they decided "oh yeah, your daughter was in college, sorry" but they'll only give him 1 year worth of back $ that he deserves.

The fact is, this issue shouldn't even have been raised. When have you ever heard someone, contemplating where their tax money was going, say, "Damn, all of those veterans are getting my hard earned money... this needs to be stopped!" Exactly, it sounds crazy.

There are many problems with billing private insurance companies for service members' injuries. Businesses could view employees who serve as a cause for their premiums to go up. Some companies might shy away from hiring service members at all. And for those people who purchase their own insurance, they may simply not be able to afford it, especially with the very real possibility that their rates will be higher because they're in the military. Also, veterans and their families could risk maxing out their benefits paying for these costly treatments.

The fact is, the military (aka the government) is sending these people into harm's way. Therefore, the government should be paying to treat veterans. Is it a perfect system? Of course not. But to suggest that we, as citizens of the U.S., should no longer support our veterans and give them treatment that they desperately need is absolutely ridiculous.

The cancellations/postponements are a serious problem, and are based more on facilities, but it's a widespread issue. Like I said, I can't imagine how annoying it would be if that was your only source of healthcare.

As far as the marriage/children thing, that is a VA-specific problem, since the DOD keeps pretty good records of marriage and children stuff--they have to for a lot of reasons. I don't think the VA knows or cares about my existence; my father isn't in that bad a condition where they could have gotten financial assistance with college.

I should have added that I also know people whose HMOs denied them certain treatments saying that they were things the VA should cover.

Aren't HMOs known for being horribly restrictive?

yes, but if that's the "private insurance" that the VA wants to bill... well, I can see there being big issues. I can see private insurances denying veterans with combat complications coverage, as they do for people with AIDS. It could really be a mess.

Aren't there forms of private insurance other than HMOs? I've never had an HMO, and I've already had a few insurers between my parents and several employers.

HMOs are becoming the prevalent insurer because they are the least expensive. PPOs can be just as restrictive. The only insurer in my area that is common that is NOT an HMO is Blue Cross and they can still be pretty restrictive and they can refuse to pay for things after the fact. The insurance world is a big huge complicated mess, honestly.

Ahh thanks for the clarification. Yeah, my dad should be (because of all the combat related issues) almost 100% disabled--in the eyes of VA. But they WILL NOT raise his disability. He has to throw a fit w/ his back & neck surgeon just so his disability could be raised to 40%. He just came back to the VA today and they are thinking of raising it to 60%.

I don't think my dad's condition is that bad, but then again, i'm not in his body. I know that he can't sleep for more than 3 hours w/o getting pains, so he's constantly tired, his hands & feet are completely numb and he can't feel them, and something is constantly hurting him.

I've heard this issue, too... And I have seen where current serving military clinicians are restricted from moonlighting, while there are quite a few who do it, though... Working for the VA has to be a labor of love, 'cuz they sure don't pay much...

I'm bumping with this link. It's not directly connected to the topic of the thread but it's connected to VA hospitals and quality of care, etc. I glanced at recent topics to see if it was listed but didn't see it. I apologize if this duplicates a discussion elsewhere.

Three patients treated at VA facilities have tested positive for HIV after being treated with equipment that the VA hadn't properly sterilized.

http://www.google.com/hostednews/ap/...I6AlAD97KFK101

As the article notes, they don't have proof that the patients contracted HIV at the facilities.

ETA: The article says something about around 5,000 people having already been notified of their follow up test results. Am I correct is assuming they mean the HIV test results? If so, isn't 3 in 5,000 a really low HIV rate by any standard? (We've got about 300 million folks in the US, and I think that the estimates are that about 1 million are living with HIV, right?) I'm not suggesting that it means the VA issues aren't a problem or anything nuts like that. I just found the rate kind of interesting. I guess people careful enough about their health to submit to colonoscopies are living really low risk lives for the most part.