In the Arena

Where Government Fails

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This is outrageous. As I travel around the country, I frequently meet with veterans, or their family members, who have been stiffed, ignored or mistreated by the Veterans Administration. Paperwork is lost. Claims disappear. It takes months, sometimes years, to get a response. The treatment afforded a new generation of wounded warriors, with a persistent pattern of new wounds, has been dilatory and scandalously inadequate. I’ve faulted Eric Shinseki, the VA Secretary, in the past–mostly for not getting out there, in the public, and making the case for the splendid leadership qualities and employability of the veterans now returning home. I’ll even grant Shinseki the benefit of the doubt on attacking the bureaucratic disaster that he has had to confront. But this whole issue raises an important question about government: Would this sort of incompetence survive in the private sector?

This is one of the central, and most valid, arguments that conservatism has. There is no creative destruction in the public sector. If caring for veterans was a function of the private economy–and I’m not suggesting that it should be–competitors to the VA would have bitten off chunks of the market, perhaps large chunks. There would be an electronic record-keeping system that accurately recorded every veteran’s time and place of service; there would be kiosks, like ATMs, that would give veterans options to pursue the services they need. Iraq and Afghanistan vets with post-traumatic stress would have the equivalent of their own Starbucks (in competition with their own McDonalds)–walk-in centers where they could go and be evaluated, and hang out with comrades, and be treated. If they didn’t provide the services in a creative and customer-friendly way, they’d fold. World War II veterans and their spouses would have the sort of chronic elder-care now being pioneered by Geisinger and other private systems.

But we have little of that. There has been no strong market force to goose the VA into transforming itself to serve a new generation of veterans in a new, computer-driven age. It remains, in too many respects, your grandfather’s VA. I think it’s morally vital that the government provides state-of-the-art services to our returning veterans, to ensure a level of humanity that the private market doesn’t always. This is a public responsibility. And, more particularly, it is the responsibility of politicians, especially Democrats–the party that believes in the efficacy of government-provided care–to demand the rigor that would push the VA into the future. I mean, if the government can’t perform this function–to care for those who sacrificed so much for the rest of us–you wonder what on earth it can do. As I said, this is the strongest argument that conservatives have and it’s one area where I tend to agree with them.

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swissArmyBrainBETA
swissArmyBrainBETA

Why would you try to make such a simple issue of funding priorities into some abstract public/private sector meditation?  The VA had electronic records and other tech solutions long before much of the rest of our system.  I took a class on Industrial engineering solutions in the hc industry, and in many ways, the VA was slightly less backward in a totally backward industry.  The system has simply been overwhelmed by the influx of new vets. 

At any rate, that's where I hope my career takes me someday.  The stories I hear from veteran coworkers (I work at a base) are infuriating. 

JohnYuEsq
JohnYuEsq

The GOP legislation awaiting Romney's signature isn't simply a return to the era of George W. Bush. From abortion rights and gun laws to tax giveaways and energy policy, it's far worse. Measures that have already sailed through the Republican House would roll back clean-air protections, gut both Medicare and Medicaid, lavish trillions in tax cuts on billionaires while raising taxes on the poor, and slash everything from college aid to veteran benefits. In fact, the tenets of Ryan Republicanism are so extreme that they even offend the pioneers of trickle-down economics. "Ryan takes out the ax and goes after programs for the poor – which is the last thing you ought to cut," says David Stockman, who served as Ronald Reagan's budget director. "It's ideology run amok."

Greed and Debt: The True Story of Mitt Romney and Bain Capital

Read more: http://www.rollingstone.com/po...

JohnYuEsq
JohnYuEsq

Persnickety Romney FAILED to learn the precept of "noblesse oblige" while DRAFT DODGING in France. Every REALISTIC Repub concedes DEFEAT.  

 

Only President Obama and the DEMOCRATS PROTECT the MIDDLE CLASS.  

 

Get the VOTE OUT! GO BIG! VOTE THE DEMOCRATIC TICKET!

Marlowe53
Marlowe53

What rot. I recently had two stays in our city's well-regarded private hospital.  The quality of care varied from decent to outrageously bad. On the second visit the pharmacy denied me the medication that I had received during my first stay because it was an unusal dosage. Records, anyone??? Nurses and lab techs dropped packaging pieces on the floor and left them, I had to make my own bed and my roommate's soiled bedpan was left on our communal sink.

With one exception, it wasn't that the workers were uncaring or unkind. Some were not well-trained and all seemed to be responsible for too many patients. That's what our MBA directed. bottom-line driven society has given us. To suggest that the VA, a huge agency, would be better served by the corporate mindset that gave us pink slime burgers is beyond ridiculous.

Stuart Zechman
Stuart Zechman

Joe Klein:

"Where Government Fails"

"Where Third Way Ideologues Fail"

paulejb
paulejb

Government efficiency decreases as it's scope expands. If Obama is re-elected there is a good chance that government will expand to the point where it becomes totally paralyzed.

Otto Man
Otto Man

"Would this sort of incompetence survive in the private sector?"

WTF?  Have you never dealt with a private insurer before?  Or gotten the run-around from a private doctor? 

Here's what an actual journalist wrote about the quality of the VA compared to private health care. 

http://www.washingtonmonthly.c...

You'll be stunned, Joe, to see that it's full of facts and figures and actual interviews.  You know, what we used to call "journalism."

kbanginmotown
kbanginmotown

If caring for veterans was a function of the private economy–and I’m not suggesting that it should be–competitors to the VA would have bitten off chunks of the market, perhaps large chunks. 
Joe, Joe, Joe...You know darn well that the only chunks that the Private sector wants are the profitable ones. 

Look at package/mail delivery: UPS and FedEx don't want to deliver Sears Catalogs to Aunt Minnie in Hooterville, Idaho for $0.03 Bulk Rate Postage.

They want to deliver high-margin expedited e-commerce packages for $18.99 2nd-day air.

And, as a result, the USPS goes deeper into the red because their high-margin business shrinks and the constitution says we need a Post Office.

If the private sector ever got its hands on VA business, you can bet that they won't be fighting to sell our Vets Aspirin and Tongue Depressors... 

vstillwell
vstillwell

This column by Klein has really gotten under my skin. My grandfather is a 91 yo WWII veteran who is alive a well today because the VA has always taken good care of him. When my father turned 30, he got horribly sick. The private sector doctors didn't know what to do and they thought he was going to die. They decided to send him to the VA hospital. After a year there, the VA doctors gave him his life back. Agent Orange is a nasty nasty thing. If it wasn't for the VA, both my father and my grandfather would be dead. 

Sending military personal on repeated tours to war leads to awful things. Imagine that! I believe Klein supported the Iraq invasion. Did Klein ever bother to make sure the VA would be funded and equipped to deal with traumatic head trauma or the losses of multiple limbs. No, he didn't. Supporting a war and then bemoaning an under staffed and under funded VA after that fact is JUST STUPID! In fact, it's more like feeling guilty about something you did and blaming others for it.

kbanginmotown
kbanginmotown

Joe is having one of his "centrist moments". 

Give him a little time (and some Gas-X) and it will pass...

vstillwell
vstillwell

Well, any of us that have dealt with cell phone or cable companies can attest to the fact that yes it happens in the private sector. When I was working retail while in college, I saw stupid things a lot. Screwing customers over by selling them garbage protection plans that weren't worth a nickle was expected. I guess Joe hasn't had a real job in so long he's forgotten. It happens all of the time. 

vstillwell
vstillwell

Oh, and I forgot about my experience last week with a local auto shop. They promised me they would fix my car, and if they couldn't, they would tow it to somebody who could (the computer was blown in the car). I thought that was a strange guarantee, but I took them up on it. Well they couldn't fix it. So I asked them to tow it to another shop and I almost got into a fist fight in the parking lot because the shop's owner got upset that I asked him to live up to his word. Anyways, saying the private sector is oh so better is just BS. Instead of giving into a Republican pipe dream, we should be working to make the VA better at what it does. 

And how has competition made our healthcare system better anyways? The last time I went to the ER, they charged me $1000 just to breath the air in that place.

Competition is good in the market place. Health care is not a market place. We're talking about people's lives for crying out loud not widgets. When will this dawn on you baby boomers. Could you imagine what the VA would be like if Verizon ran it? Really, Klein? You think the VAs bad now, you just wait, chief.

Godzilla1960
Godzilla1960

The public school county where I teach has outsourced textbook warehousing, inventory, and distribution to a private company.  

We are six weeks into the school year and kids in American history classes still don't have textbooks.  The textbooks are there, but the company doesn't have them bar coded and scanned into its system yet.

We have a fetish for the private sector that is unsupported by reality. It was the private sector that recently drove the world economy off a cliff.

Not that anyone in the private sector had to answer for their incompetence.

ghostcommander
ghostcommander

The Republi-Cons  in the Senate just defeated a Bill that would fund jobs for homeless veterans, and they have constantly been against veterans since the traditional Republican party was slain by these radical extremist Republi-Cons.

Ivy_B
Ivy_B

This is what Mitt said today at the Valley Forge Military Academy. Obviously under him the spending will all be on weapons and "stuff" rather than services for Veterans.

Standing in front of Valley Forge Cadets sitting ramrod straight and motionless in full dress uniforms, Romney said he will restore military budgets and put the United States in a leadership role in the world "once again."

http://norristown.patch.com/ar...

In addition Joe, as many problems as exist in the VA, the few people I know who use it are generally quite pleased. If you were to try the same experiment with people who have to depend on the for profit health care system and have been cut off from assistance programs, I'll bet you would find real horror stories. I know of many more people who have had problems with the private health system.

StormDog
StormDog

When I got out of the service in 1971 I was rated 40% disabled (wounded RVN 1970) due to a error I pointed out but was ignored 30+ years later I was rated 50%. VA care was an anachronism at time of my discharge, to be kind. In the 1990's it was light years better. Recently with the returning veterans from the middle east, the down economy- resulting in more  reliance on VA care and less funds things are getting a little crowed and slow. On the rating side things have always been slow and now are probably crazy in many cases. Get informed and persist.

Commentary Fortytwo
Commentary Fortytwo

Veterans should enjoy a version of Medicare where their actual care is taken care of in the private sector. There is no reason to have dedicated VA hospitals and nursing homes run by the government. Private industry has to compete for Medicare and Medicaid dollars. We got to select the care facilities for our parents even though their care was paid for by Medicaid. Give veterans a real choice between private facilities and VA facilities and the problem would largely go away. 

me987654
me987654

That's not a terrible idea.  I've always thought the Canadian health care system had a lot to offer since they only socialize health INSURANCE not health CARE.  In Canada, the provinces provide health care insurance, but people are free to select among private providers

StormDog
StormDog

 Medicare is hard to come buy, doctors do not have to take medicare patients.

The_Kenosha_Kid
The_Kenosha_Kid

Joe Klein is right! Private sector to the rescue! Announcing the new Enron Veteran's Administration!

Tim Sullivan
Tim Sullivan

The VA is consistently rated higher than private healthcare for patient satisfaction, effectiveness and cost containment. See: http://bloom.bg/boGRjz or do a quick search for plenty more proof.

We should demand more for our veterans. The VA can and should do better, but they are already providing a higher level of care than other existing options. Anecdotes, even disturbing ones, shouldn't be used as the basis for sweeping conclusions. In this case, the conclusion of the post is in direct conflict with the actual evidence that is pertinent to it.

S_Deemer
S_Deemer

From first hand observation of the VA healthcare system in action, I must respectfully disagree with Joe. Six years ago, Time published an article, "How Veterans' Hospitals Became the Best in Health Care," by Douglas Waller, and I can say that his reporting matches what I have experienced.

Read more: http://www.time.com/time/magaz...

I have been taking my father-in-law to the Atlanta VA Medical Center at least once a month for the past 4 years. It's not a luxurious place, and the atmosphere is more Walmart than Mayo Clinic, but the care he has received, whether for routine office visits or intensive care hospitalizations, has, without exception, been first-rate.

I know that there are thousands of horror stories of vets dealing with the VA, and I do not for an instant doubt them. It's a very big organization, and improvement is always possible. But bureaucratic healthcare problems are not limited to the VA. 

Three years ago, I had a motorcycle accident on a Friday afternoon that left me with a fractured wrist, and four broken bones in my right foot. After being released from the ER Friday night, I waited until Monday morning to call a major orthopedic clinic in Atlanta, which I will not name. I was told that the first available time they could see me was 2 weeks in the future. I said this was unacceptable, since I had 4 broken bones in my right foot, and since I live only a few miles away, I had my wife drive me to the clinic.  Amazingly, I got an appointment with a foot specialist for Tuesday morning. The surgeon confirmed that I had some significant damage, which would require reconstructive surgery. I ended up with 2 titanium plates and 11 screws in my right foot. All things considered, I have recovered remarkably well. The surgeon was acting head of orthopedic surgery at the Atlanta VA Medical Center. As far as I am concerned, the VA is "socialized medicine" at its best.

https://lh4.googleusercontent....

grape_crush
grape_crush

Would this sort of incompetence survive in the private sector?

Yes, it does.

But we have little of that.

We have little of that in the private sector now, Joe. I'm middle-aged, and other than the medical gizmos used, a trip to the doctor's office hasn't changed that much for me in forty-odd years.

There has been no strong market force to goose the VA into transforming itself...

Replace 'strong market force' with 'strong profit motive' and maybe you'll get a better idea of what problems there are with opening up something like the VA to businesses that are looking for new ways to make a buck.

You're right in that unless there's a serious push, an org like the VA won't improve on the service it gives our veterans...but unlike the business world, it's less likely to transform itself in a way that is detrimental to the people it serves. That profit motive is a two-edged sword; an insurance company that chooses to spend money modernizing its billing system in order to eke a few extra dollars out through improved efficiency may also refuse to pay for necessary medical services, cut/outsource service staffing, or reject legitimate claims. All for the sake of hitting that quarterly target profit.

Obviously we can do better by our veterans than continuing to put up with the problems they encounter with the VA system...but we really want to place shareholder value and quarterly profits above (or even on par) with the care these people deserve?

shepherdwong
shepherdwong

"Would this sort of incompetence survive in the private sector?"

Gee, I wonder? Is AIG still in business? At least the Veteran's Administration hasn't crashed the global economy.

http://www.getclaimhelp.com/wo...

carotexas
carotexas

Joe, I thought that the military was working with the VA to coordinate military records so that the information can be transferred as the veterans leave the service.  I have not heard any recent news about this so do not know how far along this process is.  The problem may be different computer systems.  When they will be able to accomplish this lost or missing claims should be greatly reduced.

The Veteran hospital patient computer records are excellent and I think might be better than a lot of private hospitals.

Instead of being critical of General Shinseki all the time you might check and see if the problem is elsewhere.

PerryWhite1
PerryWhite1

I'm sorry, Mr. Klein, but I have to disagree with you, despite my respect for your many years at Time.

And I wouldn't bother except that I think you're doing America a disservice by hopping on the "privatization" pony. And I'd like to take the opportunity to address you, respectfully, on the issue in the hopes of changing your mind.

The premise of my argument is that the purpose of private companies is to make money, not provide services, and they won't provide those services without punishing competition -- which almost doesn't exist in the American economy. In short: Privatization doesn't work, but moreover, it punishes the middle and lower classes while benefiting the already well off. Again.

Most economic models fail to take into account the effects of power in the economy. That's like trying to discuss politics without taking into account the effects of money! In theory, if two banks merge they can offer services more cheaply because of economies of scale and greater efficiencies. But in the American economy, almost without fail, when two banks merge they RAISE fees and rates, because they CAN. The greater power of the new, larger, merged bank chases out competition and achieves an effective monopoly. This happens in almost every field, and where monopoly isn't possible, a working cooperation between companies emerges that achieves the same effect. Witness the private health-insurance field, where companies essentially cooperate to keep prices high and spend great amounts of money to AVOID paying off policies -- thereby denying service. The reason health-insurance reform was needful -- and is still needful -- is that when left to their own devices, private companies will use every option to extract money from their clients without providing services. 

Which is why regulation -- and not DEregulation -- is necessary, and why we need another T.R.-style trustbuster. But that's another argument. 

It's why our two MBA presidents (W. and Hoover) were such dreadful failures, and why Romney's business experience isn't an argument for the presidency. Business isn't government, and government isn't business. Government's duty is provide for the general welfare, even if it takes us into debt. Business's duty is to provide profit for its investors. Two different animals. And Romney's method of making money -- firing employees, raiding pension plans, dismantling companies and "harvesting" the parts -- wouldn't work as president. He can't lay off unproductive or marginally-productive citizens (although he will ignore them) and you can't sell off Idaho to make a profit this quarter. But again, I'm digressing.

So I'd argue, as others have on this thread, that privatization of the VA is a terrible idea. The most successful health-care operations in America are Medicare and, yes, parts of the VA. The solution is to make the VA as much like Medicare as possible, not turning it over to profit-mongers who will throw veterans over the side as quickly as they can in search of an extra buck.

What we need to do is beef up the VA's budget, which the GOP has been bleeding white for the last 30 years. And I, as an American proud of and supportive of our troops, would be perfectly willing to pony up a "war tax" to pay for it. I think most Americans would agree that paying for our vets AFTER the wars is just as important -- if not MORE important -- than DURING the wars. And, as a side benefit, if wars actually cost us money we could feel, maybe we wouldn't be so eager to dive into them.

This extra money could be used to hire dedicated, talented, conscientious and experienced men and women to administer the program. And, as luck would have it, we have a huge pool of just those kinds of people: returning war veterans. This would have the added benefit of reducing the god-awful vet unemployment stats.

That's my assessment, and my suggestion, Mr. Klein. I hope you'll read it in the spirit in which it's tendered. Thanks for your time.

Ivy_B
Ivy_B

Very thoughtful response, I agree wholeheartedly. Thank you.

Tim Sullivan
Tim Sullivan

The VA is consistently rated higher than private health care providers for patient satisfaction and effectiveness. See http://bloom.bg/boGRjz and do a quick web search for more evidence. The VA isn't perfect and we should do better for our veterans, but it's better than existing alternatives - especially private insurance. To write that competition is the answer ignores the evidence.

Trajan Saldana
Trajan Saldana

the "private sector", right...ever dealt with customer service with banks, cable companies, phone companies, etc? yah, the private sector.

kbanginmotown
kbanginmotown

Still waiting for Comcast to get me my internets...yeah, customer service...whoopie...

pollardty
pollardty

I think private sector journalism has failed but I don't think the solution is to move it to the public sector only. Privatization is a simplistic, feel good Republican pipe dream that is the solution to every problem.

pollardty
pollardty

Oh...and tax cuts with less regulations.

EJIndependent
EJIndependent

Shortsighted, Joe. The "market" Republicans initiated two ill conceived wars with shoddy budget numbers and poor planning. This is not a partisan issue. It's a national one. When considering sending soldiers into war, their proper treatment and care upon returning should be part of the funding and overall cost package - i.e. realistic vision. And yes, that is a job for government.

HudsonValleyTim
HudsonValleyTim

So, it's "Sorry Sarge, but we didn't budget for so many amputees?".  This is a case where Congress should stand-up and do the right thing (or sign their kids up to carry a pack and rifle).

EJIndependent
EJIndependent

I agree with you 100%. I was responding to Mr Klein's argument that it is somehow mostly the fault of "government", i.e., Democrats, that there is not enough adequate support for our veterans. The forces of poor planning and budgeting by the "market" Republicans at the outset must be included in the calculations. There are consequences for poorly executed decision making. Adjusting to after the fact emergent results mid crisis takes time. This is where we are. And again, I agree we should do whatever is necessary to speedily rectify the systemic problems that are shortchanging our vets.

serious fun
serious fun

Have you no experience with for-profit sick-care insurance? Take any story you have heard from veterans and multiply it by ten.

The only problem the VA has is our right wing's insane desire to "take us back" to before 1850, when we had no support for veterans.

53underscore3
53underscore3

I agree that the VA is horrendously managed, but I don't think that the "private sector" is automatically a guarantee of corruption free efficiency.

AfGuyReturns
AfGuyReturns

A rhetorical question...

How much can be attributed to "horrendous" management and how much to the current staffing simply being overwhelmed by the number and severity of injuries?

Paul Dirks
Paul Dirks

So, in your fantasy world who would PAY the private entity service providers? 

The way to analyze any situation isn't to pretend that there's a public/private sector dichotomy. The proper way is to simply follow the money through the system and ask what motivation gets applied to individual workers. The main difference between the public and private sector is that the public sector takes care of the things that wouldn't otherwise make money. That is by design. You can structure the organization to better take care of it's "customers" but if your business model is to provide valuable services to veterans in exchange for their service already rendered, there's no plausible way to use 'profit motive' to promote service or efficiency. There's no profit to use as the carrot.

theoldkathy
theoldkathy

Is this largely a matter of funding?

A veteran's home in this state was in danger of going under because of insufficient staff and charges of abuse.  There was too much overtime, which considering the level of care required, was inexcusable.  The home has now been allowed to stay open, which is a good thing, but there has not been any hiring of additional staff. 

I simply don't understand how we all are letting this happen.

Sean DeCoursey
Sean DeCoursey

Let's not forget that the backlog got its start during the Bush administration when VA funding was cut just as two new wars were launched.

Joel A. Edge
Joel A. Edge

Unfortunately; the crappy service has been around for quite some time. You could pour as much money as you want into the VA, it won't improve service or outcomes. Don't get me wrong. Nice, friendly people. Just not very results oriented. 

shepherdwong
shepherdwong

 Good point. "The private sector" isn't half-controlled by anti-private-sector

ideologues bent on proving that the private sector doesn't work.

lemonjello
lemonjello

Valid points, there are definitely major issues with how veterans are cared for in this country.  But this seems to overlook the fact that the VA does well on a number of health care quality metrics.  Its early adoption of electronic health records (which runs counter to Klein's narrative here) is likely a significant factor in its success.

Arimathean
Arimathean

A private company's responsibility to the consumer pales in comparison to a private company's responsibility to its stockholders.  Private sector care might be more efficient than public service care, but it would also be substandard to the type of care that the public sector can offer.

I'm not saying I have a solution -- I just doubt that privitizing is one.  

I also have a sneaky suspicion that the inefficiency is an intrinsic part of the sustainability of the program.  If all military veterans received all of the benefits to which they are entitled, the system would be bankrupt immediately.  THAT is the real issue -- that we are overcommitting ourselves to the point that we cannot care for those who have protected us.

That is also why liberals say that protesting foreign wars IS supporting our troops.

proletaria
proletaria

"I'm not saying I have a solution -- I just doubt that privitizing is one."

I too, am skeptical as hell when it comes to privatization and military. We've seen very little good come of the two combined and I certainly wouldn't wish the awful private healthcare system onto any vet.

The solution to the problem is to have a functional congress that can address these issues. Unfortunately republicans are bent on making that "government doesn't work," mantra a self-fulfilling prophecy and as such will do nothing but block attempts to improve the lives of veterans.

I can sympathize with Klein's skepticism of bureaucracy, but I don't think any reasonable person will use that as a springboard into unregulated private sector solutions. The likes of which have seen us into this recession and continue to prolong it for personal gain.

DonQuixotic
DonQuixotic

The VA has so many problems, but I think the bigger hypocrisy about how Americans "support our troops" is our willingness to send them into multiple tours for wars that seemingly have no cause and no end in sight.

AfGuyReturns
AfGuyReturns

Found this...

"Staff Sgt. Jason Rivera, 26, a Marine recruiter in Pittsburgh, went to the home of a high school student who had expressed interest in joining the Marine Reserve to talk to his parents.

It was a large home in a well-to-do suburb north of the city. Two American flags adorned the yard. The prospect's mom greeted him wearing an American flag T-shirt.

"I want you to know we support you," she gushed.

Rivera soon reached the limits of her support.

"Military service isn't for our son. It isn't for our kind of people," she told him.

THIS pretty well sums up why it's so easy for us to get into these wars.

We already have classes in this country... the GOP believes in them... they simply don't like the obvious being pointed out. In Medieval times, they would be called the "merchant" and "warrior" classes.