It's the day after Veteran's Day

[kyburg]

And I'm still thinking about them. (Told you I did.)

I love this little chalk talk about the portion of the entire US budget the DOD, specifically The Pentagon, gets.

And then I see something like this really Useful Site and get angry.

I'm the one who likes to look at percentages, not actual dollars - but even this pisses me off.

When it comes down to the actual Life in our armed services - the people that make it all work - suddenly, we're back in school and hosting fund raisers to buy them a warm coat in the winter.

The people suddenly MUST BECOME charity cases and become objects of pity. Sickening.

And look - we're spending HOW MUCH on their portion of the GNP again?

People are the expensive part of any budget, to be honest. Where the bleep is the money going if not TO THEM?

Then the local NPR affiliate broadcasts this delightful piece of non-news last night on the drive home.

"Salas says California’s Department of Veterans Affairs isn’t doing a good enough job of that. Only 12 percent of the state’s veterans actually collect the benefits they’re due."

Wonder what it's like elsewhere.

I've had direct experience with the VA in San Bernardino county - the VA there is across the street from the best care anywhere in that county, Loma Linda University Medical Center.

Seriously. The place would not pass a JAHCO inspection to save its life - but it doesn't have to! It's a VA! But they're one of the lucky ones - they can refer across the street, and do. (Loma Linda is a not-for-profit foundation hospital.) Don't forget - it's a benefit, not insurance. If you don't use their facilities - eh. Too bad, so sad, we don't reimburse.

I can hazard a reasonable guess why they're not distributing 'benefits' - seriously, the penal system does a better job of providing services, more of them and so on. (Biggest provider of mental health services in California - the penal system. Yes it is.)

Who would waste their time banging a head against the wall for nothing. I never recommend the VA for services. I'd rather fall back to Medi-Cal/Medicaid and hold car washes. That useless.

And Jim did his clinical in a VA hospital. Ask him if you want more direct reports. What HE has to say is barely repeatable in polite company.

No, veterans deserve more than one day - and an exceptional day at that - and then be treated like ugly foster children on every day including that one thereafter.

That said, things are what they are and I'll be over at Soldier's Angels and the USO as much as I can. It is what it is.

And IT SUCKS.

Comments

[amaryllis.livejournal.com]

My husband's grandfather while alive was a resident at the VA in Yountville (also hometown to the famed French Laundry). Despite the idyllic setting, it was the most depressing place to visit. It looked and felt like a mental institution. Everyone in their was just wasting away, and dying inside. They deserve so much more.

[eyelid.livejournal.com]

I don't think many hospitals are particularly cheery inside.

[kyburg.livejournal.com]

You need to come visit and I can convince you otherwise. There's good, better and Cedars-Sinai in West LA.

[amaryllis.livejournal.com]

Yes. I've worked at Cedars-Sinai and I now work at Children's Hospital Los Angeles. I've been a happy surgical patient at two other hospitals, and you can absolutely tell when attention is being paid and when it isn't.

Dark, dank halls and falling apart rooms are not good for anyone's psyche.

[eyelid.livejournal.com]

to me, even when attention is paid and the place is bright, clean and intact, it's still hospital-y. I had a very good hospital when I gave birth but it still had that antiseptic atmosphere.

[amaryllis.livejournal.com]

oh, and I can spell "there" properly. I swear.

um - no.

[eyelid.livejournal.com]

I have no idea what the VA is like in your neck of the woods, but the VA hospital around here is EXCELLENT.

My grandfather received top-notch care there for years - far better than what my grandmother got in the private system. My father works there and he's an amazing doctor - his patients love him, his office is crammed with the various little things they give him (mostly stuff they make, from wood toys to maple syrup - there's a dollar value limit, of course).

Furthermore, MY experience of the VA system is statistically more representative than yours. In fact, the statistics show that VA medical system is better overall than the private health care system in EVERY MEASURE:

-The quality of care has been proven to be better
-patient satisfaction is higher in the VA than in the private sector (see also here)
-See general Time article on how the VA is the best health care around. (The VA system is also as cost-effective as, if not more than, private health care).



And Jim did his clinical in a VA hospital.

Our local VA hospital is a teaching hospital affiliated with the U of MN medical school. A bunch of people I know have done rotations there and have only awesomeness to report. My father actually won a teaching award for his work there.

Re: um - no.

[caitlin.livejournal.com]

From the impression I get... this is what tends to happen when things are determined to go "state-by-state". What is fabulous in one state turns out to be last-priority-crapper in another.

For instance... road repair. BIGGEST difference I can see with my own experience is going from one side of the river to the other... IA roads are decently well kept. IL roads... look and feel neglected.

Re: um - no.

[eyelid.livejournal.com]

could be, but my understanding is that the VA is federally funded. (which means that under Bush, its budget was ridiculously slashed - my dad fights to keep up with his ever-increasing caseload because it's easy for Republicans to slash veteran's services while simultaneously piously praising The Troops).

Even so, your point holds generally in that any given institution (whether public or private) lives or dies on the strength of its individual managers. Bad management of one VA hospital (or private hospital, as I'm sure we've also all experienced) will lead to a poor hospital.

Re: um - no.

[caitlin.livejournal.com]

It is so sad how various administrations will do things...

There is also another thing for 'individual' differences.... school systems, for example.

Hmm. Managers... How many people will go to Bethesda but refuse to go to Walter Reed, I wonder.

Re: um - no.

[kyburg.livejournal.com]

And the VA is hardly the bulk of the issue here. It starts when someone is lied to upon recruitment, all the way through the experience.

There's a ton of money being spent here. On whom, if not the people who make it happen - I ask.

Re: um - no.

[eyelid.livejournal.com]

The money in the defense budget doesn't go to veterans or troops, it goes to government contractors.

The VA system gets squeezed and manages to provide exemplary care in spite of it. I find it really amazing.

Are you actually a veteran? Have you ever been in the VA system?

Re: um - no.

[kyburg.livejournal.com]

It does? All by itself? Wow. Why isn't something being done - nevermind.

The VA system, if it ever provides care - does it without any oversight. Your sites look germaine, but they also appear to be clearinghouses for individual studies, which might or might not be as good as it looks from the summaries.

Me, a veteran? Baby, I'm too old and female to have been seriously considered for such a thing. My older brother taught the first class of women to be allowed into the Coast Guard, and I was 12 at the time. Too close to Vietnam, very much in the midst of Reagan...no, you did not choose to serve if you were 1) female, 2) Californian and 3) had a choice.

That said, I am surrounded by veterans, and have had to find care for them for chronic issues *directly* related to their service. Yes, I've dealt with the VA system in California, and can completely believe that they only get asked 12% of the time for help. Because nobody goes to them for help if they have any other option available to them. It's that nasty, and there's worse across the country.

I'm glad you've gotten what you needed from them. So far, you're singular in my experience.

Re: um - no.

[eyelid.livejournal.com]

The VA system, if it ever provides care - does it without any oversight.

?? It has more oversight than the private sector.


So far, you're singular in my experience.

So far, you're singular in mine. And the statistics say I'm more right than you are.

Re: um - no.

[kyburg.livejournal.com]

I'm more right than you are.

Thank you for making clear your continued interest in this discussion.

...

For the record, no. Not so much.

(I, at least gave your sources the benefit of the doubt. I don't have the resources to either validate or debunk them. That, I leave to snopes.com - in a pinch - and your sites are clearinghouses for data. I couldn't - by myself - hope to say yea or nay one way or the other.)

Don't tell me what I've experienced, toots. I'm the one who lives here. And keep your dirty feet out of my head.

Re: um - no.

[unclejimbo.livejournal.com]

I am, my brother is and so is my mother.
His care can be described as horrible. He's had an issue with his hip that occurred on active duty that the VA has consistently ignored or minimized. He's 47 and walks with a cane and is in pain all the time.

My mother suffers from PTSD caused by an attack while on a drill weekend in Chicago. Her care at the VA in Illinois and in Kentucky was to rotate her though the drug of the month with no cognitive therapy. It took my own intervention to get her to use her private insurance to get good care. We also discovered that she had a tumor on her thyroid gland which exacerbated everything.

And as I mentioned above, I saw the worst of things at VA St. Louis.

Re: um - no.

[kyburg.livejournal.com]

It's federally funded - the money goes to the VA, and they decide who gets and who doesn't.

Benefit. Not insurance. They'll -literally- kill you with the distinction.

....

[eyelid.livejournal.com]

Totally, because we all know that insurers wouldn't dare deny care!

I refer you ONCE AGAIN to the statistics I cited above, which showed that the VA system is overall better than the US private health care system in Every. Single. Respect.

Re: ....

[kyburg.livejournal.com]

Oh you can ask for what you need. All they have to say is 'this is a benefit' and they don't even have to diagnose your issue.

And then toss you out on your ass. Go down the street and pay for it then.

Re: ....

[eyelid.livejournal.com]

All they have to say is 'this is a benefit' and they don't even have to diagnose your issue.

All the insurers have to say is "we deny coverage." And then toss you out on your ass to go pay it yourself.

(In fact, you're 100% wrong about the benefit thing. If it's legally guaranteed it's irrelevant whether it's a "benefit" or not. In fact, under constitutional law you are entitled to due process before a federal benefit can be denied, which is far more than you get in private contract law).


And then toss you out on your ass. Go down the street and pay for it then.

Good thing a private insurer or hospital would never do that!

Re: um - no.

[veronica-rich.livejournal.com]

What they said. It's probably a mistake to make sweeping remarks about almost any service that's in every state, since it will likely vary from region to region (and even from the next county over). I've seen VAs that provided good care, and ones I wouldn't send my cats to.

Re: um - no.

[kyburg.livejournal.com]

You don't want to know. No, really. It's some of the worst stories you hear in medical care made real -

12%. There's a story behind that number.

Re: um - no.

[eyelid.livejournal.com]

And there's a story behind the several numbers I showed you above that show that the VA system is better in every respect than the private system. Better outcomes of care, better cost-efficiency, AND BETTER PATIENT SATISFACTION.

Re: um - no.

[kyburg.livejournal.com]

You're singular in my experience.

Re: um - no.

[eyelid.livejournal.com]

back at ya.

Re: um - no.

[unclejimbo.livejournal.com]

My experience was at the St. Louis VA hospital and when I was there, there were dedicated people trying their best to get things done for the vets, but there were a whole lot of people there going through the motions -- and slow motions at that.

The floors were filthy unless there was news that JACHO was coming in to inspect. The medical students were left to do what they wanted with little or no supervision and would ignore what the patient needed to follow their own line of diagnosis even if the chart showed clearly that they were wrong.

I'm glad your father runs such a tight ship at the VA there in MN. The problem is that the quality there is not always the same as elsewhere.

Re: um - no.

[eyelid.livejournal.com]

I'm sure you're right that there are better and worse VAs, but I think that's just going to be the case in any and every system - including the private system. When my grandma was in private care, she would have literally been killed by the negligent staff if my dad hadn't intervened and gotten her care changed. Is that the case in every private hospital? - I'm sure it isn't - it's all about the individual hospital and management.

Re: um - no.

[unclejimbo.livejournal.com]

It would mean that there would have to be very high standards set. Then they would have to be enforced. Joint Commission only shows up every 3-4 years to inspect. They've quit announcing when they come through these days, but I wouldn't mind too much if they were able to have periodic spot checks at any time to keep people on their toes.

People ask me why I don't freak out when the Inspectors are about, my reply is that I follow those standards all the time. Then I don't have to worry about it. Just plain common sense.

Re: um - no.

[tomlemos.livejournal.com]

all I have to say is that I've got a brother that has worked his way through the VA here in California as a RN. He has a degree in nursing and two Masters in gerontology.

I've talked to his friends who are nurses who work at the VA here in California.

I'll bet they'll disagree with you. I've never met a more group of caring people in their lives.

I've even had them get a friend's father properly cared for after being tossed from private hospital to private hospital, until the VA stepped in and took him off all the unnecessary medications that the private hospitals put him on. The man is finally lucid for the first time in his adult life.

Everyone's experience will vary.

Re: um - no.

[tomlemos.livejournal.com]

make that Geriatrics, I think that's the proper term.

Re: um - no.

[eyelid.livejournal.com]

I assume you mean you'll disagree with Kyburg, not with me :)

Re: um - no.

[tomlemos.livejournal.com]

yeah. I think that there's room for improvement, but for the whole system to be a mess, I don't really think so.

[thatwordgrrl.livejournal.com]

Sadly, we are treating our vets either as ruthless babykillers to be spat upon (shades of Vietnam, anyone), or pitiable charity cases who are helpless victims.

Neither is necessarily so.

[kyburg.livejournal.com]

And where is the money? I ask you. There's more than enough to do a LOT towards getting rid of both categories. Like, why are they in existence in the first place?

[eyelid.livejournal.com]

I think the commenter's point is that those categories are ancient stereotypes.

[kyburg.livejournal.com]

Still used, in present tense. That's the problem.

[eyelid.livejournal.com]

The problem is that if the stereotypes are UNTRUE - as the commenter suggests - the problems they refer to do not, in fact, exist (at least not widely.)

For instance, take the stereotype of the welfare queen with 10 kids. Reagan described the woman and was like OMG WE HAVE TO FIX THIS, except, in fact, there was no such welfare queen.

[thatwordgrrl.livejournal.com]

Sadly, I've seen both used. Quite recently. :/

[eyelid.livejournal.com]

Yes, they are used - for instance, Kyburg is using them right here and saying they are reality.

What I mean is that you're saying they're just stereotypes, while she's saying no, that's totally the actual situation for veterans now.

[lordindra.livejournal.com]

I've heard two types of VA stories.

People who got amazing service, and the not repeatable in public stories. There seems to be little middle ground.

I wonder, is this powerful congressmen getting their districts VA hospital better funding at the expense of VA hospitals in other districts, wiht less influential congressmen?

[eyelid.livejournal.com]

I suspect it's just differences in management and staff at individual hospitals.

[feyandstrange.livejournal.com]

No, state budgets to affect things, according to my good friend who works in the VA in NV. The states are supposed to kick in extra funds. Her VA office is on furloughs right now because the NV state budget mandates all state employees have 'em, and they're seriously budget-strapped and can't handle the volume of requests they're getting right now.

Also, it's often different once you're firmly in the hospitals and the system; getting past the paperwork hurdles is often tricky, and that part's where the state budget often cuts hardest.

[feyandstrange.livejournal.com]

It really varies by local and state VA. The VA people in Las Vegas are all amazingly good people, most of them vets themselves, and doing a hell of a job despite the budget tying both hands behind their back. (They don't even *have* a VA hospital right now in Nevada - but just got budget for one. This despite having a lot of unpaid furloughs.) My friends there tell me it's about as bad in CA.

Another problem is VA's rules. Most of the good stuff kicks in at 20 years of service. These days, that's waaaaay above the average - but what, two tours in Vietnam don't count for anything? THat "20 years" rule is what most of the vets know about - so a lot of them never go in to get what little they get, thinking they're not eligible. I've got a dying vet around here who's sticking to Medicare so he can stay with the same doctors, but the VA are, if I bug them, gonna cough up some pension.