I am going to tack on at the end of this post another blog I wrote about the VA and submitted to the Denver Post. I guess they found it unprintable but then again so many of my musings probably should be. Regardless of my feelings, the VA is probably too big and under financed for the job ahead. There are almost 1800 facilities seeing 200,000 veterans a day. This is only going to get worse and therein lies the rub. They are not alone.

Sooner or later our dreams are going to catch up with our checkbook. We have saved soldiers on the field of battle from what would have been sure death in Viet Nam or WW II. We have brought them home bruised and broken both physically as well as psychologically. You can’t put a price tag on their care but it is going to swell costs well beyond any foreseeable budget. Who is going to pay for this? Memorial Day sounds very patriotic until you start hitting the US of A in its wallet.

Medicare was devised in the mid 1960’s. No one could have dreamed of the advances in medical science and drugs. We have transplants, artificial limbs and organs. We have also discovered diseases that are so rare that only a few hundred people may be affected. We have heart procedures that cost $500,000. Medicines that require an annual outlay of $450,000 and higher. I believe if you pull out all the stops there are very few obstacles in medicine that can’t be overcome to prolong people’s lives for weeks months and years. No one is discussing those stops.

I am not Ted Kervorkian but someone, anyone please tell me how we are going to pay for all this? We have people hitting 65 at the rate of 10,000 per day. As a portion of the federal budget, medicine has soared from 6% in the 90’s to 17-18% now and hitting the 25% range within 10 years. It will require premiums to increase with more deductibles and less coverage. Rationing is a dirty word when it comes to healthcare but we may just come down to it being the only practical way out.

Getting back to the VA, I have to wait a few weeks(not months) for various appointments but I get them. But I can live with it…literally. Maybe it’s unfair for me to equate my personal situation because I am in decent shape and good health. But that still begs the question if you have screwed up your body should you be eligible for non stop cures? We have so many questions that will require incredible decision making and ethical calls. I am sure in some back room of NIH or Harvard Med School these tortured enigmas are longing for clear cut answers but it sure is beyond the pay grade of the gang in Congress. But under the moniker of Obamacare or any other acronym we are all going to be in this together.

I find it fascinating that during all the deliberations of the above, all we worried about was getting people under the insurance tent. No one discussed the current and future costs and how they might be reduced to something sustainable by the American public. You could soak the 1% up to their gills and not come up with the necessary numbers. You even work your way down to the 5%, 10% 0r even 25%. The beans can be counted every which way but loose but the bottom line does not lie.

When we travelled through the South there were huge billboards for this emergency room or that citing the waiting times to be seen. The clarion of 8 or 12 minutes gave you clear sailing with your cold or stomach ache all the while spending the highest treatment dollars available. In Denver several hospitals are enlarging their emergency facilities to satisfy the increased demand and of course reap the most profit. You can text “ER” to get the full rundown of those gurneys and treatment rooms just waiting for you and your loved one. Are we that incredibly stupid or just naive enough to think this will just work itself out somehow? Left to our own designs we will probably perish.

I draw these conclusions. The VA is too large with 1800 facilities and not enough professional managers to ensure top quality care without the inherent imperfections associated with a government bureaucracy. Overall our medical costs will continue to soar as we further implant profit motives into making people well. Competition has not yielded the hoped for lowering in costs. Both the Congress and its electorate(us) will not make the hard decisions to bring costs under control. The obvious solutions of means testing for social services, increasing the retirement age and a proactive form of preventive medicine will not sell back home. And after all the will of the people supersedes any rational thought to the contrary.

You know the old story about buffets. People will gorge themselves to “get their money’s worth”. Overeating and over consuming have become a national creed. Bureaucracies tend to foster cheats and scammers. We will have the obligatory investigation and heads will roll. Sort of. We knew about the VA back in the Bush years. Cerberus must be fed. We have created the monster and it has to eat. The solution? Starvation diet. Don’t bet on it. Wait isn’t there a show called The Biggest Loser?

As always
Ted The Great
Factoids:
Soliris is a drug treating a rare blood disorder that perhaps 500 Americans have. The annual cost is $409,000.
Ditto Elaprase for people with Hunter Syndrome. Annual cost $375,000
Lastly ACTH which is used for infants who have spasms. Monthly cost is $115,000.

Heart transplant…total cost before and after surgery in 2011 $997,700
Lung Transplant. $561,200 Double Lung…$797,300
Kidney….$262,900

 

 

The Wily Veteran

The cause celebre at the moment is the Department of Veterans Affairs. Ranking right up there with motherhood and apple pie you mess with vets you are barking up the wrong tree. As with other favorite whipping boys the press dig and trip the light fantastical stopping every now and then to retrieve a fact or two. All the news that fits the print. Leave out anything that doesn’t fortify your premise.

This all started with a VA Hospital in Phoenix. A retired doctor stated at least fifty people died while waiting for appointments. There were rumors of a fake waiting list that prevented these people from seeing a doctor for months,even years. That there was doctoring of books is not beyond the realm of possibility and probably real. Did these people die of natural causes while in the system? The doctor couldn’t say. Was the number really fifty? Once again no way of knowing at this time. He stated he may have exaggerated.

I am a veteran. I am enrolled in the VA medical system. After being exposed to Agent Orange I was bumped up a couple of notches on a priority list. It provides me a simple access to medications but moreso it can provide long term benefits should I become incapacitated in later years. In simple terms if I go to LaLa land Kathy can just send me out and finally be done with me. Not just yet sweetie.

About three years ago I showed up on a Saturday afternoon in February for my entry physical. My appointment (which took three weeks to get) was for 2:00P.M.To be fair it does not have the appearance of the Mayo Clinic but the people were beyond friendly and courteous. I was ushered in at 1:55. A woman sat behind a slightly dated computer terminal and asked me to sit down. Then the fun began.

She took a variety of readings from temperature to blood pressure. All the while she was asking me questions regarding my medical history. Depending on whether I answered yes or no, new trees of questions were generated. Wait a minute. You mean I don’t have to fill out twenty pages of questions in triplicate and all the while printing my name,birth date and SSN on every scrap of paper. No sir, it is all right here. I like this place.

The business man in me got intrigued. How long have they had this program? It seems that it has been in place for many years. It is public domain software and is used in several foreign countries. But wait, why don’t we use it in private medicine? Oh I get it. Not invented here. Now every time I show up I give them my last name and last four of my SSN and presto my entire history pops up. It has a fail safe if two or more drugs don’t interact properly you can’t prescribe. This is too easy.

I then received a physical covering vital systems and coordination(must have flunked) that is one of the most comprehensive I have ever gotten. I receive a flu shot, pneumonia shot and tetanus shot all in one sitting. They schedule blood tests and while we are going through this there is a knock at the door.It is a pharmacist with my prescriptions filled. The practitioner gave me her card with her cell phone and said to call her with any questions.When I strolled through the front door of our house at 701 Williams at 3:15 Kathy said, “What happened?” I said, “You wouldn’t believe it”.

Without going on and on I have been seen by dermatology, hematology, and had various scans and tests appropriate for my age. I have never in some 10 plus appointments ever had to wait more than 10 minutes past my scheduled time. Most of the time they are early. I am addressed as Sir not because I was a former officer but because I am a patient. I had an exam and biopsy for skin cancer that took less than 30 minutes. Any prescription refills are mailed to me. In a word, I am a happy camper. Maybe it’s a fluke. I don’t think so.

When I read all the hue and cry I had to write this. There are 1800 VA medical sites throughout the country. They see 200,000 people per working day or a total of 8.76 million visits per annum. I pondered if there are 1% disgruntled patrons that would be 2,000 per day. I am not one of them. With those massive numbers do things fall through the cracks? Of course. If there are 5% of the facilities that are poorly run that comes to 90 clinics and hospitals. They should be taken to task but think about all the good ones out there. What do you think is the failure rate in private institutions?

The staff is beyond competent with many doing internships and residencies at the Colorado Medical Center. They are proactive. When I just mentioned I wanted to lose weight in my initial interview I received a phone call following up. When I came home from Florida there was a note saying I had to call to make an appointment for my annual checkup. Does this sound like a bunch of screwups to you? Not all apples in the barrel are rotten. It just takes a wily veteran to understand this.

As always
Ted The Great.

Factoids;

There are three distinct areas of the Department of Veterans Affairs.:Medical, Benefits(such as disability and GI Bill) and Burials and Memorials. It employs just under 300,,000 people. It has an annual budget of approximately $90 billion.

There are 21 million veterans in the US today. Approximately 3/4 of that group has served in a war or time of conflict. The responsibility to care for veterans, spouses, survivors and dependents can last a long time. Two children of Civil War veterans still draw VA benefits. About 184 children and widows of Spanish-American War veterans still receive VA compensation or pensions.

I pay a copay on any visit to a specialty based on my income. I have a copay of $9 per month per prescription. They can change the drugs to a similar or generic at their option. Because of this the VA pays approximately 40% less for drugs than Medicare Part D.