Friday, May 30, 2014
Should We Give Kaiser Permanente a Chance with the VA?
Is Kaiser the Solution for the VA? General Eric Shinseki resigned today as Secretary of the Department of Veterans Affairs. His resignation was inevitable, but it is not a panacea for the VA. General Shinseki is not totally at fault. The VA problems have been festering for decades, but Senator Obama made a campaign issue of the VA in 2008. General Shinseki has been in office for 5½ years, but claimed today he was unaware of the problems. New leadership is a necessity, but more is needed. The culture must be changed The VA is a bureaucratic morass unresponsive to competitive pressures. Nor do the 200,000 public sector union employees fear discipline for poor performance. It is hard to change an institutionalized culture. It is a challenge to change a fossilized bureaucracy. It has to be done. Democrats are crying out for more funding, their solution to every problem - more funding for the 200,000 public sector union workers at the VA. Insufficient funding? Congress has been throwing money at the VA for a decade. The VA has the fifth largest budget of government agencies. Its funding raised 235% from 2001 to 2013. The budget was $45 billion in FY 2001 and $150.7 billion in FY2014. The medical budget rose 193% during this period. Insufficient funding? The VA has been returning hundreds of millions of dollars annually in recent years of unspent medical funding. Insufficient funding? The VA has scores of unfilled medical positions, 400 alone in primary care. Insufficient funding? The VA has 19,000 physicians. Insufficient funding? The VA’s per patient spending increased 27% between 2008 and 2012. The VA has 8.8 million patients, up 1.7 million in a decade. The government appropriations have more than kept even with the rising patient total. Insufficient funding? Redistribute the $190 million in bonuses the VA employees gave themselves last year for outstanding performance in the medical centers. The VA has received bipartisan support in recent years with an ever increasing budget. It was not subject to the sequester. Funding without accountability is a disaster. More funding without a change in culture, without accountability, will accomplish nothing. The closest counterpart to the VA in the private sector is Kaiser Permanente, the largest managed care operator in America. Kaiser operates in 9 states and the District of Columbia. It has 8.9 million members, 167,000 employees, 14,600 physicians, 37 medical centers and 611 medical offices. It has $1.6 billion in profits on $47.9 billion in revenues. Kaiser serves 100,000 more patients than the VA, but with 4,500 fewer physicians and a much smaller bureaucracy. The Kaiser computer system allows physicians in any Kaiser office to pull up the records, including lab tests and X-rays of any patient. The VA cannot upgrade its antiquated computer system. Patients will often be unable to make an appointment with their personal care physician on short notice, but the Kaiser facilities have two daily alternatives available. A same day appointment can be made with the available physicians or the patient can walk into an urgent care facility. The patient may have to wait awhile in the waiting room before being seen in urgent care, depending on the severity of the problem, but the patient will be seen that day or evening. Lab tests and X-rays are performed the same day, but special tests have to be scheduled, but to the best of my experience usually within a week. In a county, such as Orange County where Kaiser has several facilities we have several options available. Kaiser has to compete with other healthcare providers. The VA has a monopoly. The unions are as opposed to letting veterans seek care outside the VA, such as with vouchers, as they are with vouchers in education. Their know their VA facilities and public schools cannot compete private facilities. If the government cannot provide adequate medical to our veterans, then how can a “single provider,” the goal of liberals, provide medical care to 340 million Americans? It cannot. Give the private sector a chance. Give the vets vouchers. Contract out some operations with Kaiser. Bring in Kaiser execs as consultants to meaningfully reform the VA delivery of healthcare services.