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VA care improves, but bureaucracy for veterans doesn’t

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The congressmen came to Fayetteville last week to see how well the Department of Veterans Affairs is caring for the men and women who served their country in war and peace. And even in the town were the VA has arguably improved more than anywhere, they found a work very much in progress.

The special field hearing of the House Veterans Affairs Committee was conducted by Rep. Phil Roe of Tennessee, the panel’s chairman, and by member Rep. Neal Dunn of Florida — an Army veteran who served at Fort Bragg. Both of Fayetteville’s congressmen, Rep. Richard Hudson and Rep. Robert Pittenger, also attended. All four are Republicans.

It was good to see them here, where a fast-growing population of veterans lives and gets medical care. The Fayetteville area’s veteran population has grown by 70 percent in the last 10 years, VA officials say. The VA has added more than 420,000 square feet of medical space here and hired more than 840 staff members.

But the veterans are still dealing with the second-largest bureaucracy in the federal government, and sometimes that gets frustrating. Sarah Vaughn, executive director of The Independence Fund and the wife of an 82nd Airborne veteran who lost a leg in Afghanistan in 2010, talked at Friday’s hearing about that bureaucracy. She praised the medical care her husband has gotten from the VA, but offered no cheers for the rest of the organization.

She said her husband has had to make multiple three-hour round trips to VA offices to prove that he’s still missing a leg and needs a prosthesis. He’s had long waits for repairs to his wheelchair and she’s had to fix his prosthetic leg with duct tape while they waited for the VA to approve repairs. It’s a picture of a system strangled by its own disorganization.

That’s what we heard from retired Staff Sgt. Gary Goodwin, who has needed multiple surgeries, hospitalizations and visits to emergency rooms and urgent care facilities. He sought care outside the VA in 2016 for issues connected with a surgery, and not all of those bills were paid promptly. As a result, his credit rating dropped from a golden 820 to a shaky 670.

“You can’t get a loan for a box of doughnuts when you have a credit score of 670,” he told the congressmen.

David Catoe, the assistant vice president for patient financial services at Atrium Health, told much the same tale on a larger scale for his health-care system, including the difficulty in dealing with the VA’s slow and rigid systems that simply don’t get the payment job done. Catoe recommended that the VA consider using commercial payer portals instead of trying to do the work itself.

That, in fact, seems to be the larger story that we’re hearing about the VA: It’s making steady improvements in the medical care it dispenses and in the delivery speed. But the bureaucracy is hopelessly tangled and inefficient. It sounds as if some outsourcing of billing and other clerical functions is in order.

And especially in the area of covering veterans’ health care at non-VA facilities, the bureaucracy clearly needs more help. The VA doesn’t appear to have the staffing, networks or understanding to act as a health insurer. Expecting it to add that skill to an already overtaxed organization isn’t realistic. Outcomes are too much like those Sgt. Goodwin has experienced — or much worse.

Why not let a private insurer do that job? Or even another federal agency that already does it quite well: Medicare. In places where there is little VA medical presence, why not issue veterans something we might call Medicare Part V?

Despite all the political pressure, all the funding increases, all the real improvements, it’s still clear that there are many things the VA doesn’t do well. Rather than continuing to wait for miracles, it’s time find new avenues for treatment and health services for our nation’s veterans, and better ways to make sure the entire job is being done well. Expecting the VA to be the master of all trades is hopelessly unrealistic.

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