(This post first appeared in slightly different form in the Washington Monthly)
Since the resignation under fire of Health and Human Services Director Katherine Sebelius you no longer hear as much about repealing the Affordable Care Act (although certain candidates, most recently Scott Brown, continue to bring it up). But when her head rolled a lot of people seemed to feel better. Now the call is for the head of Veterans Affairs Secretary Eric Shinseki, after dozens of stories cited deaths allegedly related to delayed care for veterans at many of the nation’s 1700 veterans hospitals and treatment centers. If he is let go people may feel better. But will the issue be solved?
The so-called secret lists of veterans waiting for care is troubling, but if it is true then the system as a whole needs an overhaul. This has been apparent for some time and was previously highlighted by the conditions at Walter Reed Hospital and the delay in computerizing records. But these things most likely won’t follow merely by firing the secretary. And although Congress is calling for another investigation, at the same time recent budget proposals by the GOP reduce money for veterans, including cutting health benefits for veterans.
VA hospitals and clinics served 8.76 million veterans last year. In 2008, 37 percent of veterans sought treatment for PTSD and depression. But it is thought that at least half of all veterans suffer from these. Those who report PTSD usually also suffer from many other conditions, some of which do not manifest themselves until more than 5 years after service.
The VA is a huge bureaucracy which serves as the largest single health care system in the country. Along with men and women who served in Iraq and Afghanistan, it still serves veterans of World War II, Korea and Vietnam. Today’s veterans survive injuries that would have quickly killed veterans of earlier wars, including burns, amputations and traumatic brain injuries. And in the past ten years the numbers of vets seeking care has increased exponentially due to our most recent wars, with almost half of those veterans seeking disability compensation for their injuries.
For some perspective: In 2010 the Office of Inspector General for the Department of Health and Human Services reported that bad care contributed to 180,000 deaths of patients in Medicare alone. As many as 440,000 people nationwide suffer from some sort of preventable harm which could have contributed to their death. And that is in our civilian hospitals. Medical error is the third leading cause of death in the US.
Average wait time in hospital emergency rooms has risen. It can take two to four weeks to get an appointment with a specialist (In 2009 people waited an average of 20 days. In 2010 fifty percent of our population felt they could have avoided a trip to the ER if they had been able to get an appointment with their regular doctor People without insurance have received little or no care until recent changes with the implantation of the ACA. Before the passage of the ACA, as many as 45,000 uninsured died each year.
In many small towns, including Savannah, Georgia, waiting times to see a mental health specialist can be at least a month for a psychologist and three to six months for a psychiatrist. At the local VA clinic in Savannah, veterans wait no more than three weeks, and often less, for mental health care and walk-ins who are in crisis are treated immediately.
According to the Associated Press yesterday, a recent report indicated that the department’s internal watchdog found no evidence that delays have caused patient deaths. President Obama has appointed deputy White House chief of staff to review VA policies and procedures.
Further inquiries will be held and outrage will continue to mount until something concrete is done. This is not a new issue. But firing Shinseki is like providing palliative care for end-of-life patients: the patient will be more comfortable but he will still die. Any investigation into the VA has to result in major changes to the system as a whole which will not be possible if the problem is “solved” by yet another head rolling.