It looks like the 8-bed acute psychiatric unit at the VA Hospital in Canandaigua is going to be closed. The Democrat and Chronicle reports that it's a done deal, while the Messenger-Post says the final decision is due this week.
The VA hospital, which has long been under the threat of complete closure, became a political issue in the 2006 campaign. The announcement that it would remain open was timed suspiciously close to the election, and it was quickly followed by the news that the acute unit would probably shut down.
In the Messenger-Post article, Kuhl spits and sputters, saying "I completely disagree with the closure of the acute psychiatric unit and everything about the process the VA has taken to get there." Eric Massa also fulminates over the expected closing in a post on his 29united site. I think both are missing the big picture on medical care for Veterans.
Since many psychiatric emergencies are also medical emergencies, an 8-bed acute care psychiatric unit has great difficulty existing without a nearby medical hospital. The closing of this unit was probably a foregone conclusion, considering that the nearest VA medical facilities are in Buffalo or Syracuse. Of course, using the nearby FF Thompson hospital for acute medical care (except in dire emergencies) is verboten, because VA care can only be delivered through the VA system.
The underlying question, which Kuhl ignores and Massa only partially addresses, is why Vets must receive their care in a separate and usually inferior medical system. Why must a Veteran travel to Canandaigua, Syracuse or God-only-knows-where to get care, instead being treated at a civilian hospital or clinic?
I understand that some care given by the VA is specialized. But most of it is the same medical treatment given to civilians. If we really want to honor the service of Veterans, let's give them an insurance card that gives them access to every hospital, clinic, doctor and pharmacy in the United States. Then let's pick a few really good VA hospitals to serve as specialist centers to serve the unique needs of veterans, and close the rest.
I submit that the reasons why this suggestion won't be adopted, or even considered, is that the VA system exists to ration care for Vets and to serve the needs of interest groups and politicians.
By making care for Vets hard to access, the VA system serves fewer Veterans, thus effectively rationing treatment. Those who have insurance use more convenient local facilities. Only those with special needs, or without insurance, use the hospitals. If VA care were universally available to vets, costs would skyrocket.
By creating large, government-run facilities, the VA also gives politicians plums for their districts. VA hospitals are like military bases in that regard -- they're often situated in out-of-the-way locales (e.g., Canandaigua instead of Rochester) in order to give small towns an economic boost. They're also full of union jobs, and satisfying a union is always a good thing for a politician.
If politicians really wanted to make life better for Veterans, they'd consider a complete overhaul of the way medical care is delivered to them. Instead, we get a series of mini-dramas whenever one of the sacred cow hospitals is threatened.
Comments
I know you are going to hear 'war stories' (no pun intened) about VA Hospitals. My mother-in-law, being a military widow, was suppose to have lifetime care. They closed down so many facilities, that her 'local' Venteran's Hospital was mainly for active duty service people. They encouraged her to get a 'supplemental' policy (which she would pay for) for minor problems.
You are right--I never thought about it before--to honor our service personnel, they should be able to use any facility they want.
My war story is about my wife's uncle, who had a terminal lung disease probably related to his Vietnam combat service. He moved to be closer to the nearest VA hospital for treatment.
The discussion over VA hospitals is a classic example of where we need to recast the debate. Instead of arguing over how to perpetuate this system (by protesting every hospital closure or change), we need to re-think the way we deliver care to vets. But this kind of thinking is discouraged by almost everyone involved in the debate, since most of them have vested interests in retaining the old, busted system.
Spot on! I have never envisioned delivery of care to vets at this perspective. You are definitely on to something. Too bad our leaders in DC, State, and Local lack this imagination and remain stuck in endless bickering and drama. It is truly a soap opera. St. Elsewhere anyone (my mom's favorite)?
With no disrespect to veterans, it's clear that all citizens should have the card that you describe. Medicare isn't perfect by any means, but it could easily match the coverage that a good private plan provides at a much lower cost. The VA's drug plan and its electronic record keeping are two examples of how efficiencies can be implemented to lower costs. Add Medicare's 3% administrative overhead and you have the basis for a robust national health care plan. It seems that health care providers could be brought onboard by offering them a better deal than they get from the current Medicare and private insuror system -- less paperwork and higher, stable payment.
John Edward's plan, which allows the drug and insurance companies to compete with such a system may be the only way to lessen their influence. It's unlikely that a single payer system would be starved and neglected, as the VA system has been, since all citizens would be affected. All it will take is an overwhelming victory in '08 for Edwards, or someone who has campaigned on his plan, and legislators who are not owned by the drug and insurance companies.
There is a huge VA facility right in Bath, about 1 hour from Canandaigua...you dont have to go all the way to buffalo.
Vince: It would be nice to see a national health care plan that included some reform of the VA.
Ethan: You're right - but if you live in Rochester, Buffalo/Syracuse is about the same distance (or maybe closer) as Bath.
And, nothing against Bath, but why does a little town like Bath have a huge facility while there's no such facility in Rochester? Because VA hospitals are situated for reasons other than patient convenience.