[A quick disclaimer: Although I write a lot about the ACA, my professional expertise is in the funding of healthcare, primarily through insurance scemes. So my usual “trust me, I know what I’m talking about” approach I normally take does not apply here. Anyone who knows a wee bit about Veterans Affairs knows more than I do, and should speak up in the threads.]
I want to make a pitch for closing down our country’s Veterans Affairs hospitals (VAH) as soon as possible.
My experience with VAHs is both tenuous and indirect at best, and is actually a function of my depositing checks. I’ve have been a member of my credit union since I was first out of college and my customer loyalty to them is fierce, but they do have one flaw: They don’t have that many locations. Since we moved a few years ago, the closest location is located in Portland’s VAH. Almost all of our banking is done electronically these days, so it’s not that big a deal. Still, every now and then someone gives us a check for something. We let these pile up until there are enough to justify a bank run, and then we deposit them — usually at the VAH.
Every time I go to the VAH, I get angry. Everything about it seems to ooze an FU to the men and women who have served our country.
First off, our VAH is located in the center of Portland’s West Hills, where the Rose City’s wealthiest citizens live in the region’s most expensive homes. The VAH, on the other hand, caters to those on the lower end of the income spectrum. What’s more, it isn’t near any high-traffic commuter roads. So although public transportation does go to the VAH, those most likely to need to use it have to use multiple buses to get from where they live to get care. A trip to the doctors can literally take three hours of accumulative transportation time for some.
Those who can drive themselves don’t fare that much better. The VAH has a parking garage, but it’s not nearly big enough to accommodate the number of patients it sees on a daily basis. And in that kind of platypus-by-committee thinking that so often plagues large bureaucracies, the VAH administration’s attempt to address this issue has actually made the problem worse: They repainted the parking lines to fit more spaces in, and to maximize the number of spaces they’ve drawn them to be just slightly bigger than the width of a compact car.
Here’s what that looks like:
Keep in mind that the average VAH patient tends to be at least one of three things (and often all three): elderly, overweight, and lacking full mobility. Watching them attempt to park, try open their door enough get out, and then try to squeeze their way out of spaces that are difficult enough to navigate if you’re young, spry, and don’t need a cane makes you want to go find an admin guy to punch in the face. Worse, VAH patients tend to own older cars that have larger bodies, and they skew heavily towards blue-collar vehicles such as GMC trucks and circa-90s Chevy SUVs. Sometimes after a patient has parked, a new car replaces the one they were parked next to and parks so close that they can’t even open their doors, forcing them to wait until the new driver comes back and moves their car.
And that can take a while.
I tried taking pictures in the waiting rooms but was quickly told by security that I was not allowed, so you’ll have to take my word on this: The waiting room is packed, and a number of those with walkers and canes are forced to stand for long periods of time, because there are only so many chair to go around. The hallway that leads to my credit union’s branch passes an office that deals with some kind of patient paperwork, though I don’t know what kind. What I do know is that line of patients holding paperwork often goes right out that office’s door, and snakes throughout the hallways. God (and hundreds of VAH patients every day) knows how long it takes to go through it.
It’s worse than awful; it’s a slap in the face to those we promised to take care of in exchange for putting their lives on the line to take care of us. And I know that the response from the VA folks would be, hey, we only have so much money to work with.
Today, however, it hit me: With the ACA, why do we need to have VAHs at all? Why don’t we just do away with them forever?
Lower income veterans could begin to go to hospitals and clinics closer to where they lived that wouldn’t treat them the way industrial farms treat livestock. Other aspects of V.A. services wouldn’t need the kind of infrastructure a hospital needs, so those services could be severed from the healthcare component and moved to places more convenient to those who utilize them. We can even have the government lease the buildings and equipment to other government or non-profit healthcare organizations.
In fact, the more I’ve thought about this today, they more I think there has to be something I don’t understand about VAHs that has prevented this from already happening.
Can anyone here tell who knows more about this kind of thing tell me why this is a bad idea? If not, why don’t we do this?