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Posts Tagged ‘Veterans’

I try not to pay much attention to the staffing decisions of President Trump’s “Boston-phone-book presidency.” Yes, I realize those choices are important, but my focus is policy.

As such, I don’t have any strong opinions on the ouster of David Shulkin, the now-former Secretary at the Department of Veterans Affairs. But I definitely have something to say about whether America’s military vets should be consigned to an inefficient (at best) and costly form of government-run healthcare.

We should never forget that the VA put vets on secret – and sometimes fatal – waiting lists. And then the bureaucrats awarded themselves big bonuses. That is horribly disgusting.

By the way, the VA scandals haven’t stopped.

Here are some excerpts from a report in USA Today.

A USA TODAY investigation found the VA — the nation’s largest employer of health care workers — has for years concealed mistakes and misdeeds by staff members entrusted with the care of veterans. …In some cases, agency managers do not report troubled practitioners to the National Practitioner Data Bank, making it easier for them to keep working with patients elsewhere. The agency also failed to ensure VA hospitals reported disciplined providers to state licensing boards. In other cases, veterans’ hospitals signed secret settlement deals with dozens of doctors, nurses and health care workers that included promises to conceal serious mistakes — from inappropriate relationships and breakdowns in supervision to dangerous medical errors – even after forcing them out of the VA. …The VA has been under fire in recent years for serious problems, including revelations of life-threatening delays in treating veterans in 2014 and efforts to cover up shortfalls by falsifying records.

So what’s the answer? How can we fix a dysfunctional bureaucracy?

The honest answer is that we can’t. Inefficiency, sloth, and failure are inherent parts of government (yes, the free market also is far from perfect, but at least there’s a profit-and-loss incentive that rewards good firms and punishes bad ones).

So it’s time to get the private sector involved. Though I noted in the TV discussion that not all privatization is created equal. If the government simply contracts with selected healthcare providers, that could be a recipe for cronyism since politicians would try to help their campaign contributors.

I much prefer the advance-funding model developed by Chris Preble and Michael Cannon, which would give active-duty service members added money, up front, to purchase a benefits package to cover future costs related to their military service.

For what it’s worth, former VA Secretary Shulkin, in a recent column for the New York Times, was very critical of privatization. But it isn’t clear whether he was referring to the contracted-out version or the advance-funding version.

I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans. …individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care. …privatization leading to the dismantling of the department’s extensive health care system is a terrible idea.

But even if you accept that he’s criticizing the less-preferred from or privatization, he definitely likes throwing rocks in a giant glass house considering the VA received ever-larger amounts of money and generated a horrible track record.

As I said at the end of my interview, a private healthcare provider might get a contract via cronyism, but it still would be a better option for vets since that company presumably wouldn’t let them die on secret waiting lists.

And since the advance-funding option obviously would be for future veterans, we do need a better market-based approach for current veterans.

I’ll close by sharing a Politico article on the infamous boondoggle that got Shulkin in trouble.

Veterans Affairs Secretary David Shulkin’s chief of staff altered an email to create a pretext for taxpayers to pay for Shulkin’s wife to accompany him on a 10-day trip to Europe last summer, the agency’s inspector general reported… The report by Inspector General Michael Missal also claims that Shulkin improperly accepted a gift of Wimbledon tickets during the trip, and a VA employee’s time was misused planning tourist activities for Shulkin and his entourage. …the VA paid for Shulkin’s wife’s airfare, which cost more than $4,300.

This obviously does not reflect well on Shulkin. But the real scandal almost certainly is that the trip to Europe occurred. We don’t know how many bureaucrats participated and what supposedly was going to be achieved by this junked, but I’m guessing the total tab was enormous and the total value was zero. The fact that taxpayers also were saddled with the cost of Shulkin’s wife’s trip merely added insult to injury.

P.S. Since money isn’t unlimited, I think the focus should be on helping veterans injured in battle rather than providing lavish benefits to anyone and everyone who ever wore a uniform.

P.P.S. I mentioned in the interview that the VA is run for the benefit of its bureaucrats. If you doubt me, check out this double-dipping bureaucrat with the triple-dipping scam.

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I’ve never been susceptible to the claim that you solve problems with taxpayer money.

Indeed, this amusing poster is a pretty good summary of my views on the effectiveness of government spending.

But what about the horrific stories about veterans dying because of secret waiting lists and bureaucratic skullduggery at the Veterans Administration?

I want to take care of former soldiers who need treatment because of their service, and national defense is one of the few legitimate functions of the federal government. So is this one of the rare cases where a budget needs to increase? That’s certainly the mentality in some quarters on Capitol Hill.

Here are some excerpts from Byron York’s column in the Washington Examiner.

Sanders and his fellow Democrats want to give the VA billions more. …What is striking about Sanders’ bill is not just its price tag but how irrelevant it is to the most serious problems besetting the VA health care system. It was like adding new chrome to a car that won’t run. When Republicans stopped the bill earlier this year, Democrats predictably accused them of being insensitive to veterans’ needs. …It’s unclear what Congress will do, but one certainty in the debate is that the Sanders bill won’t solve the problem.

But what do the actual budget numbers show?

You probably won’t be surprised to learn that the VA already has lots of money.

Here’s some of what has been reported by the Wall Street Journal.

The Department of Veterans Affairs, the agency caught in a political firestorm over its medical care for veterans, has seen its funding grow faster than any other government department in recent years. Since 2000, annual spending has tripled to $63 billion to meet a surge in health-care and other costs. That is on top of the more than $85 billion the VA is set to receive this year for automatic payments such as disability benefits and pensions, a tally that has more than tripled since 2000.

But some may argue that needs are rising even faster because so many soldiers were injured in Iraq and Afghanistan.

The Federalist addressed this issue, in an article by Sean Davis.

VA funding has more than kept up with both medical inflation and increased patient loads. An analysis of budget and cost data, as well as data on the total number of VA patients and the number of acute inpatients treated, shows that the VA’s budget has grown much faster than its workload. Even when you take medical inflation into account, the VA budget still grew faster than its patient base since 2000. …The VA has a whole bunch of problems, but a lack of funding ain’t one.

Here’s a chart from Sean’s article. Hard to argue with these numbers.

P.S. Since we’re on the topic of national defense and foreign affairs, let’s take a look at a very provocative column by Steve Chapman. He says that President Obama, whether by accident or design, actually has a reasonable foreign policy. As least if you think good foreign policy should be based on a prudent understanding of the limits of government.

Conservatives generally agree on a few propositions. The federal government should avoid spending money unnecessarily. It shouldn’t exceed its basic constitutional duties. It should encourage self-reliance rather than dependency. It should accept that some problems are beyond its ability to solve.  Barack Obama, they may be surprised to learn, agrees with much of this formula. He just applies it in a realm where conservatives often don’t: foreign relations and national security. The Obama doctrine, as outlined in his policies and his speech at West Point Wednesday, is one of comparatively limited government.

Chapman elaborates, drawing an interesting parallel to domestic issues.

A…sensible view is that the U.S. can indeed remain idle while alleged dangers gather, because most of them won’t materialize. The immortal philosopher Calvin Coolidge said, “If you see 10 troubles coming down the road, you can be sure that nine will run into the ditch before they reach you.” Many conservatives believe in hurrying out to meet all 10 just in case. …Critics charge that Obama’s foreign policy shows an unwillingness to lead, or weakness, or uncertain purposes. The same complaint, of course, could be made about conservative policies on poverty, health care, urban blight, access to housing and more. “Don’t you care?” indignant liberals ask. But sometimes ambitious government undertakings are too expensive to justify, sometimes they fail to solve problems, and sometimes they make things worse. In those instances, declining to act — and explaining why — is the most authentic form of leadership. That’s just as true in the international realm as it is in the domestic one.

I’m not a foreign policy expert, but I’m very sympathetic Chapman’s hypothesis because skepticism is always a good approach when analyzing government. And his piece on NATO is must reading for similar reasons.

That being said, I’m not going to put Obama on a pedestal or assume that he’s doing the right thing on foreign policy for the right reason. My guess is that his default position in foreign affairs is passivity.

That often coincides with the libertarian position of non-intervention. But as I wrote above, libertarians also believe that national defense is one of the few legitimate functions of government, which is why they generally were allied with conservatives during the Cold War, when we faced an aggressive and imperialistic Soviet Bloc.

My guess is that if we went into a time machine and it was 1980 instead of 2014, Obama would be more like Jimmy Carter and less like Ronald Reagan.

P.P.S. Mark Steyn also has written some very wise words about libertarian-ish foreign policy.

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