Doc H, I have nearly 30 years in practice myself, and can’t agree more the current health system is broken. ( it is actually not healthy and not a system either) but the VA is also broken to. Just finished a week long emergency medicine conference and talking to practitioners from some other countries it at least on the surface (many of the systems around the world while also far from perfect) seem to do things much more efficiently.
We definitely need to remove some of the culture that exists in at least some VA ‘s that starts with removing union protections from many of the workers, that in my exposure to the VA there were many substandard workers being protected by union rules that wouldn’t last a week in the private sector

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Originally posted by captain127:
Doc H, I have nearly 30 years in practice myself, and can’t agree more the current health system is broken. ( it is actually not healthy and not a system either) but the VA is also broken to. Just finished a week long emergency medicine conference and talking to practitioners from some other countries it at least on the surface (many of the systems around the world while also far from perfect) seem to do things much more efficiently.
We definitely need to remove some of the culture that exists in at least some VA ‘s that starts with removing union protections from many of the workers, that in my exposure to the VA there were many substandard workers being protected by union rules that wouldn’t last a week in the private sector

42 years here, and retired, but I agree the VHA is far from perfect. However to paraphrase Churchill, democracy is the worst system of government, except for all the others. Many reforms are already in place, and some of those allow speedy removal of substandard performers; it's already happening, to include Medical Directors - within days. That's an order of magnitude compared to the over six months it took me once to remove a CRNA using drugs. Dumping the entire Veteran population on the private sector is not the answer though, either ethically or financially, and there's no going back from that decision. That's why the major Veterans organizations no longer support the all or nothing idea - probably, and hopefully, some hybrid of private sector care and core VHA functions will eventually develop.

I'm familiar with a number of European healthcare systems, and comparisons are difficult because none of them are "pure" systems, being a combination of socialized medicine and concierge care, many limit access to control costs, most are subsidized by heavy taxes on the population so what health care actually costs is a guess, and none of them in my experience can accurately demonstrate outcomes equivalent to the US system, which admittedly is much more expensive. WHO ranked France as having the most efficient healthcare system in the world, and I can assure you I would rather be in an American hospital to get my appendix out. Taiwan, on the other hand with their NHI, has a lot we could emulate. What the VHA really needs is a working electronic health record system, linked to the DoD and the private sector, and a billion or so spent on replacing and repairing the infrastructure crumbling around them, neither of which will happen any time soon. It has always amazed me the quality of providers that do turn up routinely in the VHA, in spite of the facilities, in spite of the press, and in spite of sometimes less than stellar leadership. And about 30% of those providers are Veterans themselves.

The VHA is a difficult organization to get your arms around - if it were ranked in the Fortune 500, it would be the Fortune 6. It employs more personnel than are in the active duty Air Force. I wish them every success, but frankly cost will be the overriding factor in any future healthcare plan, including that for Veterans. I sincerely hope the country keeps its promise to them, and probably the most important way to ensure that is to have an organization like the VHA in the political arena to advocate for them - for us - because they will surely be forgotten as just another insurance plan on the Federal dole.