Tag: VA

The MLLG Collection – Short Takes

George Noga
We accumulate numerous blog-worthy topics too short for an entire posting.
From time to time we present an eclectic collection of such pithy morsels. 
The MLLG Collection – Short Takes
By: George Noga – February 15, 2017
1. Veterans Administration: During the 2013 VA scandal, veterans died while waiting for appointments. In response, Congress voted an extra $15 billion to reduce wait times and to make it easier to fire bad employees. So, how is that working out? Wait times today are 50% longer. Private physicians see up to 8 times more patients than VA docs. In one VA office (Phoenix) 13 employees make over $300,000. The few employees fired for severe misconduct have been reinstated upon appeal. You shouldn’t be surprised; this is simply government as usual. Solution: abolish the VA; move veterans into Medicare and use VA facilities for long-term care and for treating PTSD.
2. Oil Prices: Prices plunged 70+% from recent highs and oil company profits dropped 50%. What happened to all the speculators and price gouging? If energy companies manipulate prices when they are high, why aren’t they doing it now? If they are villains when prices are high, aren’t they now beneficent angels? One thing is certain: when prices rise again, progressives will demonize speculators and oil companies.
3. Vaccinations: The nanny state intervenes in many aspects of family life when there is no public health or safety danger and even when risks are statistically nonexistent. They ban teeter-totters, jungle-gyms and require sawing off limbs under 8 feet high to prevent tree climbing. They ban many toys and outlaw blowing up balloons for kids under 14. They have infantilized America. Yet, in the one area (vaccinations) where government intervention truly is necessary, they are AWOL. Communicable diseases are spreading like wildfire but government panders to anti-science movie stars and progressives ensconced in liberal enclaves who are spreading disease. If the push back were coming from evangelicals in flyover America, the reaction would be different.
4. Source of World Peace: Peace among nations is not achieved by disarmament, weakness or even by treaties. The rare times when peace prevailed was when it was imposed by a powerful nation, e.g,, Pax Mongolica, Pax Romana, Pax Brittannia and, until recently, the Pax Americana. The clear lesson is that peace is not the absence of power but it is a condition imposed by power. War is a terrible thing, but not the worst thing. It is worse to believe that nothing, even loss of freedom, is worth fighting for.
5. Obamacare Not Insurance: One stupid-crazy part of Obamacare is not often discussed. The ACA covers 100% of many small, ordinary and predictable medical expenses such as flu shots, annual physicals, birth control and 15-20 other procedures. However, if you break a leg, the ACA subjects you to high deductibles and copays. This turns insurance on its head; routine expenses are fully covered but a serious injury, when you really need insurance, can cost over $20,000 in deductible and copays. This is akin to your homeowners insurance paying in full for broken windows but charging you $20,000 in deductible and copays if your house burns to the ground.
6. Chick-fil-A: Progressive mayors of many liberal enclaves (New York, Boston, San Francisco, Chicago) are trying to ban Chick-fil-A because its owner once opposed gay marriage – as did Barack Obama at that same time. Perhaps mayors of conservative cities should ban Ben & Jerry’s for its socialistic views. It would be interesting to see progressives’ reaction to such a move. Why stop there? Why not have only liberal companies permitted in California and only conservative companies in Texas?
Next on February 19th is our post: Americans voting with their feet. 

MLLG Special Posting – The VA Scandal

George Noga
By: George Noga – June 3, 2014
        The MLLG blog, usually written far in advance of distribution, has never devoted an entire post to a current, breaking news story. The Veterans Administration (“VA”) scandal is the exception because it is the perfect storm: (1) it is the poster child for public choice economics – a frequent topic of MLLG posts; (2) the VA is a sacred cow beloved by liberals; and (3) the scandal provides a stark preview of ObamaCare. Finally, the VA issue fits MLLG’s forte, placing a complex issue in perspective through fact-based and principled analysis – and all in about 1,000 words.
“The VA is a government jobs program that incidentally provides health care.”
        To be fair, the problems with the VA go way back – preceding the Omar Bradley Commission of 1955-1956. There have been 18 reports warning of the wait time problems just since 2005 – of which 70% occurred during the Obama Administration. Although Obama did not create the problems, his ineptitude and obeisance to public unions raised them to a new level. Also to be fair, the VA is not uniformly dismal and enjoys support among many vets – not altogether unsurprising from an agency that has $154 billion to dispense and which often certifies routine aging problems (heart disease) as service related and certifies maladies of dubious provenance as eligible for tax-free disability pensions.
“The real scandal is that the VA considers a 14 day wait to be very satisfactory. Throughout the private sector, wait times are measured in hours and not in days.”
        The VA problems have nothing to do with money. The VA budget has gone from $49 billion in 2001 to $154 billion in 2014. Just since 2003 the VA budget is up 106%, while the number of vets increased 30%. The government tends to throw money at the problem; but, just as with failing schools, no amount of money can ever fix the problem.
Real Causes of the VA Problems
        The cause of the VA mess is easily and fully explained by pubic choice economics which teaches that people respond to personal (not public) objectives. An illustration from the Soviet Union is instructive. Glass manufacturers in the USSR made windows too thin and they tended to break easily; they did this because they were evaluated based on the number of square feet of glass produced. To fix this problem, the erudite commissars changed the evaluations from square feet to pounds of glass produced. Thereafter, the factories began to produce uber thick windows with limited translucence.
       We can chuckle at the clueless Soviets, but the VA is no different. They were evaluated based on patient wait times and they responded in accordance with public choice theory – they rigged the system for their personal benefit. This is no different in principle from changing the thickness of glass due to different incentives. No one should be surprised. Of course, private sector workers also respond to personal incentives; however, business does a much better job of aligning personal incentives with those of the organization. Hence, it would be rare in the corporate world for endemic problems like those at the VA not to be immediately reported up the chain of command where action would be swift and where the failure to report negative information also would carry swift and strong personal disincentives.

        Following are some other more salient causes of the VA problems, although all are readily explainable by the theories of public choice economics.

  • In some VA clinics physicians see only one-eighth (12.5%) as many patients per day as in private practice. Each day the operating rooms are shut down by 3:00 PM. The VA is essentially a government jobs program that just happens to provide some health care – after patients wait 145 days and provided it is before 3:00 PM.
  • The VA is 70% unionized with over 200,000 unionized workers. Obama and the Democrats put the wellbeing of  unions above veterans. Public sector unions have hijacked the VA for their own aggrandizement.
  • Union work rules and seniority cause serious problems as, inter alia, unions have squelched outsourcing VA patients to reduce the backlog because outsourcing is a direct threat to union jobs.
  • VA scheduling software uses a DOS operating system – found only in museums – and 1990s era computers.
  • As to be expected, waste, fraud and abuse are endemic given the vast amount of funds and no accountability.
  • The wait time (Phoenix) to see a physician was 145 days from when a patient requested an appointment; much longer counting the entire process. The real scandal is that the targeted wait time (considered satisfactory) was 14 days. In much of the private sector, wait time is measured in hours, not days. In the early 1990s Kaiser Permanente had a 55 day wait but changed to same day scheduling. Within a year they reduced the wait time to one day.
Real Solutions to the VA Problems
        The near term future is as predictable as a Kabuki. First, liberals will claim the Shinseki resignation  brings closure to the problem. His resignation was forced not by Republicans but by Democrats up for reelection who desire to make precisely that argument. Second, there will be some short term patient outsourcing but it will end just as soon as the problem fades from view – the public sector unions will see to that. Third, government will throw some more money at the problem and they will claim victory. These raison d’etat actions will succeed in getting the issue off the radar screens of the toothless media watchdogs (and the public) until well after the next election.
“Worst of all, the VA is a precise microcosm and road map for ObamaCare. What is harming 25 million veterans today soon will afflict all 315 million Americans. Some, perhaps many, of us will die while waiting 145 days or more for an appointment.”

        The real solution, dear readers, will never happen. There is little or no raison d’etre to have a separate health care system for veterans; this makes no more sense than having a separate medical system for any other profession or line of work. To the limited extent veterans may need certain highly specialized care (such as for prosthetics), this could be accomplished via a small number of – preferably private – facilities. Care of veterans should be integrated into the civil health care system much the same as Medicare. At the very minimum, all acute care shoud be privatized and voucherized, with the VA maintaining only rehabilitation and long term care facilities. Following are the main takeaways:

  1. There is no logic for a separate VA health care system; it must be completely or mostly integrated into the  private economy – especially the acute care portion.
  2. The VA problems can never (and will never) be fixed because government is incapable of such fixes.
  3. Liberals and Democrats never fix anything – real fixes are not important; all that counts to them are intentions.
  4. Everything is predictable and explainable by reference to public choice economics.
       Worst of all, the VA system is a precise microcosm and road map for ObamaCare. Each and every problem identified in this post will be multiplied in spades for ObamaCare. The disaster that now is preventing veterans from getting care and, in some cases, has killed them, will be inflicted on all 315 million Americans. It is only a matter of time until ObamaCare makes all Americans wait 145 days (and likely more) to get an appointment and many will die waiting.