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Comment by Asbostos | Hacker News Reader

Can't you use normal healthcare? Soldiers aren't given insurance like other employees?

It wouldn't be free.

Loved or hated, the VA is a large HMO set up as a benefit for veterans to help them because many of them have had to sacrifice their personal health to fulfill orders their were given.

Any healthcare system is riddle with anecdotes of failures, but if you look at it from a population health perspective, as a whole the VA has been able to care for its patients with a pretty good quality if you consider the cost constraints they are working with. I'm not aware of any private health system that's as efficient as the VA.

Also, the VA has had a fair amount of innovation that then trickles down to the rest of the healthcare systems. One example is BlueButton, a method to obtain a dump of all your healthcare records as a patient. Eventually CMS (Medicare) enhanced it and started promoting for everyone else, under the spec "BlueButton Plus".

From what are you basing your opinion about the VA being able to take care of its patients with "pretty good quality"? Are you a veteran? Have you actually used VA services? As a former NCO and one of the first in my unit to get out of the service, I have led about thirty or forty guys through getting healthcare at various VAs around the country. One of those guys is now dead because of the VA, and the VA is explicitly forbidden from being sued for murdering patients, or from firing people for making those kinds of deadly mistakes. My guys wait months for appointments, and people die while waiting years to see specialists at the VA. Whatever you have read about the VA is plainly wrong, if it leaves you with the impression that their care is of "pretty good quality".

I am sorry to hear about that wrongful death. Nobody deserves that.

On that topic, the US as a whole ranks 24th in the world in terms of preventable deaths[1], and we spend twice per capita as the highest-performing country on the list. Our healthcare has A LONG WAYS TO GO to improve.

Back to the original topic, I'm not speaking from the POV of someone having experienced the VA care system. I'm speaking from having worked in population health. Quality is defined by specific measures that compare in aggregate the outcomes of patients given particular co-morbidities. That doesn't make it perfect, it just means that as a whole, the VA treats people as good or better than the private system.

As for wait times to see providers, keep in mind that many people on the private system may be able to see specialists but just can't afford it, so they never get treated... until it's too late. Part of the quality-based initiatives are to nudge providers (via reimbursements/penalties) to treat things while it's early enough, both for the health of patients and cost reduction—instead of waiting for complications.

[1] http://www.oecd.org/officialdocuments/publicdisplaydocumentp...

I am genuinely curious: Do you have links to more information about this aggregated health information? I would like to understand your perspective, but my prejudice against the VA system is telling me there may be an end-run around on a technicality, for example does the VA population count all veterans in their population, even if they have never sought healthcare at the VA? Does it exclude certain patients that otherwise would negatively affect the data? I am having a hard time accepting that the VA produces a population about as healthy (in aggregate or not) as the regular American population, especially given the conditions largely affecting only combat veterans (Agent Orange, Gulf War Syndrome, depleted uranium, Project SHAD, TBI, PTSD, etc), and the number of veterans with these conditions.

Unfortunately I don't have the reports handy but one of things is that they achieve outcomes similar to private health systems given much less money per capita.

Outcomes do take into account the starting conditions ("comorbidities") so this doesn't necessarily mean that the actual health of that population is better than average population. Because as you pointed out, service people get a pretty raw deal when it comes to occupational hazard. ;(

Additional info:

RAND analysis about VA and non-VA care -- http://www.rand.org/blog/2012/08/socialized-or-not-we-can-le...

Meta-study commissioned by the VA looking at existing studies comparing quality of care in VA and out of VA -- http://www.hsrd.research.va.gov/publications/esp/quality.pdf

Thank you, these links are very interesting.

Part of the social contract with our (USA) soldiers is health care. Just as the treaties say the US government will provide health care to the Native American tribes. The US has done a horrible (criminal, really) job of it.

As this point the US should give the veterans the same insurance place Congress gets.

More like Congress should get their healthcare from the VA. That would get things fixed in a hurry.

Probably, I would prefer they must get their health care from Indian Health Service (google: "don't get sick after june" for a nice explanation). But, either would hopefully put some fear in them.

VA is for veterans.

Most of us use our own health insurance from our jobs because the VA is absolute garbage.

I use the health insurance provided by my employer for the things that the VA could kill me for. When I first got out, I used the VA for everything, until I learned how truly awful the system is. Now I only use the VA for physical therapy and psych stuff, but no medication. All my medication and everything else is taken care of using my normal insurance.

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