Now that the deed ‘tis done, how will it affect you? (Part II VA)

 
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Doctor Part I dealt with Tricare and DoD healthcare delivery systems, this one will deal with the VA. Anyone who has ever viewed martial arts movies (even just Kung Fu Panda) or some sort of Science Fiction TV series knows that even small actions have ancillary effects on things you wouldn’t imagine. In the former genre it’s usually the butterfly principle where some solitary butterfly in search of nectar flaps his wings three times and 2 days later there is a tsunami in Portland, Oregon. In the latter genre it’s usually the Grandfather Paradox, where you can’t change the past because doing so alters everything after that, and thus you couldn’t have gone back in time. Anyway, the point of both of these is that no solitary event occurs within a vacuum, and this is what accounts for the discrepancies in macro-economics. And so it is with the recent Health Care Reform law. I have rather solitary discussions with my VA doctors. There is unlikely to be anyone out there as hypochondriacally oriented as myself who loathes discussing their health as much as I do. I figure whatever I have is lethal, and there isn’t much I can do about it, so why bother? On the other hand, I want to know why a doctor ends up at the VA. I want to know why there are variations in the treatments I get from one doctor to another. One doctor will prescribe 90 Percocet a month, and the next one Green Tea. More so, I talk to my doctors to get a sense of how my brothers and sisters are doing at getting treatment. Next week I will be seeing my Doctor again to do a check up and get some of that miracle panacea Ambien, and I will be talking to him about what this HCR will mean to the VA. Mind you, the direct results, as Mr. Gaytan informed the viewers on Fox and Friends yesterday, will be nothing. Now, I am pleased to call Mr. Gaytan a friend, and he is right on this, or, at least as right as one can be while looking at first order effects. If you have the VA now, you will have the VA tomorrow, and in 2014. Your VA medical care will meet the requisite criteria for the care, and thus you should see no immediate impact. So, what follows is purely speculative, and is only meant to get you guys thinking, and more importantly talking and discussing. I received an email the other day which noted that when this soldier joined the military he was offered free medical care for life. And he wanted to know now that everyone is getting that if he just had his pay cut. Now, obviously he was oversimplifying, and pointing out one of the erroneous fallacies of the Obamacare package, that now suddenly, everything will be free, free, free! Some people are going to be a little surprised I think when then find out they’ll still be paying for their health insurance. It kind of reminds me of a wonderful discussion I had with our National Adjutant once who is a bit of a biblical scholar, or at least more so than I. It was a parable from Matthew (Matt 20:1-16) where a Vintner went into town and found some unemployed chaps and offered them a job to work for the day at a rate of a denarius a day. At lunch he went out and found several more that were standing around and hired them at the same rate. Again in the later afternoon he did the same, bringing more laborers into the vineyard. At the end of the day he lined up all the laborers, and paid them each a denarius. The ones who worked all day in the hot sun voiced their disapproval that their brothers who worked mere hours received the same compensation as they did. The Vintner answered: “Friend, I am doing you no wrong. Didn’t you agree with me for a denarius? Take that which is yours, and go your way.” matthew_20_13a [OK, who knew there was a lego version of the Bible? Whoever this artist is, he's REALLY good with Legos.] Now, it is hard to argue that like the grape pluckers, those of us who retired will get all that we contracted for. And thus, our obligations, responsibilities and benefits remain unchanged. However, let’s imagine our industrious vintners next visit to town. Knowing what happened the day before, would you hire yourself out at 7am, or perhaps gamble on his return at 5pm? Healthcare delivery is a large, many-facetted, open system. One might say that a plumber is unaffected by the cost of grain. However, grain feeds cows, cows produce milk, milk goes into coffee, plumbers drink coffee. Grain becomes more expensive thus the price of milk goes up thus coffee goes up. Your 7-11 or milk salesman isn’t going to just assume the costs associated with more expensive grain, they’ll pass that along as well. Maybe not in full, for instance they might all take a 33.3% cut of the profit from their product, but either way, someone will be assuming that debt. So, what happens under HCR? If the doctors end up assuming fewer profits, what will they do? Some will no doubt flee the system for more lucrative opportunities. Such is the case with the VA doctor I had. Let me state flat out that I would go to her if she were not VA. I would have paid with my private insurance, because I have never had a doctor of her caliber. But she was tired of making less money than she could in the private sector because she had to put some of her assets into malpractice insurance, and that portion kept rising. So, she did an analysis and decided that while her private practice was more lucrative in the short term, the threat of being sued and the risk from that wasn’t worth the extra pay. And so she migrated into the VA system. Good for veterans, worse for non-veterans, but on the whole, the system remained virtually the same. Will new doctors try to find opportunities within the VA? I don’t know, what do you think? group_diag2_shad Likewise, my VA has a program where they work with the Medical School at Indiana University. I have found that I universally like and respect the medical students that I have worked with. What they lack in experience at times, they make up for in youthful enthusiasm, a deep reservoir of caring, and an attention to detail that comes from trying to excel. Now, will HCR affect doctors’ salaries? I don’t know, I’m not Milton Friedman or some other economist, but many suggest that will be the case. If a young person who is excelling at school is looking at an occupation today, and is ambivalent of where they end up, would one chose law over medicine or medicine over law? And would this mean fewer med students, less caliber med students? Or would the inverse happen? A recent study suggests that federal employees make more than their civilian counterparts (except in the military.) Perhaps the cloak of security that comes from federal employ will draw more individuals to go into medicine. That certainly would be an excellent outcome for our national health, and it stands to your personal beliefs on whether that will warrant the extra money outlays to pay for that. You conservatives will no doubt say “no” and that this is not in our Constitution, while the liberals will say “yes” and it being the cost of a government insuring “life, liberty and the pursuit happiness.” I leave that to you to decide for yourself. So, to cut this somewhat shorter, and allow you to talk, I would assert these as facts: - The first order effect of the HCR on the VA is that nothing directly will change. There are some, like my emailer who will view this as a lessening in your pay, while others will side with the Vintner. - There are some details that clearly need to be worked out. Will the tax increases proposed by the law also be able to pay for the new benefits for all? And if there is a discrepancy, will John Q. Soldier, (Ret) end up paying an increased share, or if the Administration is right and this lowers healthcare costs and increases the service, will our hypothetical retiree get some of the rewards? Either way, we must all acknowledge that the signing of the law does not make this a fait accompli, and that much work remains. - Everyone REALLY needs to settle down and look at this holistically. I am probably the one that needs to do this the most. My Facebook page is replete with people bemoaning our future Socialistic collapse and others prostrating themselves to the Brave New World that is the future. Relax. With our new healthcare on the horizon, now might be a good time to stockpile some Xanax. At least some folks are making the best of it (from Politico): Now, have at it ye brave trekkers of this Undiscovered Country (little Star Trek reference there) what say you? [EDITOR’S NOTE: Part Three of this series will address some of the issues that have been brought to light by the commenters in these pieces. So, if you have a question, by all means toss it in there.]
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Not to burst the Trek bubble, but "The Undiscovered Country" predates the valiant members of the USS Enterprise by a wee bit of time. See: Hamlet's soliloquy:

"...Who would fardels bear,
To grunt and sweat under a weary life,
But that the dread of something after death,
The undiscovered country, from whose bourn
No traveller returns, puzzles the will,
And makes us rather bear those ills we have
Than fly to others that we know not of?..."

So, really it's Death. Kind of a morbid thought, but there it is.

As to HCR, we kind of have to wait and see. I think that veterans have been given some promises, but a wise man once said:

There is an old Russian proverb: Trust but verify.
~Ronald Reagan
"Doveryai, no proveryai - trust but verify."

Clearly the talk about health care reform on this site repeats the Fox spin (Republican spin). If the facts aren't bad for Vets, then speculate and talk about fairness parables. Make them feel like finding a way for others to afford health care is somehow not fair to Vets if they don't get anything out of it. I have noticed this bias before, and am no longer a member, so you have an excuse not to print this.

The base reality is "there is a cost to everything". Where is this Trillion dollars coming from? In theory, the federal government has a specific amount of money to spend each year, the amount collected in taxes. Each year the budget is thrashed over in allocating this amount over a variety of needs. The VA, my provider as I am a disabled veteran, is in a unique position of having its budget reviewed each year and being vulnerable to budget freezing or reduction. Such is the fate of a non-appropriated Department. It goes without saying that, in spite of the supportive rhetoric from politicians, the VA budget is hammered into submission each year. As the reality of the actual cost of HCR becomes apparent, there will be a scramble to find funds for HCR so our politicians can save face. There always is. Note: I include Mr. Obama as the orchestrating politician.

I am proud to be an American Veteran, proud to stand among so many brothers and sisters. I am proud to be a member of the American Legion and Disabled American Veterans. I am not proud of the folly that our political system has become. It is an embarrassment. Politicians have lost credibility. I do not see where they are serving the interests of the American people. Yes, I am concerned what the effect of HCR on the health care of our military, active and veterans. As an American first, I am concerned what the effects HCR will have on our country as a whole. I see runaway costs, bureaucratic inefficiency and mis-management, loss of individual rights, etc, etc, etc.

Thank you for your articles and I look forward to more in the future. God bless our Democracy.

John, I think you fairly clearly missed the point of the parable, since I was saying EXACTLY what you are, that veterans were NOT hurt by this. And I resent the implication that I would remove a comment. Hasn't happened yet save people who were spamming, and won't be happening here.

Do you really think doctors only go into medicine for the money? I have to believe that there is more to it than that.

No veteran joined the military simply to "see the world."

People are going to do what they want to do. Usually people who are good at their job - quality employees aren't performing for the money. They are performing because they are passionate about their job. A good doctor is good because they like to help people, not because they only accept patients who pay cash!!

I stand firm in my belief that "John Q. Soldier, (Ret)" will end up paying an increased share without health care reform. Thus, why should he complain about any regulation of that increase imposed by the reform?

Lastly, I do hope that we can all agree on one thing - the childish behavior going on right now on the hill is completely out of line and ridiculous. If everyone who didn't get their way in the workplace went on strike, nothing would ever get accomplished in America!

Jane, do any individuals join the military for college benefits?

Do folks who excell in school routinely embrace an occupation of fry cook?

I have no idea what you are saying in the next para.

I will neither agree nor disagree with the final statement, because it is so imprecise I know it would be used to bludgeon me later.

The question that was asked in the Fox video with Mr. Gaytan isn't really answered in the video or in this article.

I believe the question that is asked is not will I loose my VA/Tricare or Tricare for Life benefits; but will I also have to PAY for insurance to satisfy the requirement to have health insurance and hence not be penalized?

In other words, how will a Vet prove to the federal government that they have “health insurance?”

Doug, No. Either your TRICARE or VA will meet the Minimum Requirements under this bill. So, whatever you pay now, even if it is zero is what you will pay tomorrow, unless there are fluctuations in the premiums themselves. But you will not be required to buy anything extra.

How often do you write your blogs? I enjoy them a lot 9 1 7

If everything is okay, then why did the leadership reject an amendment to the bill that specifically states that TRICARE for Life mets requirements. If Medicare takes the whack used to show "We are saving the taxpayer money because this bill REDUCES costs!" & then the 21% whack goes into effect as Congress goes on vacation, tell me that All is well in Zion. A companion bill was also submitted when the amendment was rejected. It can't get actioin in committee. You are no doubt correct that it wll be "fixed" but then we are back to affordability.
On the non-vet side of things, many of us knew that we had a "pension" coming from our 20+ years of military service. Factoring that in, we either worked for a company or ourselves to enhance that retirement income so the "golden years" would be comfortable. We also wanted to provide for the bride should she outlive us. Now, as we are there & paying lots of taxes each year, we are told that we need to help pay for medical insurance coverage for families (who can't afford it) making up to $88,000/year. Right!! Happy April 15th to all of you on that one. Looking past our own interests brings us to the screw job our kids & grandkids are getting put to them. For all of you that think this bill is not going to have impact on you & yours, enjoy the Kool Aid. The really sad thing is that voting along party lines were a retired Navy Capt. & a retired Army CSM. If the CSM can get a couple of more terms in Congress, he won't give a hoot about TRICARE for Life because he'll be in the "we are exempt for what the unwashed have" plan. STCM(SS), USN, Ret.

I watched with interest today a Fox News debate where a young lady admitted that insurance premiums for young Americans would rise 17% but she was confident that the tax credits they received back would nullify the impact to them. Uh, so if I pay $200 more for insurance, but then receive a $200 tax break because of this there is no impact on me? Where is that tax money coming from? Oh, maybe my taxes will go up instead, so the difference in my premium was nullified which means my healthcare wasn't adversely affected by the HCR, just my taxes! Sounds like a shell game to me. I imagine as vets we'll see the same thing, get tax credits back because of higher premiums only to be taxed somewhere else, but because it's not a tax on health care our political leaders can look us in the face and say our health care benefits weren't adversely affected. Admittedly, this is all supposition right now but for everyone who is drinking the HCR Kool Aid and enjoying it let me know how it works out for you in the next few years, if your premiums and taxes don't go up you win, but I'll bet you'll see major increases in at least one probably both.
You can say the HCR is great, and that the Obama Administration has our (Vets) best interests in mind, but it was our veteran service organizations (American Legion, DAV, VFW, etc) that fought and insured the language in the bill supported us to some extent. There is much debate as to what the administration actually had planned but because most of the negotiations were conducted behind closed doors counter to Obama's promise that all healthcare debates will be on C-Span (which when asked about it he beat around the bush on his answer) we'll probably never no what they really tried to do, we just have the outcome in the new law. I do know he broke his promise that "Any bill that comes before me I want the public to have 5 days to review it online." once the House passed the Senate HCR bill on Sunday he should not have signed that bill until Friday, but he signed it on Tuesday and he did it again with the reconciliation bill, so in less than two weeks he broke his campaign promise twice. What's the old saying "Fool me once, shame on you, fool me twice, shame on me, fool me a third time I'm obviously a gullible fool". Well we're all fools because even before he signed the HCR & Reconciliation Bills into law he had broken the 5 day promise several times in less than a year.

While I’m talking about revenues to fund programs and their impact on our national debt I’ll throughout a thought; how about this for an idea for federal taxes. We work to earn an income; that work is a product, doesn’t matter if it’s a widget, office work, or a phone bank something is done or produced. So when we work we produce income, hours worked equals income for oneself and the product produced for one’s employer is income for them. OK why not tax income like a product? The same percentage rate applies whether I buy a BMW or a Sicon so why not the same with income? If I make $15.00 an hour or 200 million a year I would pay the exact same percentage of my income relative to anyone else. Now the critics will say that that will stifle or constrict the growth of wealth or investment or innovation and remove the drive to climb to the top because it will cost you more of your product. BS if anyone thinks that greed would be stifled by this just look at other parts of the world where taxes are far more proportional to income across the wage spectrum, if one wants more money one will work to get more money always have always will. If there are happy at whatever income levels they are at then great but don’t make them pay an un-proportional amount of the gross product, everyone needs to pay the same percentage for their portion of the GDP with regards to income. If 4,000,000,000 units of a product were produced and 1 to 5% had 90% the product they would have paid 90% of the products taxes. Per unit they would have paid the exact same amount as anyone who got that product. But this seems far too rational to ever make it in our society; those with the 90% are not going to give up any of their tax breaks. As it is now the top 2 -3% do pay 45 or 50% of the national taxes but they hold over 90% of the wealth so the other 10% are paying the balancing 50%. I if got 90% of the pie and only had to pay for half of it I would fight any change too.

Although I read your entire article, your clip from Fox News (er, editorial channel) immediately raised the hair on the back of my neck. No one should believe what they report as 'facts.' As for VA Healthcare, remember it was changed shortly after Bush led us into Iraq post 9/11. Most of us became Category 8 veterans, and were (are) no longer eligible for VA Healthcare. Only by qualifying with a military-related disability are I and others now able to access the healthcare system we were told we had for life when we enlisted. I credit The Legion and other veteran organizations for sponsoring those of us who had to go through the process to obtain VA Healthcare.

The HCR bill will only work if the inclusive clause is left intact, everyone will be required to have some form of health insurance that meets the bill’s impact on our national debt. Everyone who owns a car driven on public roads is required to have a minimum of insurance. If the vehicle is financed then you are required by the lender to fully cover the car, truck, boat… if you own it outright then there are state minimums that you must maintain for coverage; if you own a house then you have homeowners insurance and possibly flood again required by the holder of your note. You may never have an accident or get a traffic violation your entire driving career “but” you will still be required to posses the minimum insurance, likewise for a house throughout the life of its note. So why not health insurance? Just because a person is healthy, never sees a doctor, and feels they have no need for insurance does not mean that they should not carry at least a minimum of some form. An single trip to an ER for even the smallest accident will cost (under our current billing system) over a thousand dollars on average (hospital bill, ER bill, doctors bill, labs, X-ray…) it’s going to be charged to someone and in the long term it ends up on the tab of those with insurance with higher premiums. That’s how the auto insurance works, your homeowners so does anyone think that if something is not done to change the current healthcare system premiums will not continue to climb? My son-in-law just had his company (a major DOD provider) premium almost double along with increases in their co-pays. Why, well maybe the insurance company has lost so many subscribers in this economy that they readjusted their plans to keep corporate profits at pre-slump levels (yes I am cynical to the motives of health insurance companies). If we use hospitals that cannot turn injured and sick people away then how does that differ from requiring protection on our car from use to others or others to us? How many drive without uninsured motorist coverage? Think about the millions of uninsured people out there, sure some of them will receive various forms of coverage for free or very little out of pocket costs but with a sliding scale according to one’s income and depth of coverage the system would be viable, fiscally responsible, and “finally” finally this country might move up to the rest of the developed countries in regards to access to quality healthcare, or we do nothing and remain ranked with most of the third world countries it’s our call.

The HCR is magic isn't it. I have never care for magic. Magic is based in lies and trickery. It works by mass consensus. Fool the masses and everything works.

The FED will inflate the dollar but that's alright as long as the world inflates their currencies. The FDA will dumb down the countries specifications for quality food ingredients and the world will raise their standards as well as their income. The manufacturing and building standards will be lowered for American products till you can tell the difference between Made in China and Made in USA. The jobs will go out of country but services will provide work for everyone. It's magic.

The only problem is if you don't believe. I believe in the Constitution of the United States of America. I believe that rule over the citizens of the USA should be by law. I don't believe that what Congress did in 2010, HCR, was in the spirit of the Constitution. They passed a law that delegated their responsibility to government agencies that remain isolated from citizen approval. Like it or not theses agencies are writing the laws as policies of the agencies. I can envision all kinds of nightmare scenarios coming from this.

I am a Veteran and this Xgeneration is telling me I can't smoke where I've been 'allowed' to smoke for twenty years. What is next?

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News from the World of Military and Veterans Issues. Iraq and A-Stan in parenthesis reflects that the author is currently deployed to that theater.