Happy Veterans' Day

by hilzoy

Rachel Nardin in the Boston Globe (h/t Christy at fdl):

"According to a study by some of my colleagues at Harvard Medical School, to be published in next month's American Journal of Public Health, nearly 1.8 million veterans had no health insurance in 2004, up 290,000 since 2000. An additional 3.8 million members of their households were also uninsured and ineligible for care at hospitals and clinics run by the Veterans Health Administration of the Department of Veterans Affairs. The 2006 data released this year show little change in these numbers.

Many uninsured veterans are barred from VA care because of a 2003 Bush administration order that halted enrollment of most middle-income veterans. Others are unable to obtain VA care because of unaffordable copayments for VA specialty care, waiting lists at some facilities or the lack of VA facilities in their communities. Almost two-thirds of uninsured veterans were employed, and nearly 9 out of 10 had worked within the past year. Most uninsured veterans were in working families. Many earned too little to afford health insurance, but too much to qualify for free care under Medicaid or VA rules.

The VA is a rare success story in our healthcare system. The system offers more equitable and higher quality care than the average care in the private sector, and has become a medical leader in research, primary care, and computerization. Studies in the Annals of Internal Medicine and elsewhere have shown that compared with patients in HMOs, a higher percentage of patients at VA facilities have adequate control of high blood pressure and diabetes, and receive appropriate medications after a heart attack. So it's not the quality of care that veterans receive that's the problem; rather, it's their restricted access to care."

This is just shameful. Guess how much a veteran without a service related condition or recent combat service has to make to be excluded from coverage? $27,790 for a single veteran, and $37,082 for a family of four. (According to Congressmen quoted here, the limit can be higher in some parts of the country. However, the VA website does not mention that fact, so even if it's true, it's not clear that it's adequately publicized.) That's not a lot of money if you want to buy health care in the individual market, as people who don't have access to health care through some other source have to do. In 2005 (pdf; p. 8), 54% of people with individual insurance (as opposed to insurance provided by a group or an employer) had annual premiums over $3,000, and 32% had annual premiums over $6,000/year. In California in 2006 (pdf, p. 17), the average premium for individual coverage was 3,108 per year. Since those plans covered just 54.6% of health care costs (p. 15), the average total expenditure on health care by Californians in the individual market in 2006 was $4,933 (p. 17). That's almost 18% of the income over which a single veteran is excluded from VA coverage.

Personally, I think it was wrong for the Bush administration to start excluding veterans from VA care in the first place. But they did. As a result, 12.7% of veterans had no health insurance in 2004 ("the most recent year for which figures are available.") We owe them better than this.

Luckily, Rep Steve Rothman and Sen. Patty Murray have introduced legislation in the House and Senate that would extend VA care to all veterans. This would cost money, but, as I said, we owe them. I would gladly see my taxes raised a bit to pay this debt.

Happy Veterans' Day.

Comments

[John Thullen]

I missed the very interesting "Liberal Hatuh" thread ......

........... but this post, Hilzoy, illustrates the INTENDED consequences of conservative, cheapskate thinking. Not to mention the unlimited UNNECESSARY Evil that results when the necessary evil of limited gummint is imposed on people who expect to get everything for free, including seeping gut wounds, stumps, and those cool head injuries that cause otherwise reasonable former military personnel to vote Republican, not that Democrat is much better.

Warren Buffet and Jimmy Buffet and I have been grievously coerced and deeply lysandered into putting up with this.

We're quitting our jobs tomorrow because the incentives are perverse and what I call the Laughter Curve has come into play ... give me a minute ....yes.... here's that napkin: as you can readily see, no matter what the tax rate (2% to 93% to 70% to 39.6% to 35%)going back to when taxes were first imposed, coerced, and stolen, the whining and complaining by the exceptional American population is eternally flatlined at 100% capacity.

Why, it's taxation with representation and that's gotta stop. The majority has forced the minority to, well, compromise their principles, and therefore the minority should now open a can of intended but grossly unnecessary Evil over the dead bodies of the majority.

They can have it in the voting booth or in the streets. Pick one.

[Incertus (Brian)]

It never ceases to gall me that all veterans, regardless of economic status, don't automatically receive VA care. It's disgusting.

What's not quite as galling, but comes close, is the notion that so many people apparently believe that the same administration who pushed this change through actually gives two s***s about the military in the first place.

[Bill]

It is poor form to use veterans as poster children in an effort to socialize medicine. Especially today.

But it’s a good political strategy. Righteous veterans, down on their luck. Then the civil servants who fought alongside them. But if the DOD guys get the benefits, why shouldn’t the DOE guys? And don’t forget those stalwarts of freedom at the EEOC. And if the civil servants get protected, how about the contract personnel?

Universal health care is inevitable. Congratulations.

There will be standard pay schedules for doctors. The best ones will then relocate their practices to the free markets of the Caribbean and take their clients with them. We’ll lose our status as the world’s center of excellence for medicine and the tax revenue that comes with it. The increase in stateside demand will require more doctors, many of whom will be imported from the degree machines of the Middle East. Most will not try to run SUVs filled with gas canisters into our airport lobbies.

Medical demand will still outstrip supply, so some sort of rationing will need to be instituted. Somebody will jokingly suggest ‘Duty to Die’, but the name ‘Children’s and Veteran’s Health Initiative’ will be the official slogan. And somewhere in the process of instituting the ‘Children’s and Veteran’s Health Initiative’, our credit rating will collapse, causing a real medical crisis.

But, who cares, I’ll get a few years of free health care.

[Anarch]

Happy (belated) Armistice Day. (:

[Jesurgislac]

Bill: It is poor form to use veterans as poster children in an effort to socialize medicine. Especially today.

Why is it poor form to point out an administration's failures of care towards veterans injured in the administration's war, on veteran's day?

Or to point out that the socialized health care that veterans in the US are supposed to receive as a benefit of having been injured in their country's service, is being starved of funds by a conservative administration which does not give a damn about supporting veterans either at war or at home?

What is veteran's day for, if not to appreciate what soldiers did, and look for real ways to show veterans they're appreciated?

[Hartmut]

Of course soldiers should not receive public healthcare at all. Their troubles are obviously the result of their own actions. They knew that becoming a soldier brought with it the risk of injury that could have been avoided by not becoming one (there is no draft, you know). Thus they can only blame themselves. With the right investments they could be healthy billionaires instead of crippled paupers, so why should the public pay the bills for their bad foresight. And the fact that they were merely wounded shows that they lacked the proper patriotic fighting spirit (otherwise the war would be won and they dead and no burden but good points for "noble sacrifice" rhethorics) [/snark]

There are actually people around [not necessarily on this blog] that would take the above serious (those are also usually card-carrying members of the "victim's fault brigade").

[OCSteve]

(According to Congressmen quoted here, the limit can be higher in some parts of the country. However, the VA website does not mention that fact, so even if it's true, it's not clear that it's adequately publicized.)

It’s in there but in typical government fashion it’s buried. If income is above the VA Income Threshold but below the Geographic Means Test they are still a Priority 7.

For example, the GMT threshold is $27,950 for Upstate NY. It’s $43,250 if you live in Suffolk County. It’s $47,100 for Nantucket and $63,350 for SF. It’s not really fair to use the $27,790 figure as it is very much determined by where you live.

Also note that this is somewhat of a word game. They could take all these people and enroll them as a Priority 8 and it wouldn’t change a thing as that is the lowest priority category. If there is no slot there is no slot.

Sure I’d love to see all veterans get 100% coverage all the time. As you say it’s the least we could do. But let me ask: As someone who served a couple of decades ago, with no service related disability, and currently making a good living – should I get free VA healthcare? As nice as that would be I don’t think so.

I think the effort and the money would be better put into a national system. Then these people would be covered and the VA can focus on what they do best which is taking care of those with service related problems.

[Jesurgislac]

OCSteve: I think the effort and the money would be better put into a national system.

Yay! ;-) You've come over to the Dark Side of The Force! Outrage leads to anger. Anger leads to the desire to fix this. And the desire to fix this leads to socialized healthcare. So says Yoda, and how can you argue with a little green muppet with a lightsaber?

[John Thullen]

Bill:

"Then the civil servants who fought beside them."

Would you object, he asked rhetorically, to a single-payer system like the Federal civil service plan which offers dozens of private health insurance plans?

Also, when the doctors take off for the beach and the higher pay, they can treat the American citizens who are increasingly flying abroad for lower-cost surgery. Seems like a good fit to me.

I appreciate your imaginative posts, especially the linking of spooky national healthcare with increased terrorism.

My concern is that American patients sent abroad will have pacemakers connected to nuclear bombs implanted inside them by terrorist foreign surgeons, timed to go off as the patients pick up their baggage at LAX.
But then I have a better imagination than you when it comes to catastrophe ;).

Then, of course, our credit rating will collapse and we all die, which is the ending of all American stories.

I blame Hillary for all she has done to cause this situation over the past seven years.

In the meantime, I have a brother who lay on a gurney in a hallway with a massive heart attack and a broken neck until our sister could fetch his private insurance card from his pants pocket in the clothes hamper at his home.

He lived (with the pacemaker electrical leads inserted upside down by a very well remunerated surgeon, causing horrible recovery problems and a surgical do-over two years later) but I'm thinking I agree with you that the "Duty To Die" initiative would be cause to blow up the government, an action I prefer to personally finding and butchering every single shareholder of the corporation who owns the hospital who causes the hospital administrator to implement such a free-market policy so that the former can cash in their capital gains and fly to the Caribbean to drink their Corona on the beach while poor carribbean thieves rifle through their stuff in their hotel room.

Why don't we all just kill ourselves?

After all, it's personal initiative, individually responsible, and last but least, immaculately efficient and saves on those pesky surgical procedures we're all going to need later on, causing the inevitable credit collapse.

[John Thullen]

Oh yeah .... the brother ..... fired from his job, ending his health insurance. All by his boss, who I expect thinks Medicare should be abolished, too, which is where my brother receives his medical care now.

I'm not asking that anyone care one way or the other. Taxes are levied more or less progressively according to income, not by degree of caring. So put your caring in your pocket where you used to carry your money. ;)

It's coercive, I say, and that's the way it will stay. For now, anyway, until the American people coerce a non-coercive government, which would simply move the coercion to the private boardroom and, inevitably, the streets, where coercion gets really sloppy.

If we're lucky, our credit rating will collapse before that and we'll all die.

[Larv]

OCSteve:

But let me ask: As someone who served a couple of decades ago, with no service related disability, and currently making a good living – should I get free VA healthcare?

Ah, but as conservatives are fond of pointing out, it's not really "free", as you would be paying for it through taxes. For those of less means who pay little or no taxes, it would be much closer to actually free. I think that's pretty much as it should be.

[Hartmut]

apropos Duty to Die
Just after posting my snark above I read in the newspapers that the Turkish soldiers captured by the PKK recently and now released are courtmartialed with the minister of justice publicly declaring that their being alive is a prove of guilt. One of the charges by the way is - that is not a joke - illegally leaving the country. A "hero only when dead" and "fighting to the last bullet then committing suicide" mentality seems to prevail there.
It has to be mentioned though that Erdogan is very displeased about his minister's behaviour and publicly rebuked him.
I don't know about the actual US soldiers on the front line but I believe I remember some similar sentiments of "conservatives" about captured GIs (not limited to smearing veterans that run for political offices that is).

[dutchmarbel]

There will be standard pay schedules for doctors. The best ones will then relocate their practices to the free markets of the Caribbean and take their clients with them.

That statement would make more sense if the US had more doctors per patient than the countries that have universal health care. Unfortunately they don't. They *are* in the top tier for importing doctors who were educated elsewhere though, so I agree that there would be a demand problem. Free market however doesn't seem to be the solution.

The centre of excellence is true in some parts, not true in others; there are quite a few area's where the US provides rather poor care. Seeing the flaws is essential for the motivation to improve imho.

[OCSteve]

Larv: Ah, but as conservatives are fond of pointing out, it's not really "free", as you would be paying for it through taxes

True. But it would be “free” to me in that the thousands I now spend on premiums would remain in my pocket. More than that, my employer would save thousands and thus be more amenable to giving me a nice raise. So it would put a substantial amount of money into my pocket.

There are 25 million veterans in the country – over 8% of the population. So if you really want to “extend VA care to all veterans” as hilzoy stated that’s an ambitious goal. I have to think that we don’t actually mean all here. Short of a national plan I would think we still want a means test for VA care that is not directly related to a service disability or illness. I offer myself as an example of a veteran most people would not think should get free care from the VA - although I’ll certainly take it if it’s offered.

[Gary Farber]

"Why is it poor form to point out an administration's failures of care towards veterans injured in the administration's war, on veteran's day?"

Jes, Bill isn't interested in conversation. He's a troll. All he does is refuse to acknowledge using made up quotes, not respond, pointlessly link to search engines, and run away.

It's a waste of time trying to argue with him, based on his record here. He's a troll.

[earlofhuntingdon]

Bush promised to bring private sector "management methods" to government. He has.

Denying already low paid service personnel access to VA benefits - by regulation, not Congressional statute - he is just avoiding liability for his "negative externalities". What any good energy, automative or financial services industry exec does.

A vet's earnings must be almost to the poverty level before he or she can obtain VA medical benefits. Given how poorly service personnel are paid - look at how much more the private sector has to pay to get them to do the same things - that's just another example of Bush running things on the cheap while spending vast sums on corporate contributors.

Among other reasons this Bush policy is wrong is that many vets present risks life and medical insurers love to avoid. Many vets have been forced to take rare vaccines most of us can say "No" to. They have trained in US and foreign swamps, deserts, jungles, mountains, flood plains and dirty shore lines, confronting microbes and strains most of us have never heard of. Not to mention having been exposed to chemicals and noises that would shock a hazmat team.

Guess what insurers like to say to applicants with those backgrounds? About the same thing an auto insurer would say to a cross-eyed alcoholic: either "Forget it" or "pony up".

Among other consequences, that makes especially irresponsible Bush's failure to enforce veterans laws that require an employer to take back vets at the same job, pay scale, etc. A lot of those might still have included medical care or other insurance it would be hard to obtain outside of an employee pool.

[hilzoy]

OCSteve: Actually, I do think all vets should be covered. I have pretty strong views about vets, and service, and debts. Even if someone didn't serve in combat, s/he was prepared to, and that counts for a lot, I think.

For that reason, nothing I said here particularly implies that there should be universal health insurance of some kind. I think there should be, but that's a different argument.

I love the idea that universal health insurance would cause us to institute some form of rationing. We have rationing now. It's based on ability to pay. I find it hard to imagine a less reasonable basis on which to ration health care.