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"...what have we got—a Republic or a Monarchy?” “A Republic, if you can keep it

House Veterans Affairs Committee members voiced support Tuesday for recommendations by a congressional panel to reform VA health services, to include improvements to the current setup of government hospitals and private doctors that provide care to veterans.

But committee members differed on the scope of the new collaborative system, with some Democrats arguing that the Commission on Care’s proposal, to give all eligible veterans access to private networks as well as Veterans Affairs facilities, would divert funds from VA hospitals and clinics.

In July, the Commission on Care released a report with 18 recommendations to improve veterans medical services and the Veterans Health Administration.

The recommendations included creating a health care system of government facilities and private networks, installing a board of directors to ensure the continuity of transformation and leadership of VHA, closing nonperforming or underused VA facilities and installing a chief information officer to manage the department's health IT infrastructure.

President Obama last week said he concurred with 15 of the panel's recommendations, objecting to the proposal to create the governing board, which he said would undermine the VHA leadership, and the recommendation to appoint the under secretary of health for five years, which he described as "unconstitutional."

He also took exception to the private network proposal, suggesting that Congress instead support the VA’s plan to consolidate its community care programs, which he said would “more clearly ensure the long-term viability and sustainability of the VA health care system."

VA Secretary Bob McDonald also said last week that with reform initiatives underway at VA,  the department is tackling 15 of the 18 recommendations.

VA has opposed any effort to eliminate eligibility restrictions for the Veterans Choice program, the private care initiative created in 2014 in response to the scandal over appointment wait times and delayed care at VA.

Under that program, veterans who face a wait of 30 days or more for an appointment or live a 40-mile drive from a VA hospital or clinic, are eligible for care through a private physician.

That program has been plagued by access problems and claims reimbursement problems and needs to be transformed, both VA officials and members of Congress have said.

But broadening it to the point that every veteran can use it could ultimately hurt VA hospitals and clinics, said Rep. Mark Takano, a California Democrat and ranking member of the committee.

"It’s clear to me the status quo is unacceptable but I don’t believe that completely remaking the VA is the right answer either," Takano said. "There is an important balance between transforming the VA while maintaining the services and support that millions of veterans rely on."

Others said expanding the network of private doctors who care for veterans would ensure that veterans would play a bigger role in their own care and all participating doctors would, in effect, become VA doctors.

"We have to sit down and determine where the best care for veterans is," said Rep. Phil Roe, a medical doctor and Tennessee Republican. "I think this is a remarkable document and I think it has the chance for putting veterans and doctors back in charge of their care and not a system."

Critics have said the public-private network recommendation amounts to “privatizing” VA, including the American Federation of Government Employees, which added it would “dismantle the specialized integrated health care system and incur costs that will inevitably lead to lower quality care" for veterans.

Commission on Care chairwoman Dr. Nancy Schlichting, Henry Ford Health System CEO, stressed that the recommendation is not an attempt to unravel the veterans health system.

"We had to find the balance ... because we recognized there was a danger of weakening the system. But what we realized is the limitations [of the Choice program] were causing undue problems for veterans. We feel we are strengthening it."
"If these changes are not made, they threaten the viability of long-term VA care," added commission vice chairman Dr. Toby Cosgrove, director of the Cleveland Clinic. "It’s quite conceivable that more patients would gravitate to VA if the department improved its access."

Commissioners stressed that an important part of their recommendations is closing more than 200 unused or aging VA facilities. Acknowledging that there often is little appetite among lawmakers to close government facilities in their districts that provide jobs, Schlichting said the closure of VA facilities would not have as large an impact on communities as a military base closure because many of the health care jobs would transfer to neighboring private sector facilities.

Lawmakers signaled they were open to considering the move, which VA supports.

"This could really make a difference if we could implement this [report] ... a 100-bed hospital can do today what a 500-bed hospital could do years ago. The VA is still stuck in the 500-bed model," Roe said.

Me Here.......When are the idiots in DC get the simple idea that local is better than having to drive hundreds of miles for care that is tens of miles away?  I have been told by Congressman Upton (MI 6) that the original intent was that is the service was more than 40 miles away, the Veteran can go local.  Someone changed the bill without telling Congress before they passed it.  Or was I told a big story?

The one thing we can be sure of, if Hillary is able to steal the election, The huge mess that is the VA will look darned good compared to the mess she will make of the Nation's Health Care System.  What Barry didn't screw up with his Death Care, she will.

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