You're Fired

The local rag has a front page article ballyhooing the recent Trump signing of a bill which is touted as being the means to revamping and improving the VA system. At first glance, I held a modicum of hope that this really implied substantive change which would directly effect the system and have a positive  impact on patient care. Boy was I foolish!

       What the bill actually does, and essentially all that it does, is make it easier to do what Trump has self promoted his own reality show image to reflect, that being to fire people. Understand, I fuly agree that whistleblowers who are sincerely concerned about real issues and not personal vendettas, should be protected. Now, ask yourself if Trump agrees with this philosophy with regard to his own cadre of sycophants. I think we know the answer to that, based on public events of the past months of Trump's agonistic demeanor and behavior.  By the way, the term "agonistic" is a recent construct to describe hostile and aggressive behaviour in animals, which fits the Cheetoh in Chief right down to the ground.

       Secondarily, and to me even more troubling, is that the law would essentially remove almost all due process in the removal of an employee deemed to merit dismissal. Again, as an experienced (12 years of NEA related union bargaining and contract committee duties) labor negitator with an advanced degree in Human Resource Management, I have issues with this. 

       Contrary to the opinion of some (usually management), most unions, especally professional ones, have no interest in protecting a truly deficient employee for the simple reason that "One bad apple.....!" In some cases, admittedly, organizations have agreed to conditions which make it difficult to remove a bad employee. This is as much the fault of upper management who agreed to said conditions as it is to the Union which said,"OK." We have seen similar issues with the American automobile industry, because in the flush of cash with a global market post WW II, the major auto makers caved to the UAW with ludicrous pay and benefits packages rather than embrace quality circles and labor /management collaboration. It's called "welfare capitalism" and it started with Henry Ford

        In a relatively short time from the late 1800s to 1936, labor went from being the "property" of the feudal lords such as Rockefeller, Morgan, Gould, et al (and much worse, especially in the garment industry), to being the "enemy" empowered by depression era labor legislation.   Don't wince, these men often spoke of "My workers" in the possessive, and meant it. In Pittsburgh and environs, it went so far as the establishment of a private, magnate hired and paid, militia, the Iron and Coal Police. 

       Here's a bit of history for ya: "Pennsylvania's Coal and Iron Police ruled small patch towns and industrial cities for their coal and iron company bosses from 1865 to 1931. Armed with a gun and badge and backed by state legislation, the members of the private police force were granted power in a practically unspecified jurisdiction. Set in Pennsylvania's anthracite and bituminous regions, including Luzerne, Schuylkill, Westmoreland, Beaver, Somerset, and Indiana Counties, at a time when labor disputes were deadly, the officers are the story behind American labor history's high-profile events and attention-grabbing headlines. Paid to protect company property, their duties varied but unfortunately often resulted in strikebreaking, intimidation, and violence.

      That said, as a negotiator/board member, I have been a party to a significant  number of employee/management related conflicts where the union directors simply refused to support an employee who was clearly in the wrong. However, in an equal or greater number of cases, the real issue was simply personality conflict and not competence or performance. Of course, management will fight to never admit that one of their Peter Principle promotees (is that a word?) was elevated to management in error. I know of several instances in which the School Board response was to simply laterally and downwardly transfer an administrator, because, apparently, no administrator can ever be fired. Ok, ok, violent crime would be a deal breaker, but not ever for simple  incompetence, that I know of. 

       But, back to Trump's recent "You're fired" signing. In many cases, the tragic truth is also that management just wants to be able to do it, apparently at will and have no responsibility for justifying it. Let me be clear; in some cases this amounts to ruining an individual's personal and financial life simply because one can. This is the condition under which Teachers in Orange County Florida work for the first three years of employment. A teacher can find themselves unemployed for the following year at the end of three years (or two, or one, or 90 days) with no discussion as to the reason why.  In one case, a good two year employee was let go (without any justification at all, as is allowed in the three year period) because a teacher at the principal's former school wanted to change schools. Out goes the good, new, teacher, in comes the friend. And we wonder why most new teachers don't last more than five years?  

        But, this was about the veterans' administration, so here goes. Quality of care apparently varies widely over the system and, to a degree, is dependent upon the facility's being adequately staffed for the patient load. As second consideration must be that not every complaint is justified.

        Assuming every veteran is always right is a dangerous assumption, indeed, as evidenced by the recent gun waving, (thankfully non-fatal) event in the local clinic, which is a star in the VA constellation. The problem was a  psychotic break, or similar event, having nothing to do with the VA and everything to do with the individual, who, by all acounts had been troubled for years and wanted someone to blame. That said, one or several such people are the stuf of dreams for those in the  print and broadcast media businesses. (listen to Don Henley's "Dirty Laundry" for examples) 

     A more common problem is the sheer numbers of patients some hospitals are obliged to see. Obviously, this is magnified in areas of concentrations of veteran retirees. Again, a key point, I do not mean retired from the military as a career member, I mean no longer working. Sun City in Phoenix, AZ, is a representative case in point. They are also, unsurprisingly, one of the regions where complaints of long wait times are common. Interestingly enough, the uproar over "fudging" wait times and patient lists, was directly attributable to managemnment decisions, not hourly employees.  

        So, what might a real overhaul of the VA look like rather than just making it "easier to fire people?" To begin with, the VA now serves, or is supposed to serve, all veterans, all the time, for all medical conditions. It might be a good time to ask several questions about the mission, rather than fire the pilot.

       First: I will begin by admitting that I can find no data to support or negate the magnitude of the potential impact of the following proposal, but I am certain of this: Career military retirees have what is arguably the best health care insurance in the US - Tricare.

        Prior to age 65, but after military retirement, the veteran and dependents, upon completing  20 years (or more)  service has a top shelf contributory plan which is as good or better than the vast number of civilian health care plans, and  for less out of pocket cost.  Upon reaching 65, The retiree has Medicare as first provider and Tricare for Life , which covers essentially everything else. The cost? The retiree pays Medicare part B, period. Veteran retirees even have access to an optional low fee dental plan as well. 

       Tricare, unlike the VA allows the retiree to use essentially any doctor they choose, and covers everything that Medicare doesn't. It also provides access to a better drug plan than almost any other.  This represents, for the average military retiree and spouse, somewhere in the range of $12,000 to $15,000 annually worth of health care insurance and allows use of any facility or provider. In spite of this, I personally know at least one 30 year retiree who uses the VA clinic for routing physicals, medicine, medications, etc. and even travels farther to get there that a host of better specialist practices. Any retiree who uses the VA when they could use any doctor they choose is taking space that other, less fortunate vets may need.  Requiring military retiree veterans with non-service connected disabilities to use the civilian health care system would be a good start to reduce the load and open care avenues for others who don't have the "Cadillac coverage" of Tricare.

         A second and more controversial proposal is this: When a young man or woman completes a single tour of service and leaves the military with no service connected disability whatsoever,  but continues smoking for 50 years, should the government foot the bill for lung cancer treatment when they reach 70?  I'm not talking about any person with any disablilty, emotiona, physical or otherwise. I'm (again to use a reductio ad absurdum) speaking of the person who leaves after 4 years in top shape and good health, has no VA disability, and breaks their back base jumping. Why is this a VA issue? Should it be? Another example is the vet who, now at 75, needs hearing aids. The VA supplies about $4,000 worth free. even if the Vet was a Vietnam era draftee who left the service with perfect hearing.

          And in summary on this topic, while there is no "means test", as such, if one makes a good living and has a good retirement, it may take a while to get into the system. Unless, of course you are "lucky" enough to be considered disabled, in which case you get head of the line privileges. Again, an example: If you set foot in Vietnam during a certain period, you are considered disabled, because somewhere, at sometime during that period, Agent Orange was used. It could have been 150 miles away, and you are now 68 and asymptomatic, but, no sweat, you're disabled.

        My own bottom line, as a retiree with 26 years' service who does not use VA medical services, for reasons outlined above, although I'm classified 30% disabled is this: The Veterans Administration has, over time, morphed into an organization which has been tasked to serve a large number of patients which it probably should not be responsible for. Concenrate however on who should the VA serve? 

       First and foremost: the VA should provide lifetime medical care to any person who is disabled in the service of the nation in the military. Said care should be the best available, period, and should extend to prosthetics, housing modifications, etc. No disabled individual who has honorably served should ever want for top tier healthcare.

       Secondarily, no military retiree who has Tricare and zero disability should us the VA for exams or medical procedures. I would allow   exception for prescription drugs (since the VA, unlike Medicare, negotiates and gets lower drug costs than Medicare) Eyeglasses and Audiology should be optional to retirees, based on facility and availability, Eye exams are covered under Tricare, but the VA pays far less, ergo charges far less, for the glasses once the prescription is written by the civilian optometrist. 

       Finally, I must point out that this last has a family related contradiction, but I still believe the point is valid. If a member serves less than a career and is discharged in good health, with no  VA verified service connected disability whatsoever; then if, and only if, a subsequent medical problem can be shown to have been due to military service, the VA should open their doors to that patient. Having said that, My dear late brother died of cancer under VA care, which he unfailingly described in glowing terms. he did a 2 year stint in the Army in Korea and Thailand, was never under Agent Orange or fire. Nothing he experienced in the army had any bearing on the occurrence of tongue cancer at 64 years old. He was a self employed musician and was unable to afford the cost of the advanced procedures which the VA performed in efforts to heal him. Am I glad the VA was there for him? Of course. Do I think he should have had to use it (or be eligible, in truth)? I do not. Should any person who works in America, having served or not,  have to rely on such help because they can't afford decent health care? No they should not. You want to "fix" the VA? adopt single payer, national health care and let the VA do what it was intended to do.