Well, here I had a response all typed up, and POOF, thread closed. So, here goes part two:

When DS had surgery (2 years ago today, in fact), this is how it went down. He had to go to his PCM, which, at the time, was doctor "out in town", IOW not a doctor on base, since they were "full" and gave us a PCM out in town. We had to go to him, and incur the expense of the visit for the gov't to pay. He then referred us to a surgeon. We waited on the referral (permission to go see the surgeon) and then went to have a consult with the surgeon. Again, a civilian surgeon. I would NEVER had let a military surgeon perform this procedure on my child. The surgeon sent DS for an MRI and blood work. Once we decided we would go ahead with the surgery, the surgeon's office had to submit a written report stating why they felt this surgery was necessary for DS. This was reviewed, and we were given the go-ahead to get this done in a civilian hospital.

So, I guess you could say the pre-authorization is the review panel.

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Doing the right thing isn't always the same as doing the easy thing.

Just want to clarify this before we go further:

NIGHTOWLRN said: I apologize for using the broad term benefits. This issue I am addressing is a model of health care, not trying to get into the system. Yes, children and spouses qualify for CHAMPVA and TRICARE, bereavement counseling, and a few other specific things. These are reimbursement issues. This care is not provided by VHA generally. If a TRICARE family member wishes to seek care at a VA facility, it can be done in some situations, but it is at as a space available to assure our Veterans are cared for first.

VHA health care is evidence based, totally electronic, and focused on a lifetime relationship where prevention and early care is the goal. Of course, that isn't sexy and it doesn't pay as much. In my 30 years involvement with the health care industry, I have not seen better care and more appropriately provided. It is no wonder the political pushback is so very strong to changing our current model of health care. "

Is VHA health care a type of "all in one facility" care? Much like a VA hospital, or a MTF?

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Doing the right thing isn't always the same as doing the easy thing.

Yes, a MTF is a Military Treatment Facility. Under Tri-Care Prime (there are several options you can choose fromL: Prime, Standard, Extra) you are assigned a PCM (Primary Care Manager) and they can be at a MTF for the retired service member and dependents, or "out in town" if they are "full" at the MTF. It is a 45 minute drive for us to get to the MTF, where the kids' PCM and DH's PCM is, IF you can even get an appt. A bit off topic, but, I figured the more info. we can throw out there, the better.

You did answer my questions. I have another, tho. Is VHA health care more like an HMO? Also, are there any VHA health care facilities for reference? I'm trying to envision how they work.

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Doing the right thing isn't always the same as doing the easy thing.

I'm sure VA, IHS, Coop Health Clinics (typically city or county run), etc. are excellent in theory.
I have yet to see any government ran program work as they were set up to work.

As evidenced by the recent focus on mental health for vets---obviously, the VA dropped the ball on mental health care for vets.

If the VA is the best care that we can provide for the men and women who sacrificed for our country? We certainly have some work to do!

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

A VHA model is a lifetime commitment to quality health care. If our country adopted this model, it wouldn't be one people could jump from to another. It would it "it." The reward would be overall fewer expenses.

All VHA facilities operate under the VA health care model. If your husband goes to a VA facility in Florida and then gets sick in California, the MD will immediately log on and know what tests he has had, what MDs he has seen, what medications he is on, and his health history in a matter of minutes.

If you all move, your husband's next VA MD will know if he's been immunized for the flu, if he needs diabetic screening, if he needs PTSD screening, if he needs to have his lipid profile done, etc.

Simple example -- colon cancer. In the VA -- a Veteran is screened. If they move to another VA system, that system knows if they have been screened and, if not, offers them screening and sends them the card to the new address. Our current system = I need screening and I move. Case closed. The next time I enter the system I have advanced colon cancer and die or require much more $$$ to cure me.

I agree, they are excellent in theory. When you get down to the nitty gritty of it, it is still a gov't run thing, and their track record isn't that fabulous.

I believe that health care provided in the private sector, or what I refer to as "out in town" is a much better way to go about one's health care needs. Each person should be responsible for their own health and health care decisions.

Also, found this on Veteran's Mental Health. Is this what you were referring to Marilyn?


U.S. GAO - VA Health Care: Spending for Mental Health Strategic Plan Initiatives Was Substantially Less Than Planned
The Department of Veterans Affairs (VA) provides mental health services to veterans with conditions such as post-traumatic stress disorder (PTSD) and substance abuse disorders. To address gaps in services needed by veterans, VA approved a mental health strategic plan in 2004.

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Doing the right thing isn't always the same as doing the easy thing.

google US vets and suicide. NUMEROUS articles, documentation, and statistics.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

I will send you my EX if you want up close example on that one. He was not allowed to re-enlist for another tour of Vietnam because he liked killing too much - that is what the army told him. Yet, they wouldn't even let him see any army shrink.


I assume just as with the poster about back surgeries, yes we all know people that fall thru the loop holes, but there are a lot of the holes, and a lot of veterans that have not gottten the medical or mental help that they deserve after protecting the rest of us, so we can sit here and quibble about semantics.

What do you mean, it would be "it"? If they chose this plan, they could not go back to their other plan, or they would not want to?
I like the idea of a doctor knowing your meds, etc. However, unless ALL the doctors and treatment facilities are on the same "network" so to speak, this is not going to work. For instance, DH can still go to an "out in town" provider, if no appts. are availalbe at the MTF where his PCM is. They are NOT linked up with the computers where his PCM is, so they have no idea what meds/tests/etc. he has had. So, either all the medical providers have to link into one nationwide system, or care would be restricted to a certain set of providers that are linked in to that system. Is this how a VHA facility works?

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Doing the right thing isn't always the same as doing the easy thing.

I believe these issues occur prior to a person becoming a "veteran." Long deployements, substance abuse, etc occur long before they enter the VHA system. Additionally, many Veterans do not seek health care prior to dying by suicide. VHA cannot make a Veteran seek mental health services.

The issue is really a partnership and information sharing between DoD and VHA, which is just now starting to happen.

Additionally, the Veteran population is more likely to experience mental health crisis than the general population.

VHA has a full court blitz to address Veteran mental illness. Sadly, suicide is one of those horrible things that is difficult to prevent. We can't involuntarily hospitalize people who we fear are suicidal. Medications can only do so much. And, the military population is less likely to share their feelings and concerns due to the indoctrination of military life.

If we had a single payer system, those facilities who wanted to participate in the system and receive payment would have to be in the electronic network and would have to agree to meet expected quality standards and to provide evidence based medical care.

If your husband is under the care of the VA and he receives care on a fee basis, it is up to his primary care MD to find out the results of his fee basis appointments and to scan them in to VistA. Then, those results are available to any MD in the VHA who provides him care.

I honestly can't believe you won't to lay this on the veterans....I really can't.
Of all the things I expected you to argue, I certainly wouldn't have expected this. I'm kind of disappointed in you.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

No. What I am saying is that the problem can't be layed on the VHAs inability to provide care. The problem is multi leveled. The VHA has telemental health for rural Veterans, Psychiatrists at VHAs and CBOCs, suicide hotlines, Vet Centers to help Veterans with MH issues, support groups. All sorts of help. The issue isn't just the VHA. And, again, those who leave the military are higher risk. Most have access to guns, which increases the impulsiveness finality.
And, again, we are really talking about the VHA model of health care. Not VHA and suicidal Veterans - which has more to do with the DoD and VHA communication and MH care.

Finally, VHA can hardly be blamed for a Veteran who dies by suicide without seeking MH help. VHA benefits are not forced. VHA does have a system where specialists contact every Veteran who separates within 30 days and tells them of their MH benefits and suggests support groups and counseling to help with the transition from active duty to civilan life. But, they can't force them to seek care.

So, we hear of Veteans who die by suicide, and recruiters who die by suicide, but you don't know if the Veteran sought help and the recruiter doesn't recieve VHA benefits.

Additionally, many depressed people who do or do not seek MH care from private care providers ultimately die by suicide. They just don't make the front page and aren't the subject of congressional inquiry.

So, are you advocating the "fix" for health care is for everyone to be on the same "plan"? And, said "plan" would be run by the government, who would set the quality standards? That sort of scares me a little bit.

I was under the assumption that the doctors that I see under my current health care plan, are already meeting a quality standard. Otherwise, my health insurance would not pay them.

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Doing the right thing isn't always the same as doing the easy thing.

"So, are you advocating the "fix" for health care is for everyone to be on the same "plan"? And, said "plan" would be run by the government, who would set the quality standards? That sort of scares me a little bit. " That should scare the hell out of all of us!!
First of all, the quality statndards would be set by the government.. that in itself is scary. And evidence based care?? You are kidding, RIGHT?? You can make statistics and evidence show anything you want it to....
Second of all, there goes any medical research. They would not pay at all for things related to research.
The sad part is, if people would not have abused this system for so many years, it would not be in the sad state it is now.

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Be careful what you wish for.....

The problem with our health care system is the insurance companies. If we have a single payer system that will NOT eliminate the problem. We will still be paying the insurance companies and I believe they will have an even bigger control over us than they do now. And the fact that the program will be administered by the Federal Government means it will be a bureaucratic mess. The Federal Government is fiscally irresponsible. They don't care about administering their programs in a logical money saving efficient way. They care about cotinuining the cash flow so they can fund their bloated salaries and level of fringe benefits for those in management and middle management.
I don't trust them especially when they do things behind closed doors. That is just ridiculous and goes against everything the USA supposedly stands for.

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The political system is broke and it's a joke.

Interesting Anna,
werent you one of the most PRO OBAMA supporters here??
"That is just ridiculous and goes against everything the USA supposedly stands for. " No I think it is proof that once again a politician lied...

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Be careful what you wish for.....

Yes I was mistaken. I thought he really was going to be honest and do his best to make this country a better place. I think now -this is just my opinion-that he sees how things should be in an idealistic sense and he refuses to look at the reality of the situation. And for those who want free health care--NOTHING is FREE. Someone has to pay for it. Which would be fine if it were done in a logical fashion. But there are other things involved too. For example: I do everything I can do to keep myself healthy why should I have to pay for people who eat crap, don't exercise, smoke cigarettes or crack or crank, and do other unhealthy things?
So my problems with Obama run deeper than this big farce but for the subject at hand my problems are: Closed doors who knows what the hell they are saying?
The Feds administering the program
Me a healthy person paying out the @$$ for people who will now have another excuse not to be healthy because they're sucking milk off the public teat
Where are the bags of money going to come from that will pay for this?
The insurance companies decide who gets what care and they are trying to make a profit so as I'm getting older of course I worry that I may get cancer or something else and just die because I am not worth medicine and care I need to receive. This is not a joke it's happening right now. It'll be even worse if this goes through. My Aunt in Canada paid for her own health care when she had cancer so she could make her own choices. Free health care is fine if you have the flu or a sprained ankle but if you have something serious you can kiss your family good bye.

It makes me sick good thing I already have insurance. Insurance that my husband and my job pay for. If we didn't need insurance we would have higher salaries so we are

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The political system is broke and it's a joke.

Anna, just wait until people start filing their taxes. Remember that "stimulus" money we got when he first got into office. What, I think it was like $13 a week or month, more in our paychecks. Well, let's see how much people are liking it when they do their taxes. That money was just basically that much less tax they paid out of their pay check. So, for the people who have it figured pretty right on the money, they will likely "owe" taxes come April 15th. The tax tables weren't revised, the gov't just took out less from your pay check, so you can have it then and there, but, you will still owe the SAME come April 15th.

A bit OT, I know, but, just another one of those things that people think is "helping" them.......

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Doing the right thing isn't always the same as doing the easy thing.

All,
We were told by HR to increase our withholding when that started. I have and I hope that it helps come tax time.

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Be careful what you wish for.....

Well that's a person's own fault if they didn't take that into account. If people didn't read where the money came from that's their own fault if they didn't adjust their taxes. Seriously I would think adults would understand that.

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Mom to Jake, Zach & Meghan
SJCC STREAKS FOOTBALL!!
CLEVELAND BROWNS FOOTBALL!

Although I get the point you are trying to make, it reminds me of the whole mortgage/bank fiasco. Just as people should have been aware of where the money came from with the stimulas checks....the same can be true for all those who bought houses they could not afford, and now want to be bailed out of the mess they got themselves into! Personal responsibility has taken a huge backseat in this country! It is time for people to stand up and take charge of their own lives, and not want everything handed to them. I am not sure what will end up happening with the health care issue. I am worried, and I think we are not going down a road that we should be....

I found this, which seems to be in regards to medicine in the UK. However, if this is where we're headed, it is scary as hell.

Biological therapy
Biological therapies are treatments that use natural substances from the body or drugs made from these substances. Sorafenib is a type of biological therapy called a tyrosine kinase inhibitor (TKI). Tyrosine kinase is a protein which acts as a chemical messenger.

Sorafenib has been shown in clinical trials to extend the lives of people with liver cancer. Sorafenib was approved for use in the European Union in October 2007. However, both the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) have issued guidance stating that sorafenib is not approved for NHS use because it is not cost effective."

Which treatment for liver cancer? : Cancer Research UK : CancerHelp UK

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Doing the right thing isn't always the same as doing the easy thing.

Scary doesn't even begin to cover it.
What is happening now is already scary. People work their whole lives up to 60, 70 years paying into the system and taking care of their families often extended families. They get old and sick and they are of no use to society anymore.
Not to mention that if this really was such a wonderful plan then why don't the President, Senators, and Congressmen get rid of their insurance and pariticpate in this boondoggle?

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The political system is broke and it's a joke.