President Obama’s choice of Bob McDonald, former CEO of Procter & Gamble, to be the new head of the Department of Veterans Affairs reveals the president’s fundamental lack of understanding of VA culture. True, McDonald is a West Point graduate who knows how the military (as well as a large corporation) runs, but he lacks a medical background or particular insight into this unwieldy behemoth, which employs 300,000 people.
A better choice would be Tom Coburn, a physician who is due to retire from the Senate this year. Not only is Coburn the survivor of three cancers (melanoma, colon, and prostate), and not only is he a pioneer in investigating governmental waste and corruption, but he has also just released a scathing report revealing that poor and delayed medical treatment at the VA over a decade led to more than 1,000 deaths and cost the feds close to $1 billion in malpractice suits. Coburn understands that these numbers are just the tip of the iceberg, and that the VA needs to be rebuilt from the ground up.
Like the National Health Service in England, the VA provides health care directly, hiring its own doctors and nurses and building its own hospitals — but also like the NHS, it is cumbersome and insensitive to the needs of its patients. There is no reason to believe that McDonald has the experience or insight to heal a system that handles over 83 million outpatient visits and over 700,000 inpatient admissions per year yet is known among veterans as a place of last resort, a health-care safety net.
My patient “Gerald” is a case in point. A retired surgeon, he uses his Medicare to cover his basic care with me and goes to the VA only if I am not available or if one of his prescriptions isn’t covered by his secondary insurance. Don’t get me wrong — it was a VA clinic doctor who first discovered that Gerald’s blood sugar was out of control and started him on insulin. But Gerald tells me the doctor who diagnosed him was the exception, and he says his overall experience there has been subpar.
Unfortunately, not all veterans are as resourceful as Gerald, who has access to several different health-care systems, and while some are lucky and receive stellar care at the VA, others are not so lucky, as Senator Coburn’s report shows. Keep in mind that our veterans have many health-care needs that require intricate treatments. Close to one-third of veterans smoke, a sixth are heavy drinkers, and at least a third of our post-9/11 vets are suffering from post-traumatic stress or depression. These conditions render a patient much more difficult to treat. Oftentimes the VA is overwhelmed by these needs and doesn’t provide adequate care.
The VA is also woefully lacking when it comes to emergency care; the department admits that veterans wait at least twice as long for their emergency care as the average American.
The inevitable outcome of being overwhelmed is rationing. And rationing leads to euthanasia. It is not a coincidence that the VA has recently focused on mandatory end-of-life counseling, promoting a book called Your Life, Your Choices.
What is the solution? For starters, we need a captain at the helm of the VA ship with seafaring experience. Then we need an infusion of private alternatives with an expanded access for our vets. Medicaid should be provided automatically for those vets who can’t afford private insurance. I would suggest that all vets with incomes lower than 213 percent of the federal poverty line be eligible, the magic number for children in states with expanded Medicaid coverage under Obamacare.
Our warriors deserve better than another cosmetic solution, delivered to them straight from the former head of Procter & Gamble, the very king of cosmetics.
— Marc Siegel is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A-Team.