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U.S. Department of Veterans Affairs Secretary Eric Shinseki addresses reporters after testifying before a Senate Veterans Affairs Committee hearing on VA health care, on Capitol Hill in Washington May 15, 2014. REUTERS/Jonathan Ernst  (UNITED STATES - Tag
 I'm really not being a smart-ass - this time. A week ago Monday, MB wrote "Audit finds more than 57,000 veterans still waiting for VA appointment 90 days after requesting one". Understandably, MB's source was the White House and the VA. Well, all three sources are wrong. I've been chasing this down since early March.
Here's the error and why it was made:

With the enactment of the ACA and the requirement that people either have health insurance or pay a fine came one little, teeny, tiny caveat: signing up with the VA satisfies the requirement for health insurance. It says so right here. "4. Enrollment in VA health care meets health care law requirements; you don't need any other coverage." And it's free [most know it's not - they earned it].

The unexpected side effect of Obamacare is that Veterans who left their branch of service decades ago are now signing up and they are doing it by the thousands. So, too, are those who served in Afghanistan and Iraq. Here's the secret that the VA has overlooked: A whole lot of these folks in every age range don't like doctors or mainstream medicine.

Gen. Eric Shinseki
 Ever since the Portland, Oregon VA Hospital did a very quick remodel of it's main lobby I have been trying to nail down a couple of facts. Here's what I've learned:

1. Enrollment is the Step 1 Start Point for any Veteran wanting VA Health Coverage. Prior to the implementation of Obamacare, the Portland OR VA Hospital had 1 person at the Enrollment Desk. That person had time to do other things in addition to enrolling Veterans. The waiting room for the VA Enrollment Office consisted of 3 chairs and room for a wheelchair.

2. Since Obamacare went into effect, the Portland OR VA Enrollment Office expanded - well, exploded is more like it. The Enrollment Office went from one desk with one person working about 2/3 of their day on enrollment to 10 Stations fulltime. The waiting room went from 3 chairs plus room for 1 wheelchair to a large lobby filled with chairs with not enough room for all of the wheelchairs. The lobby has an electronic board listing about 50 names of people waiting to enroll. It's also possible and strongly encouraged for Veterans to enroll on line through Myheathyvet.

3. The 57,000 is not and cannot be accurate for two reasons. The first is that the enrollment activity nationwide is way up. I tried to pin that number down starting in late March. No one within VA was talking. That was long before "the scandal" broke. I tried and failed to reach anyone who would respond at VISN 20 - the regional office for the Pacific Northwest.

When I posed a question about increased enrollment since the ACA was implemented on April 24 through the VA's web site, the response was that I would get an answer within 5 business days. It came by phone. The woman who called stated that her job at the VA involved tracking enrollment numbers. She asked what prompted my question. I told her about what I saw in the lobby of the Portland OR VA hospital. She was surprised at the volume I witnessed. She didn't have the answer yet but assumed that she probably would fairly soon.

Then I went back to the hospital and started quietly asking questions of those who were waiting in the lobby. I asked what branch were you in, when did you serve, where they lived, why they were there, what prompted them to come, what healthcare problems did they hope to solve, and whatever additional questions came up. Remember, all this occurred before "the scandal" broke.

What I learned that all branches were represented including a surprising number who were in the Coast Guard. The earliest dates were in the 1950's, the latest was a Marine home on leave after a tour in Afghanistan. I met people from Alaska, Idaho, all over Oregon and Washington, and a couple from Minnesota who were staying with their kids. Obamacare prompted most people to come - and that includes those who wanted to avoid Obamacare. Only 3 cited the AVA. Several wanted assurance that it wouldn't cost them anything.

To avoid HIPPA violations I asked if standard healthcare problems were the problem or if there were unknown issues that they wanted taken care of. That got an interesting response. There were a number of self-identified American Indians and a number of "mountain men who live off the grid". Both of these groups - about 10 all told - asked if they would be forced to get medical care. I told them it was their choice. These folks wanted "to be legal" but didn't like doctors, pill-pushers, or any of that voo-doo medicine.

My totally unprofessional opinion

Many more people than expected are coming to the VA for the first time ever. A lot of these people are coming because it is free [most know it's not - they earned it]. Most are coming "to be legal" and cover themselves just in case. What is surprising to me are the number of people who have no intention of getting medical care through the VA.

The Rant

None of what I am reporting here excuses the duplicitous off-the-books scheduling. I'm told by VA schedulers that whole bag of worms has festered at the VA for decades. It was created to enable VA executives not worthy of a bag of spit to get unearned bonuses. This "scandal" only surfaced because General Shinseki imposed performance criteria applicable to the level of healthcare every American should get.

VA executives were led by the fired Under Secretary for the Veterans Health Administration, Dr. Robert Pretzel, who turned up his nose at those criteria, and said they were just political. He and the hapless hoard immediately surrounding him need perspective. Attica would be nice.

The Bottom Line & The Next "BIG VA SCANDAL"  :

1. I believe that there are many more than 57,000 Veterans who have not yet seen their first appointment, but there may be less than 57,000 who want to see a VA doctor.

2. "The VA Appointment Scandal"  was generated by top VA executives to settle a score or two with General Shinseki. Those who created the double booking crap are probably all dead and buried for decades. Their successors are half-witted political operatives who were given VA executive jobs by both parties to get them out of their hair. The primary job of those half-wits was to make lower-level executive look like they were eligible for bonus pay.

3. The Next "BIG VA SCANDAL": The VA Doesn't know how to hire people*  With the House and Senate convening a conference on the Veterans Appropriation Bill, there will be about 60% more money devoted to healthcare. That means more money to hire more medical staff.  However, under current US Civil Service guidelines, it takes at least 1 year to fill a new technical civil service job, and a 18 months or more (usually 2 years) to fill an existing vacancy.

6:59 PM PT: As many of you know I'm a diabetic. I will now make dinner [Stouffer's Lasagna - blood sugars were low today] while trying to cover this diary.

7:40 PM PT: Excuse me, but I need to may my respects at IGTNT for 5 more soldiers for whom we light the candles. It make take an hour before I return. These IGTNT diaries are getting harder all the time.

11:36 PM PT: I just learned that UPDATES can't be corrected.

The 7:40 PM update should read as follows:

Excuse me, but I need to pay my respects at IGTNT for 5 more soldiers for whom we light the candles. It may take an hour before I return. These IGTNT diaries are getting harder all the time.

Within the comments Meteor Blades and I discuss whether or not that  first appoint Veterans get with a doctor is automatic. Credit Meteor Blades for catching what someone in an e-mail verifies a change in VA procedures. According to the long-time VA employee:

       " This is a recent change, not sure when, but my guess is when an executive responsible for dealing with the influx of new Veterans since January and about March figured out that 1st appointments for all of these newly enrolled Vets couldn't possibly be met within 18 days even with increased staffing."

I will follow up on this this week. Thanks for everyone's interest and a major hat tip to Meteor Blades. I wonder how many eagle-eyed reporters caught the change he did.


Originally posted to llbear on Tue Jun 17, 2014 at 04:23 PM PDT.

Also republished by DKos Military Veterans.

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