Comments for Much ado about nothing (for now).

Much ado about nothing (for now).

2009-03-10T23:35:03Z

Doesn't mean we don't need to keep an eye on these guys, but let's fight the fights that... need fighting.

Over at Blackfive, Matt's been reading CNN and finds that VA Secretary Shinseki in hot water and looking like a deer in the headlights at a committee hearing. From CNN's Political Tracker:

WASHINGTON (CNN) - Veterans Affairs Secretary Eric Shinseki confirmed Tuesday that the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance, but was told by lawmakers that it would be "dead on arrival" if sent to Congress...

The article continues:

...No official proposal to create such a program has been announced publicly, but veterans groups wrote a pre-emptive letter last week to President Obama opposing the idea after hearing the plan was under consideration. The groups also noticed an increase in “third-party collections” estimated in the 2010 budget proposal—something they said could only be achieved if the VA started billing for service-related injuries.

Asked about the proposal, Shinseki said it was under "consideration."

"A final decision hasn't been made yet," he said...

I know this is going to make me sound like I'm trying to get a job as Phil Carter's secretary at the VA... but - so what?

I'll wait for the outraged sputtering to stop.

This is no different (as I understand it thus far) than how I *already* get treated by TRICARE as a retiree.

If, for example, my wife has insurance with her firm and it covers me, *and* I have TRICARE and I'm using that - then TRICARE, by law, will bill her insurance. In fact, every year I have to certify that I do, or do not, have "third party coverage" because if I do, TRICARE, by law, is going to be a second payer.

No additional costs to me from TRICARE, just TRICARE (read, the gov't) saying we're going to act like any other service provider and bill your insurance company.

My wife never got insurance through her company - because she was covered under TRICARE. Mind you, one of the incentives to increasing TRICARE enrollment fees is to get people like me to take my corporate insurance vice using TRICARE.

Until someone shows me that the intent of the rule change is to *require* veterans with service-connected disabilities to get private insurance in order to get treated... then all this is doing is trying to treat service-connected vets (I'm one of those, too, at a 70% rating) the same way military retirees get treated, which is not a net cost to the vet in question.

Now, when you're like me, you're in Priority Group One, which actually means the VA is responsible for *all* of my health care, service-connected or not, though I choose to use TRICARE so that I can get my wife covered.

The people most affected by this will be veterans in the lower priority groups who only use the VA for service-connected injury care. If the VA isn't covering their full care, and they have insurance, this rule would allow the VA to bill their insurance carrier.

If the veteran does *not* have insurance, no change. I don't see this as an assault on us, until they start requiring you to have some form of private insurance. That changes things, clearly.

I find it interesting that Senator Murray said it's "dead on arrival" considering it was Congress who made the change to the law to ensure that TRICARE could automatically be a "second payer" to private insurance if you had it.

Color me watchful on these fellas, but not seeing this one as a threat. Yet. Much room for mischief, and it's good to let them know we're paying attention.

Eyes on the ball. Don't get distracted by making mountains out of molehills.

Comment from RetRsvMike on 2009-03-11

2009-03-11T21:33:36Z

well, i would then put up the later part of my argument as the lead part; i.e. treatment should be free at VA for service connected compensable things.

the confidentiality part is my own take on things. once two data systems start bouncing info off each other, i have zero confidence that ANYTHING about either set of data isn't going to be seen inappropriately.

as it is, when i have a VA appointment, i schedule a vacation day from my employer, rather than just booking "med time off" as i would for a civilian doctor's appt. what i do at VA is none of my employer's business, nor is it the business of my HMO.

Comment from John of Argghhh! on 2009-03-11

2009-03-11T20:33:03Z

The confidentiality issues are an interesting twist.

We do understand that the proposal is for veterans *using* the VA, for VA-provided services? And that in that case, if the vet has private insurance, the VA wants to be able to bill it like any other provider?

And the VA would eat the co-pay.

Or am I again, missing something?

Comment from RetRsvMike on 2009-03-11

2009-03-11T20:26:05Z

sorry for the delay in flash to bang on your call for a repeat....

here's a mostly hypothetical, based on a Reservist:
- soldier has a service related injury while deployed. upon arrival at demobilization station, is told to fill out these here papers, and get scheduled (or not) for treatment at an Active Duty post (and/or slotted into a slop battalion at a Reserve Mob Station while awaiting treatment. Option A gets him extended orders, treatment in military facilities, and a good chance of detailed documentation pursuant to a later VA claim. Option B involves not filling out the papers, not having proper documentation for a later VA claim, but soldier gets to go home and resume civilian career, and pursue treatment close to home thru work provided HMO. the choice hinges on "how serious do i feel about this injury".
- assume soldier chooses Option B. if it is a rotator cuff injury, no problem. civilian ortho and sports related treatment available on the civilian market is just fine. physical therapy, surgery, whatever is needed. documentation is generally accomplished, and eventually the paperwork gets posted over into the VA system, and maybe (or not) the claim gets approved. would i necessarily care whether the VA talks to my HMO about my rotator cuff? probably not.
- now change the injury to PTSD, and the civilian employer to "Police Department". specialty care IS available on the civilian market for SIMILAR types of diagnosed problems, HOWEVER the HMO is going to be steering you towards a limited number of care providers, any one of which may also be treating your brother officers. YOU have PTSD, THEY have counseling because of a partner got shot. SIMILAR situations, but the vet should be getting FREE care from the VA. the cop should be paying a co-pay.
- ...and i'm naturally leery of confidentiality of medical records, either in the VA system or the civilian health care system, and i'm sceptical that an employer won't somehow find out about what treatment a vet is getting at VA, whether thru the HMO or through word of mouth ("hey desk sergeant, guess who i bumped into in the waiting room over at the shrink's office....")

keep it sensitive and highly compartmented is my motto on this topic, and VA care for vets with service connected and compensable diagnoses should be completely gratis.

(you mean you want me to pay the co-pay out of the money you're sending me as compensation for the injury?? sure, it's a mere pittance, but i see it as a pity)

Comment from BillT on 2009-03-11

2009-03-11T19:31:32Z

And at least after next year, you won't be funding your disability any more. That's a decades-long fight we finally won.

Bets?

Based on how long it took just to get my disability approved, I'll most likely be occupying my gummint-issue pine box before that happens. Unless they take *that* away to help fund the disability payments...

Comment from John of Argghhh! on 2009-03-11

2009-03-11T18:54:49Z

If they apply the TRICARE approach - you aren't going to pay the out-of-pockets of your coverage.

In your example, if my overall bill was $100, and I was responsible for $20, then VA would bill your insurer for $80, and you wouldn't not be charged the $20.

If the government is paying the bill... the bill is falling on the 50% or so of us that are paying taxes.

The "military rider" aspect could be covered by either a payment that pays the rider or simply not allowing the insurance companies to make the distinction.

No, I don't see the vicious circle this will start, and now, it doesn't bother me that Shinseki (really Shinseki based on CBO inputs) is considering it.

The bill has to get paid, I would rather they look at alternatives, and discuss them openly, than just kick this can down the road.

It is precisely Shineki's *job* to look at the alternatives. And the fact that a retired General is looking at alternatives that already apply to him in terms of being an Army retiree doesn't give me the heebejeebees.

And don't think the Bush Administration wouldn't have floated similar initiatives.

They're all facing the same problem.

And we're all going to end up paying the bill somewhere.

Comment from AFSister on 2009-03-11

2009-03-11T17:39:42Z

Private, or employer-sponsored, insurance coverage varies, as does the amount contributed by the patient. Let's try an example.
If I am in the Reserve, and injured while on duty, this proposal would mean my private (or employer) insurance would pay first. If that policy is a standard "blue cross" type of coverage, I have to pay 20% of all costs, and my insurance would pay the remaining 80%. If I had a PPO, my cash outlay would be much less- pennies on the dollar compared to what my private insurance would pay.
So depending on the type of coverage you have, it will cost you more- maybe MUCH more- to pay for your military-induced injury.

And then we have the cost to the insurance companies.
Right now it costs about $400 a month for single coverage under a group plan for a PPO. Family coverage can triple that. If private insurance companies start having to pay the huge medical bills incurred by our soldiers for military-related injuries, you can bet your damn bippy that cost will go up dramatically- for EVERYONE in the country. Even though most employers pay somewhere around 75% of the monthly premium, everyone (corporations and employees) will bear the burden of the increased premiums. There's also a good possiblity that a "military rider" will be added to private insurance company premiums, much like they do now for life insurance for smokers.

Plus there's the heirarchy of coverage.
When you go to the doctor, you have to tell them who your primary insurer is. If you are injured on the job, the primary insurer for that care is ALWAYS ALWAYS ALWAYS worker's comp. Private insurance does NOT cover the difference- so why would they allow military injuries to bypass this? Then we end up with insurance companies fighting the government (VA, Tricare) over who is responsible for the bill, and in the meantime... care stops for the injured because they can no longer afford the medical bills while the insurance companies fight it out.

Can you see the vicious circle this will start, John?
This is a bad idea, and it disturbs me deeply that Shinsiki even suggested it in the first place.

Comment from John of Argghhh! on 2009-03-11

2009-03-11T12:54:02Z

As I noted, the devil is in the details, and the details could certainly kill it for me. My disadvantage here is that I've *never* had non-military coverage. My wife didn't use her employer coverage because we used TRICARE.

As I see this, the crux is for non-priority group one, non-miltary-retiree veterans who have other health insurance, which is, frankly, probably the majority of them.

The question then becomes, do their private insurance out-of-pocket expenses go up under this plan?

I suspect *that* depends on whether they have non-employer or self-purchased health insurance or company-provided health insurance, and how per-capita costs are handled there.

That's what I'm getting at trying to know.

Comment from Joshua of Leavenworth on 2009-03-11

2009-03-11T12:25:39Z

It may impact you in the sense that now your spouse's insurance will be covering costs that had been paid by the VA. If I understand correctly, your current service related treatments are not paid by TRICARE but directly by the VA, where as now they would be by either TRICARE or if you have it your spouses insurance; then your TRICARE. But if your service related injuries (which up to now your spouse's insurance didn't have to deal with) are fairly high in cost then it will cause the insurance group coverage cost to go up and a larger deduction to be taken from your spouse's paycheck.

I could be misunderstanding all of this.

Comment from John of Argghhh! on 2009-03-11

2009-03-11T11:57:45Z

You make my point on the perfidy of the system (I share you annoyance about the GI Bill, said the guy who paid for his own Masters, and didn't see a dime from the gov't). as it has played out over the centuries. We've been lying to the troops to get them to enlist since 1775, not to put too fine a point on it.

And at least after next year, you won't be funding your disability any more. That's a decades-long fight we finally won.

That said, as I've been nattering on about for the last two weeks, we need to pick our fights and characterize things accurately.

Oh, I know, it's worked so well for us in the past, right?

Comment from BillT on 2009-03-11

2009-03-11T11:21:34Z

Lessee. When I first started out, I was told I'd be eligible for the GI Bill and would have lifetime freebie health care If were disabled or hung with it until I retired. Then Congress withdrew my GI Bill eligibility because I took too long to use it, even though my application was denied all three times I tried to use it, and the Supreme Court decided that the Army's promise of health care was null and void, because it wasn't in writing, even though recruiting brochures in the '60s promised it in writing.

Now I'm paying for my own disability compensation because it's being deducted from my retiree pay, and, aside from Tricare, I'm uninsurable because of the nature of my disabilities.

Maybe I just oughta shoot myself to take advantage of my -- promised -- gummint-provided pine box before I lose that "benefit," too.

Ummm -- just kidding on that last one, natch...

Comment from John of Argghhh! on 2009-03-11

2009-03-11T11:15:36Z

I clearly am just not "getting it". Perhaps it's because I already play under these rules.

Unless someone can show me otherwise, it's no net cost to the veteran. Again, if the plan would work as it does under TRICARE, all that happens is that the veteran's insurance is billed and the VA gets whatever it gets from the insurance carrier. Unrecovered costs are *not* passed on to the veteran. As far as the veteran is concerned, outside of related paperwork, there is no cost increase from the situation now - but the VA gets some external reimbursement not funded by the taxpayer. For a chronically under-funded agency, this is bad how?

Remember - these are yours and my dollars that fund this in the end, via taxes.

The calculus changes when the rule reads "The veteran *must* carry private health insurance." Then I'm on board to sharpen the tines of my pitchfork and wrap some branches with oil-soaked rags.

We can just keep kicking all these cans down the road, ladies and gents, but that's the path the politicians take, such as in not facing up to the realities of what's happening with Social Security.

If we're going to keep ignoring the problem because we don't like the answer... well, the reason we get the politicians we do becomes clearer, doesn't it?

I just don't see how this isn't an inherently conservative approach, given the current state of play in the health care system.

Just as I see the issues affecting TRICARE - the fact that enrollment costs and fees haven't changed since 1995 might necessitate some changes in fees now. Mind you, I personally benefit from all this, but I can see how it makes the system unsustainable unless all y'all don't *mind* paying ever more for my health care.

Comment from Grumpy on 2009-03-11

2009-03-11T06:01:58Z

John, to me, it's ironic, yesterday, I went over to the VA neurologist. I, like you, am service-connected disabled, 100% total and permanent. I don't think this concept is really on the table. I think this is more the product of a perverted political thing, not elected, nor appointed. He, she, it, or they should be flown out to the nice warm ocean and dropped off. Whoever can become "Life Sustaining Members of the Shark Preservation Society."

Comment from AFSister on 2009-03-10

2009-03-11T02:37:35Z

Service-related injuries should be taken care of by the VA, just as civilian work-related injuries are taken care of by Worker's Comp.

Period.

Comment from The Thomas on 2009-03-10

2009-03-11T01:57:45Z

That article was front page, above the fold this evening in the Grand Rapids Press.

They have been covering this on an irregular basis, but I haven't seen any comment from our congress critters.

Comment from The Thomas on 2009-03-10

2009-03-11T01:51:58Z

Or in the case of Airman Joseph Weston, just drop him like a hot potato.

Comment from John of Argghhh! on 2009-03-10

2009-03-11T01:45:20Z

James - in one sense, perhaps, allowing the VA to bill to insurance would provide the funds to improve services.

The dynamic goes against that, certainly, in the way the gov't operates.

Mikey - would you are to elaborate?

Again - my perspective is, if you already have the insurance (vice a new requirement to carry it which means you have to spend more) what's your beef with that?

Enlighten me, please. And I mean that with no snark.

Comment from RetRsvMike on 2009-03-10

2009-03-11T00:56:26Z

and yet it is a mountain, neverthless.

unlike retiree care, VA treatment for service related (and compensable) conditions should be gratis.

there is no way i want VA even speaking to my civilian HMO.

Comment from James on 2009-03-10

2009-03-11T00:33:29Z

If yu could change the lasty sentance, to make molehills in mountains. I think it would have more meaning, Im still waiting to see if the service could be improved at the local VA. Too many vets without access, very limited access here in KC.