I received the following from a friend who is a physician in the Veterans Health Administration. This fills in a lot of the lacunae in my previous comprehension of the present VA medical service. For example, I had no idea that treatment is now available to all honorably discharged veterans without regard to service connection of disabilities. This evidently results from a very large expansion of eligibility during the administration of President Bill Clinton. That expansion "flooded" the system. The system that the doctor describes seems very generous to me. BTW I have never used VA medical facilities but am in Priority Group 1 in their system. pl
"I can certainly tell you about the patients that I see, as its quite a broad range. You’re correct in that its mostly former vets and not military retirees, though I also see the retirees occasionally.
At least half of my patients do not have a service connection and are not combat vets. Pretty much anyone who served and had an honorable discharge can be seen at the VA these days. There was a large influx with the arrival of the ACA and concerns about penalties for those who didn’t have insurance. If you go to the VA, you do not need to carry any other insurance plan. its actually an incredible boon to most vets. The only costs are for visits ($15 for primary care and $50 for any specialists). There are ranges of prices for meds, the most expensive being $11 per month. All labs, radiologic tests, splints, crutches, wheelchairs, etc are all covered. I’m not certain, but I think there is no charge for inpatient services. Some vets come to the VA just for the hearing or optometry services, but many use the VA as Part D medicare. More and more, patients who have outside doctors are coming in and requesting to transfer all their care to the VA. They appreciate having their care under one roof, where doctors can easily communicate with each other and all the records are in the same electronic medical system and immediately available.
Admittedly there may be quite a difference from one VA to the next. Here in New England, many are associated with the local medical schools and teaching hospitals. Its not unusual for patients to find that the surgeon, neurologist, etc they’re seeing outside the VA, also has some hours in the VA.
The psychiatric services offered at the VA are not reproducible for the most part in any other system. There are a number of individual as well as group therapies, some in areas not generally covered by outside insurance. For example, anger management, grief and loss, combat PTSD, military sexual trauma. Many of the therapists are also vets.
Anyone below a certain income gets free care, regardless of service connection status. I have a number of presumably higher income patients who come as well, to include lawyers, college deans, other physicians, etc. They come because they feel the care is excellent or sometimes just for a bargain, such as a reduction in the price of their medications.
The new rule in the VA is that every referral is to be seen within 30 days. That goes for an initial primary care visit as well as any specialty visit. If the speciality services cannot see a vet within the 30 days, they place a referral for “community care”. This is where things sometimes break down. As most of us who do not use the VA for care know, its not uncommon to wait for months to see a specialist. The “community care” vet doesn’t get to go to the front of the line. It often happens that the VA specialist could have seen them in 35 days or 60 days, but now they wait indefinitely to see the outside doctor, because its 30 days or outside care, period. The referral process for “community care” is better than it had been, but its run by a Non-VA contractor and problems abound. Many doctors, acupuncturists, chiropractors and others stop taking VA patients due to not getting paid in a timely manner or not getting paid at all. Its not unusual for vets to get bills for the services they received from these outside sources and may be reported to collection agencies for lack of payment.
Privatization may have a role in areas of the country where access to a VA is difficult, but should not be generalized to all VAs, many of which are high functioning and offer unique care to Veterans. " A VA doctor