An absolutely fascinating interview. Thank you for sharing it.

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New VA mission: “To fulfill President Lincoln’s promise to care for those who have served in our nation’s military and for their families, caregivers, and survivors.”

Previous VA mission: “To care for him who shall have borne the battle, and for his widow, and his orphan -- President Lincoln”

In addition to the bureaucracy mentioned in the article, the active filing of claims for disability that is INSTRUCTED at the time of separation or retirement from the military contributed to the prior backlog and current influx. While relieving the backlog by creating efficiencies in the administrative aspect of the system was admirable, I disagree that was the correct problem to solve. I think the more appropriate problem seeking a remedy would have been to ask why there were 800,000+ claims for illnesses that are often associated with normal aging or lifestyle choices and nothing battle related and only remotely service connected. Just because someone served in the military and was discharged honorably, I question why the emphysema created by their continued decision to smoke or the obstructive sleep apnea associated with weight gain during service and after separation are service connected?

For example, in the DODI 6130.03 Vol I, medical accession standards, nicotine dependence cannot even be considered a disqualifying condition. So one can join a smoker, continue to smoke, serve, separate, continue to smoke as a civilian, and then seek VA claims through some lightly connected “exposure” that could possibly be related to lung disease. No time does anyone say, “hey, you entered nicotine dependent, continued to smoke despite access to free cessation opportunities while on active duty, and now you have the long term sequellae from your decision. Thank you for your service, but please follow up with your ACA private doctor.” The VA has long been burdened by current VA rated personnel who instruct everyone in mandatory classes at the time of separation on how to game the system. Continue the efficiencies mentioned in the article, but go to the source if you want to permanently fix the problem.

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I work for a federal agency and the sheer amount of lawyering normal employees have to go through made this article hit close to home. It really does feel most days I'm asking someone or other "is it allowed for me to do this". The worst part of it is that when you're actually in the thick of it, these "silly laws" are not apparent, and for every silly law there's a rather reasonable law that we ought to respect but still binds us in an unexpected way.

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>There are movements to fully privatize the VA ... I just don't know how to do that

It's pretty straightforward: you offer a VA health insurance policy that corresponds to the % disability level. The VA has a $300bn budget per year. There's something like 16.5M vets. So that's $18k/beneficiary. The highest Medicare per beneficiary spend in the US is like $13k in FL. And the veteran patient base skews way younger so this isn't even a like for like comparison.

I'm a veteran and one of the most important decisions I made in my life was not entering the VA hellscape upon getting out. As soon as I walked into that building I knew I'd be signing up for Vogon level customer service with a side of mental illness.

I appreciate that well intentioned reformers prefer to change institutions for the better (and God bless them) but it's time to acknowledge the structural failure of government run healthcare and move onto another model entirely. I mean, half of this article is about getting people to interpret the law sanely, coordinate best practices, and not copy and paste regulation. That's a dire level of incompetence and generally not giving a shit.

I also found it... odd that you didn't mention the parking lot suicides. Of course you're under no obligation to address that but I think the general public should know that the VA sucks so much that veterans premeditatedly kill themselves as an act of protest. These aren't impulsive suicides, these are suicides with an explicit a message of "The VA Sucks". Maybe others can name another customer service organization that sucks so much their customers kill themselves in protest. I can't though.

So yea, you seem smart. Maybe think a little harder on how to elegantly extinct the VA.

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