RAND VA Healthcare Quality

RAND Study Says VA Healthcare As Good Or Better Than Private Sector, Again; Should We Believe Them?

A new RAND study claims VA healthcare is as good or better than private sector care, at least when respun by VA. For the past few years, RAND has published numerous other studies spun by VA and the press as saying VA healthcare is as good or better than private sector care.

But are we comparing apples to apples?

Meanwhile, we have seen report after report of veterans being harmed from fraudulent wait list scandals, failures to provide adequate care, incompetent clinicians providing poor care, and otherwise bad conduct like fly infestations and more.

With all these reports, even without reviewing the metrics used, can we trust RAND to provide fair investigations and reports of VA healthcare quality? Or, has RAND bought into the rhetoric that VA healthcare is the model of socialized healthcare technocrats plan to roll out for the American public once the scandals are marginalized?

On April 25, 2018, RAND published its newest report on VA healthcare. I am conducting background on the report, but I wanted to provide readers with a full scope of what is being said while I secure FOIA responses about the study.

RELATED: RAND Bait And Switch Study Sham

Here is what VA says about the RAND study that was conducted on the subcontract of another company called MITRE:

VA healthcare rated same or better than private hospitals

RAND study finds VA provides high-quality healthcare

Veterans receive the same or better care at VA medical facilities as patients at non-VA hospitals according to a recent RAND Corp study.

“The RAND study adds to a growing list of research confirming what many Veterans and VA employees believe – VA provides high-quality care,” said VA Acting Secretary Robert Wilkie. “We are constantly striving to improve our care at VA, but this should encourage Veterans and the public that VA care is, in many instances, as good as or better than the private sector.”

The study, which was published online April 25, compared each VA facility to three non-VA facilities with similar geographic settings (rural/urban,) size (number of beds) and complexity of care. The analysis focused on three of the six “Domains of Quality of Care” as defined by the Institute of Medicine, (now known as the National Academy of Medicine) including safety, effectiveness and patient-centered care.

The authors of the RAND study analyzed inpatient and outpatient performance measures used by VA and non-VA hospitals. On inpatient care, VA hospitals performed on average the same or significantly better than non-VA hospitals on 21 of 26 measures. VA performed significantly better than commercial and Medicaid Health Maintenance Organizations on 28 of 30 measures, with no difference on the other two. There was a wide variation in performance across VA, but an even wider variation among the non-VA hospitals.

For more information, see the quality data available on VA’s Access to Care website at www.accesstocare.va.gov.

What Do You Think?

Is this typical VA propaganda?

That is what VA says about the RAND study. You can imagine there are at least two camps within VA that have different views about quality of VA healthcare. The pro-Veterans Choice camp will want to negative VA healthcare stories to circulate. The pro-Socialized Medicine camp will want stories to circulate about VA healthcare being great.

RELATED: Journalists Falsely Report On VA Healthcare Quality

I would like to point out that VA highlights the use of a “Domains of Quality of Care” metric when selecting the three non-VA hospitals to compare VA hospitals against. VA does not mention which hospitals were selected, but that seems relevant, right?

In order to see the actual RAND study, you need to buy it for $39.95 from Springer Link. Bummer. But we can glean at least a little information from the abstract titled, “Comparing Quality of Care in Veterans Affairs and Non-Veterans Affairs Settings.”

RELATED: VA Misleads Public About Fixing Veterans Crisis Line

As summarized, the RAND study conducted the evaluation as follows:

We assessed Patient Safety Indicators (PSIs), 30-day risk-standardized mortality and readmission measures, and ORYX measures for inpatient safety and effectiveness; Healthcare Effectiveness Data and Information Set (HEDIS®) measures for outpatient effectiveness; and Consumer Assessment of Healthcare Providers and Systems Hospital Survey (HCAHPS) and Survey of Healthcare Experiences of Patients (SHEP) survey measures for inpatient patient-centeredness. For inpatient care, we used propensity score matching to identify a subset of non-VA hospitals that were comparable to VA hospitals.

The key results, at least according to the abstract authors were:

VA hospitals performed on average the same as or significantly better than non-VA hospitals on all six measures of inpatient safety, all three inpatient mortality measures, and 12 inpatient effectiveness measures, but significantly worse than non-VA hospitals on three readmission measures and two effectiveness measures. The performance of VA facilities was significantly better than commercial HMOs and Medicaid HMOs for all 16 outpatient effectiveness measures and for Medicare HMOs, it was significantly better for 14 measures and did not differ for two measures. High variation across VA facilities in the performance of some quality measures was observed, although variation was even greater among non-VA facilities.

And… it’s all important conclusion was:

The VA system performed similarly or better than the non-VA system on most of the nationally recognized measures of inpatient and outpatient care quality, but high variation across VA facilities indicates a need for targeted quality improvement.

RELATED: VA Pays Millions For Stonewall-and-Spin Propaganda Machine

What It Means?

Based on the above, is VA being honest? How do you think the actual study may have been manipulated to create the result VA wants with its MITRE contract?

The program was funded through the following vehicle:

This work was completed under a subcontract from The MITRE Corporation for the U.S. Department of Veterans Affairs at the request of the Veterans Access, Choice, and Accountability Act of 2014 Section 201. The report was prepared under Prime Contract No. HHS-M500-2012-00008I, Prime Task Order No. VA118A14F0373.

At the end of the day, I want to know what you think. Take a deep dive into the study. Try to locate or buy a copy and let us know what it actually says about the hospitals selected.

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  1. Some is, most isn’t. Pharmacy, as an example, can’t just call the VA pharmacist in San Diego, CA. Your message will be relayed to the pharmacist, they have 34 to 48 hours to get back to you. Lackadaisical attitude by many VA employees. May change primary care doctors ONLY once a year and then may just be assigned a nurse practitioner. Even illegals on welfare can change once a month. From the time I pull into
    the parking lot to the time I walk into the front entrance can take 30 minutes. Generally, a cluster F.

  2. This “Rand Study” just goes to show that, if you have enough money (like the VA has), then you can buy anyone’s opinion.
    This is what VA is all about. “Dishonesty for dollars”.
    There is an economic principal that prooves VA is not as good as private health care: Its called “the law of diminshing Returns”, and combines with “Economies of Scale”. As my professor explained:
    If you consume “one” big mac, you get a level of enjoyment that could be measured.
    However, if you consumed 91 Big Mac’s, rest assured the 91’st big mac will not give you as much enjoyment as the first. In fact, he suggested the 91st big mac enjoyment would be a negative number. You would be so sick of big macs you would never want to see another.
    In a similar way, health care managed by a small company would be managed more efficiently than one managed by the federal government, because the federal government is too large to manage millions at a given time. So, the efficiency drops just like the enjoyment of big macs after you eat too many.

  3. My sense also. And for private medicine, we are 37th in the world. But I’ll bet some facilities are still on the cutting edge, including VA facilities.

    That bomb analogy is perfect.

  4. I downloaded and read the study. I’m a retired Air Force physician and was chief of a medical staff. I understand the metrics used in this study. This is a very good study of comparisons between the VA and the civilian healthcare sector that uses industry-standard metrics. The methodology is good.

    The problem, as noted by the authors, is that there is wide variation of quality in the VHA. On average, the VA is doing as well as or better than the private sector. But no one gets healthcare “on average.” Veterans get healthcare at a specific VA. Some VA hospitals are not doing as well as others and quality needs to improve in those facilities. This is also noted by the authors.

    As we said in the Air Force, if you set out to bomb a bridge and half of your bombs hit on one side and half on the other, on average you’ve hit the bridge. But we don’t bomb on averages. Dittos for the VHA. On average, system-wide, they are doing well. Due to the large variation of quality among VHA facilities some are missing the mark. VHA needs to reduce variation and improve the quality in those facilities.

    1. What’s wrong with Social Security? It keeps millions of people with income and healthcare. It works extremely well.

  5. ““Our hands are tied. Call your Congressman”. That must be part of ALL their training including our dear back-stabbing VSOs, politicians, et al. Same old song, dance, excuses. Wish I had a buck for every time I heard this line of crap from our so-called representatives, so-called brothers and sisters, or fellow Amuuurricans.

  6. Well???? Pelosi’s hubby is RAND. Catch on?? Long way from the days of Miss Lube rack, Nancy.

  7. Called Congress. They say “Call your patient advocate”. Called patient advocate. They say “Our hands are tied. Call your Congressman”. Really?!?!?

    1. Download and file an SF-95 per the case I posted. The SF-95 is filed to the VA GC office for your area. They have six months to respond and then you file a case following the guidelines presented in 918 F.Supp.2d 301
      Stanley P. LASKOWSKI, III and Marisol Laskowski, Plaintiffs
      No. 3:10cv600.
      United States District Court,
      M.D. Pennsylvania.
      Jan. 16, 2013.
      [918 F.Supp.2d 304]
      Daniel T. Brier, John B. Dempsey, Patrick A. Casey, Myers Brier & Kelly, LLP, Scranton, PA,
      for Plaintiff.
      George Michael Thiel, U.S. Attorney’s Office, Scranton, PA, for Defendant.
      [918 F.Supp.2d 305]

      Ben won’t take your case and neither will most attorneys. But you can file yourself and when the District Courts get enough cases Congress will have to respond to Section 4 of the 14th Amendment.

  8. RAND does but one thing. They take existing information generally in the form of very large databases and “study” the numbers to see what conclusions can be drawn. RAND does not actually go into hospitals or veterans homes or anywhere else to observe data being collected at all. They crunch numbers and when the numbers do not fit they apply mathematical constructions called advanced matrix transforms on the data which is how they make an elephant look like a mouse when the elephant won’t fit into the room being studied.

    How do I know what an advance matrix transform is as used by RAND? I learned about them in the last election when RAND analyzed voter numbers and predicted Hillary would win. They used these transforms on numbers that did not fit the prediction in which say a vast segment of folks hated the filthy woman in states deemed friendly to her. So they crunched the numbers and…. viola! However the fact that they had skewed the numbers using such a wild technique as these so called “transforms” was buried deep in the study protocol. It was there but who the hell digs for that stuff?

    The study is only as valid as the validity of the data provided to them. The only possible source of such large volumes of data needed is who? VA. Alternatively the data for private sources is provided by who? Private Companies. One source of data has a budget of billions and a PR budget alone that dwarfs the entire budget of the private hospitals combined in this study. The other source of data, private hospitals, likely spent less than five cents on PR during the course of the study.

    I am gonna ask some questions of my own to illustrate how absurd this notion seems logically to me that VA healthcare does a better job of serving the patients than a private hospital does;

    How many otherwise law abiding patients in private hospitals are escorted by armed guard to see their doctor? How about licensure of healthcare workers? All private hospitals hold their staff to state standards. VA allows its practitioners to practice with licensure below minimum state licensing standards for some medical procedures. Is RAND saying that higher licensure standards made no difference? The American with Disabilities Act which forces private hospitals to comply with bare minimum accessibility standards does not apply to VA facilities and is not adhered to by VA. Compliance by private hospitals to the ADA is mandatory for the sake of the disabled. Is the RAND study suggesting that rigid compliance to ADA by private hospitals but zero ADA compliance by VA hospitals made no differences in care at all for the disabled?

    VA is legally bound to accept an unlimited number of patients irregardless of their ability to serve them. Private hospitals can and do stop accepting new patients if quality is impacted for existing patients. This RAND study is trying to suggest that uncontrollable growth and unmanageable patient load results in equal or better care than private hospitals who legally limit their patient load to match what their staff can reasonably handle. Hmmm.

    There simply can be no study of these two delivery vehicles for health care when the two modes are so very incongruent. In a private hospital a nurse who does not report a bad doctor will be fired. In a VA hospital a nurse that does report a bad doctor often will be fired so much so that a special task force is set up to try to stop it.

    Private hospitals do not control their own armed federal police force. Private hospitals are not immune from prosecution. Private doctors are not immune from malpractice suits. Private hospitals are not immune from bankruptcy. VA hospitals ALL are.

    … and RAND concludes they provide the same or better care? Uh huh. Sounds like an advanced matrix transform to me, Hillary.

    1. One correction that should be made: VA hospitals and doctors are not immune from malpractice suits. (see Lem’s post above or read 918 F.Supp.2d 301 as a good example)

  9. That RAND survey is forged or otherwise jacked. I stopped VA as did my DH. We go private & it’s far better. (But keep in mind, I work with thousands of vets) The staff even told us when they weren’t supposed to “get out while you can. They’re not going to take care of your condition” (which I don’t want to get into on a public forum) Drs told us this. Pharmacists told us & so did the nursing staff & every single one of them blamed it on DT & GOP. (Over several visits this occurred)

    For me personally, I waited 6 MONTHS for a referral because apparently Choice ran out. I never did get that referral. I took myself to the civ dr. They’re not leaving me like this & god knows I’m not letting VA operate. I’d rather walk in pain than not @ all.

    While I’m thinking about it on Choice- those drs are subjecting vets to unnecessary medical procedures. Those drs are trying to fleece Choice. They’re greedy AF. Choice is a total mess. Yes, I have examples; which I will only talk about privately out of respect for anonymity of my vets.

    Tricare should be opened back up for DVs or open Champ VA up for all DVs. Screw Choice because while it was well intentioned, it’s being misused horribly. Screw VA- They care about public appearance not the actual Vet. But VA doesn’t want to close because they’re making a shit ton off of us. Regardless of whether you’re service connected or not, VA is still charging your private insurance for showing up.

    Vets, now ask yourself, is the treatment I get from VA worth paying for? My answer & the answer of the majority of my vets is no!! (Never mind the law says VA pays for service connected- VA says you’re paying for it with your private insurance that you’re required to have under Ocare even tho that section was repealed VA still requires you to put in private insurance @ the kiosk) (yes I know VA counts as insurance, but a lot of vets also have Medicare or private thru their spouse) VA doesn’t send the Vet the bill. VA sends it directly to your insurance company which may or may not ask you about the charges/visit. My insurance company did & I dimed out VA & told my insurance company not to pay VA because it was a service connected issue & provided all appropriate paperwork with my statement. My insurance didn’t pay it & VA had to eat it. VA depends on the Vet not knowing their rights…. just like the civ drs contracted for Choice depends on vets not knowing how Choice works or how the private medical field works. BTW, I know you didn’t really think you would get a choice of dr on Choice. VA here picks your Choice dr for you. (Which is another way Choice is being horribly misused)(once a dr is picked you don’t get to change the dr) That also reminds me- VA is refusing to let vets change their VA PCP. VA is saying you must have been with the PCP for @ least 12 months before you can request a new one.

    1. Hope you can fund your care. I’m filing an SF-95 claim to be joined to my civil action against the VA and Navy for a Choice bill they didn’t pay.

  10. RAND is not an independent study organization. Period. They will use stats that VA wants them to use. SURVEYS, I have repeatedly requested them after being insulted, assaulted, threatened with refusal to refill my medications; not one Survey. Why doesn’t the VA get JCAHO evaluations with a letter grade as to evaluations regarding cleanliness, orderliness, access to Mandatory information for ALL employees to be aware of. I don’t believe this study. After dealing with these Doctors at VA, and the blatant disrespect. These last several years of denying Pain medications, cold turkey to 80-90% of those of us that have suffered the worst of the worst possible ‘WORK RELATED INJURIES” just to look good on paper. This is not how the Private Sector treats those in pain. I’m sure Congress doesn’t have any problems getting treated for their old age aches and pains? Those old timers never jumped out of planes, carried equipment that broke their backs, and yet its the Veterans that President Trump and deposed VA Secretary Shulkin mandated, “NO OPIOIDS FOR VETERANS.” (and the Doctors at VA say, “if you want pain meds, you will have to get them outside of VA, because we aren’t giving you any.” Senator McCain, where do you get your Medical Care, you are a Veteran-try getting that same white glove care at VA.
    RAND failed to study those numbers, I’m sure there might be an organization that isn’t getting some kick back willing to do a Real Study….but VA will never allow it!

    1. I was personally told by doctors, pharmacists, & nursing staff @ VA- DT & Congress are pressuring VA to cut everyone off their pain meds. They go thru a whole sales routine about how bad opioids are. When it becomes apparent you know their spill is full of it, they tell you go outside VA. If you’re 100% go outside & then send the VA the bill for reimbursement. If you’re not 100% but are service connected for the injury requiring opioids, send the VA the bill for reimbursement. VA has to cover service connected. They might give you shit over it, but they have to pay it.

      1. Horse poop Molly. Are you coming out here to post only to lie and fuck with people? No ‘they’ don’t and will not. Locally getting pain meds is only for the well connected and cliques. Or those who can bear sitting in some quacks waiting room for up to six hours for a weekly script now. Yep, one week and more money for the health care freaks and rip offs, oh joy. Any body seeing the game being played here while many suffer, gubbermint gets more control and AMA trash laugh all the way to the bank? After years of cutting peoples, vets, pain meds off they claim a victory over the drug war….. then claim they need more laws to govern all meds more, more intrusions into our lives and files and health care. That the pain med issue is still epidemic proportions and countless suicides or over-doses are happening per day. All because of those evil pain pills. So which is it?

        I told the last freak after sitting in his office for four hours and playing his game that I was not going to go bankrupt again, for the third time, over health care. I ‘ll die first. As he wanted to send me off to see a list of MDs I have already seen in the VA and out and no help to be found. What did this Semite do? Belly laughed as his side-kick nurse got a little chuckle out of it too like I was joking around. Sure shows the attitude of both the young and older medical regime.

        Try again Molly.

      2. File an SF-95 claiming refusal to treat and the pain is driving you toward suicide.

      3. That’s not been their track record: the VA stopped paying hundreds of VETERAN’sS CHOICE providers, clinics and doctors. They stopped taking Veteran patients because they couldn’t get paid.

      4. I’m only posting partial excerpts because of the length. The case provides a good go-by.

        The case to look up is: 918 F.Supp.2d 301
        Stanley P. LASKOWSKI, III and Marisol Laskowski, Plaintiffs
        No. 3:10cv600.
        United States District Court,
        M.D. Pennsylvania.
        Jan. 16, 2013.
        [918 F.Supp.2d 304]

        Generally, the doctrine of sovereign immunity protects the United States from suit. The
        FTCA, however, waives this immunity for situations where negligent or wrongful acts or
        omissions of government employees, acting in the scope of their employment, cause injury to
        others. 28 U.S.C. § 1346(b)(1). The FTCA provides: “The United States shall be liable,
        respecting the provisions of this title relating to tort claims, in the same manner and to the
        same extent as a private individual under like circumstances, but shall not be liable for interest prior to judgment or for punitive damages.” 28 U.S.C. § 2674. The United States
        District Courts have jurisdiction over FTCA claims. 28 U.S.C. § 1346(b)(1).

        Plaintiff reported to PA Borowski that he had not slept for two days and that he had
        suffered from nightmares since 2003. He told Borowski of a recurring nightmare andreported daytime irritability and isolation. He also indicated that he had a history of
        substance abuse with alcohol and drugs when he was eighteen to nineteen years old.
        Borowski concluded that plaintiff had Adjustment Disorder with PTSD features. ( Id. ¶ 34).
        He prescribed 25–50 mg of Trazadone for sleep. ( Id.) Plaintiff specifically requested “talk
        therapy” on April 11, 2007; regardless, in the subsequent four months, the defendant did not
        provide “talk therapy” or psychotherapy. (Doc. 70, N.T. 9/17/12 at 56).

        As noted above, the main cause of action in this case is medical malpractice, and under
        the FTCA, we must apply Pennsylvania state law. Pennsylvania courts have defined medical
        malpractice “as the ‘unwarranted departure from generally accepted standards of medical
        practice resulting in injury to a patient, including all liability-producing conduct arising from
        the rendition of professional medical services.’ ” Grossman v. Barke, 868 A.2d 561, 566
        (Pa.Super.Ct.2005) (citing Toogood v. Owen J. Rogal D.D.S., P.C., 573 Pa. 245, 824 A.2d
        1140, 1145 (2003)). To recover on a theory of medical malpractice under Pennsylvania law,
        the plaintiff must establish:
        (1) a duty owed by the physician to the patient
        (2) a breach of duty from the physician to the patient
        (3) that the breach of duty was the proximate cause of, or a substantial factor in,
        bringing about the harm suffered by the patient, and
        (4) damages suffered by the patient that were a direct result of that harm.
        Thierfelder v. Wolfert, ––– Pa. ––––, 52 A.3d 1251, 1264 (Pa.2012) (quoting Mitzelfelt v.
        Kamrin, 526 Pa. 54, 584 A.2d 888, 891 (1990)).

        In addition to these elements, the plaintiff in a medical malpractice case is “ ‘required to
        present an expert witness who will testify, to a reasonable degree of medical certainty, that
        the acts of the physician deviated from good and acceptable medical standards, and that such
        deviation was the proximate cause of the harm suffered.’ ” 9Estate of Keating ex rel. Keating
        v. Coatesville VA Med. Ctr., 498 Fed.Appx. 181, 184, 2012 WL 3140915, at *2 (3d Cir.2012)
        (quoting Mitzelfelt, 584 A.2d at 892). We will address these issues separately.
        1. Duty/Standard of Care
        The government and plaintiff agree that the professional staff at the WBVAMC owed
        plaintiff duties and obligations to ensure that he received appropriate medical treatment.
        (Doc. 62, Undisputed Facts ¶¶ 74–75). Thus, the first element needed
        [918 F.Supp.2d 314]
        to establish a medical malpractice claim is satisfied. The parties dispute, however, whether
        plaintiff established the applicable standard of care. Plaintiff asserts that his expert
        witnesses, Dr. Robert Goldstein and Dr. Harvey Dondershine, sufficiently established the
        standard of care with respect to seven different aspects of PTSD treatment. (Doc. 75, Pls.’
        Proposed Findings of Fact & Conclusions of Law at 58–78). Defendant argues, with a
        particular focus on the WBVAMC’s pharmaceutical and telephone prescription practices, that
        plaintiff’s experts have failed to establish the relevant standard of care. (Doc. 74, Request for
        Findings of Fact & Conclusions of Law on Behalf of the United States of America at 46–47).

        2. Breach
        In addition to establishing the standard of care that the defendant owed, plaintiff has
        also established a breach of the standard of care. We will address each breach as it
        corresponds to the specific aspects of the standard of care discussed above.

        The court finds that plaintiffs have established by a preponderance of the evidence:
        The defendant negligently treated or failed to treat Stanley P. Laskowski, III between
        April and August 2007;
        The defendant’s negligence was a factual and legal cause in bringing about plaintiffs’
        harms/damages; and
        Plaintiff Stanley P. Laskowski, III was not comparatively negligent.
        [918 F.Supp.2d 333]
        We award the plaintiffs the following damages:
        Stanley P. Laskowski, III’s Past Lost Earnings and Lost Earning Capacity: $214,582.00
        Stanley P. Laskowski, III’s Future Loss of Earnings and Lost Earning Capacity:
        Stanley P. Laskowski, III’s Past Non-Economic Damages in a lump sum, including pain
        and suffering, embarrassment and humiliation and loss of the ability to enjoy the pleasures
        of life: $500,000.00
        Stanley P. Laskowski, III’s Future Non-Economic Damages in a lump sum, including
        pain and suffering, embarrassment and humiliation and loss of the ability to enjoy the
        pleasures of life: $700,000.00
        Marisol Laskowski’s past, present and future loss of her husband’s services to her and
        the past, present, and future loss of companionship of her husband, including her spouse’s
        company, society, cooperation, affection, aid in the marital relationship, support, comfort,
        assistance, association, and the loss of ability to engage in sexual relations: $140,615.00

    2. Let’s admit it: Most Veterans treated at VA facilities aren’t able to get care anywhere else, for a number of reasons. Of course the vast majority of them are going to say the VA gives quality care, they don’t want to be cut off. It’s fear. There are very few of us who have been able to walk away and get REAL quality healthcare, and when we need it, and be able to choose who our doctors will be and which facilities we can go to. Therein lies the differences.

      It would be different if the VA actually paid their bills to the Choice Providers and more Veterans could compare the quality of care. But it was quite a move on the VA’s part to not pay. It stopped yet another possible vulnerability in having the real world have a look inside. Can you imagine the reports and news when Veterans who were treated at VA facilities went outside and the outside doctors found misdiagnosis, incorrect treatments, et al.

  11. cj ¯¯̿̿¯̿̿’̿̿̿̿̿̿̿’̿̿’̿̿̿̿̿’̿̿̿)͇̿̿)̿̿̿̿ ‘̿̿̿̿̿̿\̵͇̿̿\=(•̪̀●́)=o/̵͇̿̿/’̿̿ ̿ ̿̿ says:

    What do I think? AAAHHHHHHAHAHAHAHAHAHAHAHAHAHAHAHA……….Ben your a funny guy, when ya want to be, Same as or better than the private sector……….AHHHHHHAHAHAHAHAHAHAHAHAHAHAHAAAAA,, good one.

  12. Or process claims which is why they are not processing anything to the BVA or CAVA. The hired lackey contract Attorneys aren’t being paid so they aren’t working their contracts. Choice providers are also not being paid. Probably doesn’t believe in either the CAVA the new organization of the BVA (not under SecVA anymore, they are real judges).

  13. From one of their webpages I see Rand Corp is really making bank on playing mouth piece for the VA and the Democrats.


    1. I don’t know why you tie the VA to the democrats. It’s the republicans who are backing the cuts to budgets and the appointments Trump makes. You can’t have it both ways.

      I would suggest you consider who is taking your benefits away. It certainly is not the democrats.

      1. Personally CWV you need to back off on some of your meds.

        We know you miss Hillary but she lost and there is nothing you can do about it.

        Oh and by the way CWV, Trump did select Ronny Jackson. Which would have put an excellent choice in charge of the VA but Dems pulled their bogus news bullshit to destroy the mans career.

        Also no one is taking anything away from me. I know that they have been doing some investigations into people receiving Benefits fraudulently and are taking their Benefits away.

        Is someone taking your benefits away?

  14. By the way: May 6—May 12 is “Nat’l Nurses Week”, a time to “thank” your oh-so-helpful, cheery, engaged in your world class healthcare while at the VA this week. Suggestion boxes are in single rows in bathrooms.

    But seriously, if you see someone that’s doing a great job as a nurse this week or any week, perhaps encouraging the ‘good ones’ to stab the ‘bad ones’ in the back via whistleblower could help pull the suggestion box lever…?

  15. “https://www.wishtv.com/national/army-veteran-fired-after-removing-tattered-american-flag/1161181907”
    He was doing what the law requires him to do.

  16. Another example of a total values system breakdown in VA management. What mitre and rand should be doing is a study on VA management personnel. VA health care is not the same or better, one system is somewhat accountable the other (the VA) is not, but it would be interesting to know what equation was used to factor that in the study. Many veterans think their receiving high quality health care, that’s because many veterans don’t know their not. The oppressed sometimes have to be educated to the fact that they are in fact being oppressed.
    “On Bullshit” by Harry G. Frankfurt a recommended read for VA management, because they need to understand the problem before any meaningful change can happen.

  17. This is a comparison. What would happen if private care and va care were compared to the rest of the world. We are 37th overall in world health care. 19th among the industrialized 19. In other words we are below such places a Cuba and other third world countries.

    If you haven’t experienced “private care” what makes you think it would be better. Maybe you could get a Doctor to say you had good genes and would live to be 200. Might make you feel good but doesn’t change the fact that the Doctor and facility is not among the best in the world.

  18. Look at the facebook section for VA clinics or hospitals. Nothing but positive wonderful heart warming studies. If you post a negative that is over the top, it gets taken down.
    The VA has a monopoly and nothing will change that.
    Its on the computer web, must be true

  19. “The RAND study adds to a growing list of research confirming what many Veterans and VA employees believe – VA provides high-quality care,” said VA Acting Secretary Robert Wilkie. “We are constantly striving to improve our care at VA, but this should encourage Veterans and the public that VA care is, in many instances, as good as or better than the private sector.”

    Somewhere along the way, RAND either got some bucks, or a head nod towards future business with the Dept. of Veterans Affairs. Scandal after Scandal after Scandal after Scandal. Now the magic wand is (via this report) waved – – – and VOILA !! – – – the VA is the kind of Healthcare every Joe and Jane Citizen would want to have.


  20. RAND: Really Another Nonsensical Determination.

    This purchased think-tanked opinion is only to settle the nerves of the investors whom back their interests in Gov’t contracts and it also serves to blow another fresh meatgrinder blast from the VA’s intestinal past & fog to the American Taxpayer, letting them know it’s…’All for the Vets’…plus, it’s almost stage-prop time for Veterans to be paraded around for Memorial Day, all fine and dandy at the VA, just bring mosquito netting next time you go to the VA and also better wear heavier boots and fill pockets with lead fish lure weights in order to keep the flies from taking-off with you…at least the private sector has this thing called malpractice insurance.

    Really Another Nonsensical Determination, and mine was free…

    1. RAND Read Another Nonsense Distraction.
      Rank Assholes Need Deflection.

  21. If Rand is correct why do only 20% of veterans use VHA and the other 80% (who can afford to) pay for their own health care? Why do McCain and congress get their healthcare from hospitals like Mayo Clinic?

  22. RAND and MITRE. Two whores that will write whatever is wanted by whatever government hack is paying them to write.

    I can’t see the VA using RAND for this without swamp rats in congress approving of it.

    I wonder if the MITRE report on Lewsite chemical agent detection in the first Gulf War is still classified.

    All I need to know of RAND reporting was learned long ago when Pentagon flunkies used them as some kind of independent research to claim Gulf War veterans were not sick from being exposed to X, Y or Z.

    Bernard Rostker was the lead Pentagon flunky put in charge of that cover-up. Bernard Rostker bounced back and forth between jobs at the Pentagon and jobs at RAND since the 1960s, yet they wanted to claim RAND was independent?

    Rostker delayed issuing a report on Depleted Uranium exposures as long as he could. After pressure from Congress, he contracted with RAND for a study on DU which basically concluded a veteran could eat DU, but no harm would come from it because it would be expelled from the body very quickly. RAND also claimed there was no accurate way to measure veterans exposure.

    I asked if they looked for the presence of U236, and why the Pentagon was more concerned over deer being contaminated than veterans. I provided an Army report on testing deer for U236 at Jefferson Proving Ground where DU was fired. The Pentagon wanted to turn the land over to civilian use such as hunting, and needed to find out if the deer would be safe to eat.

    The RAND response was that they were unaware of testing for U236, unaware of the JPG report, but they would look into it. They never did.

    As for this study, gathering VA statistics is an exercise in gathering whatever makes VA look best, and we all know VA will only report bad statistics if they are forced to. Funny. I don’t ever recall being surveyed by the VA after any appointment. I bet if I wore a VSO hat to the VA these surveys would be dropping like snowflakes.
    Its difficult to ignore records of veterans being readmitted to the hospital after an inpatient stay….that is why RAND had to include the stat that the VA was “significantly worse” on two measures on readmissions.
    As for paying for the report, pfffft. Its a report already paid for with tax dollars under this contract. If RAND demands more money for some bullshit they would likely claim is copyrighted, then the VA can pay for it by raiding more Choice funds like they did for this study.

    Why would the VA enter into a contractor anyway in which a veteran would be charged for information affecting their health?

    RAND tried to pull the exact same shit with the DU report. Claim copyright and charge vets for it.

    The copy I got was through FOIA. No charge.

    VA thinks they can use RAND to show how good the VA is doing. That only works on uninformed people and the media who want a quick soundbite.

    1. RAND? Like we can believe anything from them, the CDC, FDA, DoD, Pentapukes-gon, or much from bought off PC scientist or those coming out reporting threats if not agreeing with the herd. I bet those real researchers and truth tellers like Helen Caldicott and others that came out about DU along with measurements or exposure damages would object to RAND and other lying pukes.

      Colleges have taken over our public school systems along with big voices in what is taught, or not, or who gets put into positions for any possible hiring or school super jobs that can last for life. Anyone noticing what’s happening in academics or has been? Naw, not much everything is groovy. That includes their power over such entities like Ivy Tech or what credits are allowed to be transferred to other lib arts four year Marxist campuses. Even over what kind of schools can locate here within their “effective and heavy influential geographic areas which is normally seven counties per college.” All this includes, as some of us are aware of, when changing colleges or schools you must purchase their books written by their professors or connected ones. We, they, the kiddies, are supposed to and forced to swallow any and all ‘studies,’ stats, or so-called research the college crowd puts out. And we townies or ones in-the-know better not dare challenge anything about any of it.

      Locally every morning on the NBC channel they pass along their puke studies and claims from their experts like RAND, some college, or others. Locally having to deal with and live under three major lefty colleges with the local butt kissing lying media the public seems to believe every word or claim made by them. The town leaders need some input, a study, paid research or advice they run to one of the local college experts or affiliates. Make class projects out of such things the kiddies think we should live with as they laugh and move on having a grade point or kudos for helping ruin the town. Economy, what laws/ordinances, are needed. How to design the town and country side, the streets, to how tall our grass can be, kind of trees to plant, kind of art we want to see on the streets, what makes us happy, what we need or want. Better not be about truth, too country, or offensive to the “experts” and pollsters.

      According to local college experts and professors all is well in our lefty global village but we need more illegals and refugees and more censoring, brain-washing, for the betterment of our ‘community.’ Both state parties and officials must agree. One such recent study/research mentioned or asked ‘If identity politics,’ party affiliation, history of complaints against some in the medical community made a difference in our health care. The results were… ‘no of course not.’ Nothing interfered with people or patients getting the best quality of care that can found.’ “Health care workers and staff don’t think about such matters when it comes to treating our patients.” “Our patients are like family.” So THEY say and “studies” show. BARF. I have hard evidence that is all BS and I have never been called about any polling or such bull. If so, why were a group of us told to vote Democrat for better care, to support Obummer and Hillary? Make a complaint or talk negative about the VA or local med schools or workers…. our health care in Indiana will end. Nothing to do about such threats or union chatter either, nothing. Contacting medical boards, state’s AG, politicians just makes it worse. You know where I think they can stick their lying studies and polls.

  23. Office of Inspector General Veterans Affaris
    May 2nd, 2017

    Veterans Benefits Administration (VBA) caught spending money appropriated by Congress to pay Veterans benefits was illegally spent in another VA IT scam. More than $11 million dollars.


    Worth noting is the fact that the misappropriations of Veterans Benefits funds occurred while none other than, Agent Orange Denier, J. Thomas Murphy was Acting Principal Deputy Under Secretary for Benefits in the Department of Veterans Affairs.

    Mr. Murphy claimed that he misappropriated the funds because the person he had replaced ok’ed the misappropriation. Although his predecessor says they never approved the stealing of Veteran’s benefits funding to fund any Illegal scams Murphy is running.

    Thomas J. Murphy is currently the Executive in Charge, for Veterans Benefits Administration.

    Murphy has been on his way out for a while at the VA. Guess they are now giving him a little push towards the door.

    1. Murphy should be forced out for his misappropriation, but that will only happen if those in congress didn’t intend for him to misappropriate for their cronies.

      I wonder if the Federal Register would contain any notice from the VA about reprogramming this money.

      Or if the House VA committee would have any notice from the VA about doing this.

      1. 91Veteran there is no listing in the Federal Register. This is a strait up case of Murphy illegally spending money appropriated by congress to pay Veterans Benefits being used to pay for IT expenses including IT Consultants linked to the Cerner deal. Rather than using the IT budget to pay.

      2. The money was appropriated to pay Veterans educational benefits. So even thought the funding was suppose to be there no doubt a number of Veterans may have been turned down because the money was illegally spent.

        The VAOIG report is a good read on the subject.


  24. Terminal care at the VA is far better than anything else around here. But then we are in a extremely high density veteran area when compared to our overall extremely low density population area.

  25. At least here, that is true. And both suck compared to 30 years ago or Japan.

    I believe the problem is that the VA quit giving scholarships repaid by service in favor of banks being able to follow doctors for life for their student loan debt. A lot of potential doctors are cut out by family wealth and banks not approving the loans for that first 4 years of college, even premed. Not enough qualified doctors and the ones we get aren’t as qualified as they were in the day when the military and VA were trading education for service.

    No draft so not as many screened for potential in boot camps and put through school for service including engineering and the medical professions.

    Good article would be to check out the diminished opportunities.

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