Monday letters: VA leadersmust be honest

June 9, 2014 

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There is much outrage about long waiting lists and cover-ups at the VA. This is a chronic problem, made worse by a culture that often rewards those who produce desired statistics and punishes those who tell the truth. Such pressures exist in government, the banking industry, General Motors and elsewhere.

If VA leaders were more honest, they would tell us that you can’t fix a waiting list by imposing a limit on its length. You must instead implement a form of triage, and possibly rationing, in places where demand cannot be controlled and supply of resources is limited. However, few politicians would endorse overt rationing of care, and veterans’ groups would scream loudly when triaged to a lower priority than they feel they deserve.

Simply getting a veteran with multiple severe health problems seen by a health-care worker (and therefore off the waiting list) does little to provide the long-term, sophisticated treatment and rehabilitation he or she probably needs.

Referring veterans to the private health-care system might work for routine or episodic care, but not for those who need specialized care, except in some cities with an abundance of medical and mental-health services. To do this for hundreds of thousands of people would cost more than our taxpayers would support.

President Obama, I believe, is aware of these complexities. He should turn his attention to changing the culture of deception in the VA and other areas he can influence.

Charles Goldman, M.D.

Columbia

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