http://online.wsj.com/articles/hal-scherz-doctors-war-stories-from-va-hospitals-1401233147?tesla=y&mg=reno64-wsj
An interesting editorial calling for the abolishing of the VA system and for veterans to be given insurance benefits that can be used in the private medical market. This would work if the insurance benefits made it worthwhile for hospitals and physicians to see the veterans. If the reimbursement is set too low, as it is for Medicaid, there is not a lot of incentive for the private healthcare system to see more patients that you lose money on.
Paywalled. Or you can type "hal scherz doctors war stories from va hospitals" into google and get the whole article.
Basically, the article says the VA works just like the DMV. You have a handful of folks who really do care, and a LOT of drones that sit on their fourth point of contact getting paid to convert oxygen to carbon dioxide. The solution proposed in the article is to turn the VA system into Medicare. Which won't happen, because senior brass are quite happy with their quality of service. Veterans wouldn't be happy if they were essentially dumped on Medicare, which is probably exactly what would happen. Medicare doesn't run hospitals, they simply pay the bill. But they don't pay the full bill, they pay only a portion of the full bill and say "Sod off, if you want our money, you take it and like it, or don't accept any of our patents." Unless a medical establishment is a "medicare mill" (high volume, low quality), Medicare will not come close to paying the bills and is not sustainable. MillCreek could provide the exact numbers in detail, I'd bet $20 on it in a heartbeat.
Ignoring the vet dumping (could happen) and brass preferential treatment (which could be retained)?
VA system won't be reformed, because it can't be, because it has union members. It'd be normally VERY hard to fire any civil service employee or union member. Combine the two? Good luck. AFL-CIO, of whom AFGE belongs, will NOT allow VA hospitals to be shut down, even if they were throwing MoH winners into wood chippers.