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Yes. One POS claimed the babies that she was paid to carry.Adoptive Mom's Medical, Criminal Past Causes Surrogate to Revoke AgreementSurrogates are supposed to be screened for mental stability, and they sign a contract where they understand and promise not to claim the child that is not theirs. The ideal surrogate already has a complete family, and bills to pay, before they start carrying for others. Many women with postpartum depression do not bond to their own genetic babies.Most surrogates are gestational only, and the eggs belong to a third party — either the legal mother (who paid all of the surrogate’s expenses, including her mortgage/rent payments) had good ovaries but scarred tubes/uterus, or another woman was used as egg donor (that was me). It is absolutely criminal when surrogates keep babies that were paid for in the tens of thousands to the surrogate. States who claim that the one who carries the child is the legal mother, are taking the lazy way out, because it’s all too easy to see where the baby came from. DNA, what a concept, A signed contract, also, what a concept.This entire “has to bond at birth” hooplah is a recent and unnecessary “criterion.” Buy a $20 bottle of oxytocin and inject it until you orgasm (excuse me, deliver), then sniff the baby while they are wet. Viola, bonding. It’s how we get surrogate moms of all species to bond to a baby that isn’t theirs. My best friend/boyfriend wasn’t even handed over to his adoptive parents until he was several months old, and they all bonded quite fine. That Staten Island adoption agency made sure that the baby you were getting was healthy and worthy of their fee, so a certified, nursing trained foster mom actually took care of the baby through the sleepless nights phase. Her report on my boyfriend was that he was a very happy baby, with a very big appetite. That had not changed one bit 2 decades later :). His adoptive mom and dad were the best, and they just DOTED on him. Four years later, they adopted a daughter, who never got the attention their “handsome son” got, even though I thought she had very classic looks, and her “brother,” although handsome from the side, had quite a wedge face.The surrogate who carried 2 of my 3 DNA daughters (I was egg donor, and a 3rd woman was their legal mom, married to the DNA and legal father) was wonderful. I chatted with her at length. She had carried three boys as individual pregnancies before she was a surrogate 3 times, delivering twins each of the three times, for three separate families. She had no interest in having to financially support any more babies that the 3 she already had. The legal parents reimbursed all of her living expenses, which included food, mortgage, maternity clothing, and medical expenses. She enjoyed being pregnant, and the raised hormones appeared to raise her immunity, as she didn’t get sick while pregnant any of the times. Her husband was thrilled to get financial help while his wife got to stay home with the boys.In the delivery room, the hospital let our surrogate hold one of the girls, while the nurses cleaned up the second girl to arrive. She still did not freak out and try to claim them. She later sent them care packages (just as my mother did, as their honorary grandmother), and traded photos.The legal parents arrived by airplane (from Montana to Illinois) to pick up the newborns, and flew them home at 2 days of age. Their legal mom breastfed them, as she had carried the first baby to term just 5 months before. Why the surrogate? Because the legal mom had lupus — her body attacked the baby she was carrying at 3 months’ gestation. They were convinced they were going to miscarry, so the legal father panicked and put the surrogate on hormones. 2.5 weeks later, when it was time to implant the frozen embryos, the legal mom’s pregnancy had stabilized. The largest cost (I think about $8K at the time) are the hormones, so they decided to go ahead and start the parallel pregnancy — it’s literally only a few hundred dollars to thaw and insert (half that when you add embryos to a surrogate mare). Sadly, lupus rejection returned at 6 months for the legal mom, so she was put on bed rest and was given injection to mature her baby’s lungs. This first girl was delivered 3.5 lb at 7 months. The twins followed out of the surrogate, 5 months later, 6 lb 4 oz and 6 lb 10 oz at 8 months gestation. All were healthy and none needed any surgeries.Why did the legal mom even carry the first baby herself? Because the state where legal dad was insured was Washington state, and there the surrogate is considered the mother, so they refused to allow a surrogate for the first fresh embryo. The legal moms tubes were infected, so they had to tie her tubes before even adding the fresh embryo to her uterus. Thankfully, the frozen spares could be flown to a sister clinic in New Jersey, where the Illinois surrogate flew to receive them. I, the egg donor, flew from Michigan to Washington State to donate.In summary:Baby #1 started out as an egg in Michigan, retrieved and implanted inside of Legal mom in Washington, went on vacation to Hawaii, and returned to Montana to be delivered.Babies #2 and #3 started out as eggs in Michigan, retrieved and frozen in Washington, flew to New Jersey to be implanted into surrogate who then flew back to Illinois to deliver them, where they were then flown back to Montana.Legal parents were already double mortgaged before even meeting me. They had already paid a 22 yr old egg donor, but after injecting the thousands of dollars in hormones, and just before flying out to donate, her boyfriend convinced her not to do it. The legal parents then hired me. Our first donation in California was a disaster. The incompetent clinic didn’t even check to see if any of the sperm had entered any of the eggs until the next morning, when it was too late to inject any of the sperm (the father had low motility). The largest embryo that resulted was only 6 cells. The Washington clinic, with 12 doctors and many assistants, frequently monitored progress, and immediately injected the eggs. We ended up with many embryos, 4 of which were 4AA (grade A choice prime :)). 3 4AA embryos actually survived thawing and were implanted into the surrogate, but by the 10 day HCG check, only 2 remained.I’m just giving a very high level summary of just some of the hoops we all went through, not counting all of the my blood and urine pre-screenings, including extra STD testing by California, The many, many needles, including the monster catheter type needles in my butt on the last 3 days. the multiple trips to get ultrasounded locally for progress on egg development, the extra days I sat around before and after donating — before, because the ultrasounds didn’t scale the same from city to city, and at least 24 hrs after, so that I wasn’t stuck on the plane during possible hyper-ovulation syndrome, which requires a trip to an emergency room to get a shot to reverse and save your life. I got paid only $1300, reimbursement for the vacation days I had to buy. Egg donation itself was the equivalent of having someone cut a hole in the side of your vaginal wall, then use an electric wire scraper inside of a mini ice cream scoop to harvest eggs, and some of them actually hurt was the doctor did this. Ouch! And of course the table and stirrups and instruments were always cold. I always love the room the men get to sperm donate in — beautiful window view, cozy carpeting, large screen TV, big speakers, x-rated videos. Egg donors get bright lights, cold everything, and pain.Oh, all 3 girls are in college now, one on a full tuition scholarship (the others on most, but not full).>**&@!#&(&*< those of you who feel that a surrogate deserves to keep the unrelated babies that they have been paid tens of thousands of dollars to carry to term, by people who have been heartbroken, and bank broken, trying for 10 years for the children they so desperately desire. The legal parents of my girls were considered too old for regular adoption, already in their 40’s. They had tried that route, too.EDIT: Adding info from a comment I made below:What an interesting comment. I’m not rich. The parents of my genetic girls were not rich. Far from it. They were already double mortgaged on their house before they even reimbursed me for the vacation days I had to pay for to sit around in WA state, one day early in case my local MI hospital’s ultrasound was not accurate, and one day after, so I wasn’t on a plane with hyperovulation syndrome, where I could have died (my OBGYN’s close friend actually got the syndrome while donating, and barely survived), being an egg donor for exactly $1,300.00 — the cost of my purchased vacation days, so I made ZERO dollars for my donorship. Surrogates, back then, were paid about $40K to carry a baby to term, and are likely paid much more now. The legal parents of these 3 girls went deep, deep, into debt to make babies genetically related to the father, then 2 were carried by a surrogate, in parallel with the mother herself trying to carry one of the girls to term, despite having lupus, so, due to her body attacking the baby, she almost miscarried at 3 months, then again at 6 months, and was bedridden until 7 months, when that daughter was born only weighing 3.5 lbs. And you want to let the surrogate just cackle and walk away with the other 2 babies ???Our Illinois surrogate already had 3 sons of her own, all carried individually. After our twins, she went on to carry two more sets of twins to term for 2 more couples. For likely $40K each set, while raising her 3 sons, saving tons of money not commuting to a job and having someone else babysit. I stayed in touch with her over email. Nice lady. She and my New York mom were both sending the Montana girls care packages every birthday and Christmas for 20 years. It takes a village, and we were that village.My 3 girls actually studied for their SATs to get their full tuition scholarships. No one had to buy them into college. They are also ACTUALLY athletes and musicians, but didn’t use either to get into their schools. Just their brains.(even more in the comment at the bottom)

Yes, This is an excerpt from “Caregiving 101: A Practical Guide to Caring for a Loved One “ It will explain a bit about how to find and hire good in home help.Chapter 2.Calling in the ProsDespite all the best efforts of you and your team of caregiver heroes, there may be a time to call professional caregivers into your home. There is no shame in this. You and your team are not giving up. These folks have walked this road before. They are usually quite experienced, skilled, and knowledgeable. They can be a tremendously helpful part of the team. Professional help can fill gaps in difficult times so other caregivers can rest and rejuvenate. They can perform tasks that may be beyond the comfort level of your team. They can help lead, teach, and often defuse potential growing conflicts that are common. Asking for experienced paid help means you care more for your loved one than for your own pride, so don’t be afraid to reach out for help.We had set parameters for when we would call on paid caregivers. This helped put everyone, even Karen, at ease. It allowed us to step back from our caregiver roles for a time and be just friends, family, lovers again.Finding Good Professional Caregiver HelpSo how does one find these elusive nightingales of mercy? The first and maybe the best resource are the people in your caregiving team: your friends, neighbors, and the people all around you. Chances are, they know someone who knows someone who has been very effective in a caregiving situation.Many professional caregivers are well connected. If they can’t take the case, they may know someone who can. This is how we found the best caregivers for my mom.If you are connected with hospice, a comfort care nurse, a social worker, or a caseworker, they may be able to help you find the right professional caregivers. They may know individuals for hire as independent contractors, or they may work with an agency that places paid caregivers.Also, if you live near a school with a nursing program, the admissions people there may know of aspiring students who need work experience. Students are usually bright and enthusiastic, but they do often lack experience.A home-care agency is a company that employs and often trains and oversees caregivers in various aspects of health care, including professional home caregivers. They usually have set hours and shifts, though this may be negotiable. They charge you a fee and may work with third-party payers like your state’s Medicaid program or your private disability insurance. You can find an agency yourself online using keywords such as “home care.”Self-directed care falls somewhere between hiring a caregiver yourself and using an agency. In this model, the agency can help introduce you to the caregiver, help train them, and help you with managing the financial resources available for paid caregiving. One agency I talked to, Consumer Direct Care http://consumerdirectcare. com/, actually helps you with payroll and taxes and sometimes acts as a bridge between your Medicaid coverage and the paid caregiver. Even with all this assistance, this model is less expensive than going through a traditional agency, and the savings canresult in higher pay for the paid caregiver. Higher pay usually attracts better caregivers.Some states have allowances written into their Medicaid program for the self-directed care model as well as many other wonderful services. To find out about programs and resources in your state, search for your state Medicaid officewww.Medicaid.gov or just type “Medicaid” and the name of your state into your search engine. You may also be able to search out such agencies yourself with the keywords “self-directed care,” “self-determined care,” or “person-centered care.”…Selecting the Right ProfessionalSo many questions revolve around bringing someone into your home:• Will they be able to be there at the right times?• Do they have the skills and abilities your loved one needs?• Do they possess the temperament and personality that work with your loved one and your team?• Most importantly, do they connect and care well for your loved one and just “feel right” to you and your loved one?Trust your gut and the feedback from your care network, and invite your loved one to participate in the selection if they are able.If your loved one needs more medically related skills from a paid caregiver, such as wound dressing, care for lines like IVs or catheters, more advanced bowel or bladder care, or more advanced help with mobility, look a bit more closely at the letters behind the caregivers’ names. Below is a short list of what some common abbreviations mean in relation to training and expertise. Requirements and specific skills-and-practices acts—laws that say what each type of caregiver can and cannot do—vary somewhat state by state.Companion. This is more of a job title than a professional designation. This person may or may not have any formal training yet they can be critically important in helping someone who cannot be left alone safely. They might help with meals, light housekeeping, laundry and transportation. They cannot help with medication and probably cannot help with any more advanced nursing care. You also may see the general home care designations of direct support professional (DSP), and caregiver.People working under these designations may or may not have experience or training.Certified nursing assistant (CNA). This is probably the most common professional designation in caregivers both for in the home and in facilities such as hospitals and nursing homes. In most states, they can perform basic medical-related tasks such as changing a dressing and caring for lines (like catheters or IVs) under the supervision of a nurse or doctor. In some states, this designation is written NAC or NA-C. To earn the certificate, they must complete 75 hours of coursework and hands- on skills work, as well as take a written and skills test. NA-R means they have taken the coursework and registered but have not yet received their certificate.Certified medication aid (CMA). This person works under the supervision of a nurse or doctor and can administer most medications but not by central lines or chemotherapy depending on the state.Personal care attendant (PCA). This means the person has completed 16 hours of coursework (about three days) plus specific orientation to that case.Attendant care worker (ACW). This designation began in Arizona as a base level of training required for that state’s Medicaid reimbursement. It is now gaining favor as a benchmark for other states. It requires that people sit for an examination that includes a written test and a practical skills test. Generally the coursework to be ready for the test takes about 40 to 60 hours of focused learning.Home health aide (HHA). These people are usually capable to do many of the same basic tasks as CNA’s but their focus is more on care in the home. The formal education requirements vary state by state. However, all states do require training for someone to be certified as an HHA, with the minimum at the time of this writing being 75 training hours.…Going Through the Selection ProcessOnce you know the kind of professional help you want, make a list of candidates. I like to create a folder for each one or at least a page of paper with their name, contact information, their work experience, and any notes. On this paper you can write reminders for the questions you might want to ask during the interview. Here is a link to a fairly generic but nicely comprehensive list of possible interview questions from Find Child Care, Senior Care, Pet Care and Housekeeping http://www.care.com/senior-care-senior-caregiver-interview-tips-p1145-q7744646. When you are interviewing, write down the answers in a way that makes sense to you. Also record your overall impression of the person. I like one to five stars and a quick note as to why. Then you’re ready to contact them.Phone call. Chances are, when you call you will leave a message and ask them to call back. If they don’t call back, cross them off your list. Don’t give out your address until you are ready to set up an in-person interview. Try for at least five candidates to interview.Telephone interview. You can ask many basic questions quickly in a phone interview. Describe the days and hours you will need and the level of specific needs your loved one has, such as minimal assist with bathing, dressing, toileting, help with mobility, etc. You may ask about the person’s availability, transportation (do they have a reliable car?), allergies, whether they smoke, etc. You can ask about their work history, especially their last few jobs and why they left. You can ask what types of clients they like most and least. If they still seem like a good fit, you are ready for an in-person, in-home interview.In-home interview. For the best chance to see the person interact with your loved one and gain a good sense of your loved one’s reaction, do an in-person interview in your home. Your loved one is really the person making the choice. It’s their care. Introduce the candidate to your loved one. Does the interaction feel right? Is the person respectful, interacting well, fitting in with your family? Take your time, don’t rush. Be open. Listen. Be prepared with your care plan, the Carebook, and your interview sheet. Explain fully your needs and expectations. You may review their availability, training, prior work history, how their last job ended, and anything else that wasn’t answered well on the phone.Because I know what I’m looking for, I like to give the person an opportunity to work a little in the interview process. Can they help with whatever is needed at the time? Is there a skill you know is needed, like a maximum assist transfer? Can the candidate do it with you? Ask what their questions are. Listen, and be honest in your answers. Ask for at least three references, two of which should be professional references from people they have worked with. You may also consider a background check. Each state has its own and you may find the form by typing “background check form” and the name of your state into your search engine. Lastly, talk about salary and any benefits. You will need their social security number if you are going to hire them legally.Cultural considerations. You may notice that many agency caregivers are immigrants. This is not necessarily a problem. In some of the Muslim cultures of Africa, the Philippines, and Southeast Asia, caring for people in need is more honored than in our culture. If you are considering hiring an immigrant, can you and your loved one put aside any prejudices that may exist? Questions that are most important are more about the ability to understand each other’s communication and whether your loved one is able to connect with them comfortably.References. Yes, actually call the people the candidate says will give a good review. If it’s a professional reference, ask about the specifics of what the person did there. If the candidate stated what they were paid, you may confirm it. Confirm why they left the position. Watch for words like “difficult,” “challenged,” or other negative words. Don’t be afraid to ask whether you should hire the person. Many human resource policies will not allow a reference to tell you more than the dates of employment, but ask any questions you want, to get what you need. I like to ask things like “Would you hire them again?” or “Hypothetically, is a person like her great with nonverbal patients?” to try to get at the information you need.For a good video about hiring an in-home caregiver, check this YouTube from Washington State’s Department of Social and Health Serviceshttps://www.youtube.com/watch?v=L3skIWEmpas&feature=youtu.be.Managing Hired HelpOnce you have hired your new helper, be there to help familiarize them with care and routines. This will make everyone more comfortable and give you a chance to watch them work with your loved one. Again, are they respectful? Do the two interact well together? You can also get a better view of their skills. Once they are up and running, you will want to stop by unannounced. It’s just another way to check up on their good work.Don’t be afraid to let a paid caregiver go if the fit isn’t good. You’re paying them, you’re the boss; think of it as moving the employee on to a better-fitting job. Everyone benefits from a good match, and nobody benefits from a poor match.…Salary and BenefitsWage information varies region by region and over time, so I won’t give specifics here. You can look up expected salaries for your area by searching “salary” and the professional designation, for example, “salary CNA Seattle” or “salary homecaregiver.” Salaries are considered for 2000 hours per year, so you may calculate an hourly rate by dividing the salary by 2000.…Payroll and TaxesIf you are hiring from an agency, the caregiver is an employee of the agency so you do not need to worry about the payroll. If you hire a caregiver directly, they are your employee or a contractor. The simplest way to handle this is to file and provide them with an IRS form 1099 for independent contractors at the end of the year (or the end of their work for you, if that happens first). Keep track of your payments by tracking the checks in your bank account and/or get a receipt book.…Paying for In-home CaregiversWhen my mom was sick, her neighbor told us to get a pocketful of $100 bills and just go out and find good caregivers. This is in fact what many people do for shorter-term in-home care.Under Finding Good Professional Caregiver Help earlier in this chapter, we discussed Medicaid. Maybe that agency can help; they can be tremendously helpful with many resources for those who qualify. Many states have opted in to a waiver system that allows Medicaid to provide in-home support for people. To learn if your loved one qualifies and find out more about how Medicaid can help, see Chapter 8, Medicare, Medicaid, and Private Insurance. You also can look up your state’s website with the keywords “Medicaid” and the name of your state. One of the most clearly written and informative sites I’ve seen is Home - Long-Term Care Information http://longtermcare.gov/ medicare-medicaid-more/Medicaid/.Medicare and most private health insurance policies do not provide for home health aides or caregivers. They will provide for “skilled” in-home care. This means skilled medical services such as physical therapy, occupational therapy, speech therapy, and skills that require a nurse or nurse’s aid under the supervision of a nurse if the person is homebound. They will do this for a limited time following a recent hospital stay for the illness or injury being treated and require medical necessity and physician’s orders.Medicare supplements do not pay for in-home caregivers. They also tend to follow the Medicare guidelines listed above and are mostly focused on helping pay the amounts Medicare does not cover.The Department of Veterans Affairs (VA) provides caregiver help to veterans registered at a VA for health care. They can provide support to caregivers as well as other professional home health services. Programs include home-based primary care, home health aides, respite for family caregivers and a variety of other caregiver services. The website www.caregiver.va.gov/ is an excellent website for family caregivers to find support and services. There is also an established VA’s Caregiver Support Line 1-855-260-3274 toll-free to ask about caregiver support services. Each VA has a Caregiver Coordinator who can help caregivers find out about how to qualify for additional benefits.The Aid and Attendant program may give increased allowances to qualifying veterans to help with long term care and respite care (see below). If you don’t already have a VA caseworker, contact your VA health care team for your specific case. If your loved one is not already registered at a VA, find your local VA office by typing “Veterans Affairs” and your city into your search engine or go to www.va.gov.Various Veterans Service Organizations can you navigate the VA system and help with getting VA benefits. The Veterans of Foreign Wars (VFW), Paralyzed Veterans of America (PVA), Disabled American Veterans (DAV), and other Veteran Service Organizations may also help you navigate the system.Private disability insurance does not directly pay for in-home caregivers, but Social Security Disability (SSDI) might through Medicaid. If your loved one is already enrolled in SSI, check with their caseworker or your local Social Security office.Private long-term care insurance or combination life insurance and long-term care insurance usually does pay for home health aides and companion services.This is private insurance you buy when you’re healthy. There are many rules to follow. Read your policy carefully and ask a trusted advisor to help you decide when to start using the insurance, because most policies limit the total time you can use them. Be aware that once your insurance company gives the OK for a service, you may need to pay out of pocket for an “elimination period,” and once you start using the insurance for anything, it may start the clock ticking on a payment window that closes according to the time stated for your policy.Some life insurance policies may allow for your loved one to tap into their life insurance benefit in the form of an accelerated death benefit (ADB). Your loved one may be able to use this if they are terminally ill or have a life-threatening diagnosis, needs long-term care services for an extended amount of time, and/or is confined to a nursing home and incapable of performing activities of daily living (ADLs) independently. Typically this amount is capped at 1 percent of the death benefit per month for home care, 2 percent for nursing home care, and 50 percent total. You may want to consider that taking a lump sum of money in a person’s name may create a situation where their assets exceed the amount allowed by Medicaid or Supplemental Social Security and may jeopardize those benefits.Chapter 8, Medicaid, Medicare, and Private Insurance, has more about all this, including links to help you find a good lawyer.Making sure it “Feels Right”I leave you with this story about hiring Karin, a most wonderful caregiver who helped us when my mom was sick.Karin is a registered nurse (RN) and has a company called 24/7 staffing. She identifies herself as a terrible businesswoman.24/7 is a tax ID and a loose network of caregivers of different backgrounds and educational and credential levels, from RNs, respiratory therapists (RTs), and CNAs to folks with no credentials who are low-cost and there to be companions.Karin doesn’t take a fee or percentage from the other people in her 24/7 network. She gets her work entirely by word of mouth; the work comes to her. Usually friends of friends, family, or other people who have gone through caregiving situations say “I know someone …” If she cannot or will not take the case, she often can turn to one of her contacts in 24/7 who she feels will be a good fit. Likewise they may turn to her.The most important thing to Karin when deciding to take a case is the “fit.” It’s a feeling that she should be there with this person, with this family, in this home, helping them through this journey. The moment she met my mom, Karin knew she should help us. They reached out to each other, shook hands, and Mom smiled and then took Karin’s hand in both her hands. Their hands were warm together. She was meant to be there.* * * * *Often our most complex and important decisions are not made on what we think of as a rational basis. They are far too complex for the little wedge of neurons on the front of our brains for that. We make decisions about who to let into our homes, lives, and caring hearts because it feels right. There is so much more to it than all these forms and questions can outline. Of course we did the interview, checked the references, did all the steps listed above, and they all checked out ok. Those are important to avoid a nasty situation and help provide structure, but this is how Karin decides to take a case: if it is a good fit. This is also how we decided too. It felt right.

There are so many roads to go down in answering this question, none of them satisfactory. But, let’s follow two or three to see if something of value can be found. There is a qualifier here, and that is we have to understand the “they” in your question. “They” is not the White House. “They” is Congress, the ultimate board of directors for all things federal. The White House may lobby aggressively for privatization (though the Trump White House is backing off on that pledge), but in the end, dumping a Cabinet department—one of the very largest, with 150+ hospitals, hundreds of clinics, mobile clinics, VetCenters, and specialty care centers vital to the treatment and rehabilitation of wounded warriors—would come with massive congressional input and pushback, given that every state, and probably every voting district in the U.S. is linked in some way to veterans.Former Congressman John Linder (R-GA), a Vietnam-era veteran writing for The Hill this past January, made an oft-repeated, and undeniably passionate, personal, and compelling case for privatizing VA: “The VA should first commit to shortening the long lines waiting for the determination of eligibility for VA medical care. The government’s role in veterans’ care should then be focused entirely on matters that are the result of war. Traumatic brain injury, amputations, post-traumatic stress and the rehabilitation from those injuries are unique and special, and we should dedicate the entire medical resources of our government toward improving the lives of the wounded and their families.“Medicare needs reform as to reimbursement formulas and regulatory burdens,” Linder continued, “but it is the most patient-centric of all of our government healthcare programs. VA eligible vets should be enrolled in Medicare and allowed to make their own healthcare decisions. If that is privatizing VA healthcare, this old vet is for it.”Linder’s argument has a populist foundation—and, frankly, a pretty reasonable one if you’re the veteran or veteran family member in this situation—and that is there are many aging veterans (WW II are dying at the rate of 400 per day), and Cold War and Vietnam vets who aren’t far behind them who don’t enjoy urban or even suburban access to a VA hospital or clinic. There are many younger veterans suffering from traumatic brain injuries (TBI) or amputations or who are para- or quadriplegics for whom local access to VA specialized care is simply not an option—they have to look locally for care.Privatizing advocates in Congress, with Senator Bernie Sanders leading the way, pushed through legislation in 2014 allowing veterans to seek care from a private medical facility using the Choice Card, with reimbursement from the government if the nearest VA hospital is more than 40 miles away or the wait time for a closer VA hospital is over 30 days. In 2015, Senator John McCain (R-AZ) called for a permanent Choice Card that would have opened health care access anywhere, anytime, to all veterans. While that legislation languished, Donald Trump was elected and, just a few days ago, the President signed a bill to extend the current Choice program, closing financially-burdensome loopholes for veterans, but not fully implementing the McCain vision for private-care-for-all-vets.But VA isn’t just medical facilities: VA is benefits—the Veterans Benefits Administration, VBA—covering home loans, student loans, employment and training, insurance programs; While not statutorily a part of VA, the U.S. Court of Appeals for Veterans Claims in inextricably linked to veterans’ claims processes. VA is also cemeteries—unlike Arlington National Cemetery, which is operated by the Department of the Army and the Military District of Washington, VA’s vast inventory of final resting places for the nation’s veterans come under the services and supervision of the National Cemetery Administration (NCA). The Department of Veterans Affairs also shares special interests like veterans homelessness programs with other Cabinet Departments. There is also an Office of Tribal Government Relations within VA.Do the privatization advocates want benefits and cemeteries in their operations portfolios? Maybe benefits…but cemeteries, not likely; homelessness programs? Probably pass on that, too. So, if the question is appended to include “…privatized the VA healthcare system,” there is some room for a more detailed reply.Does the Congress have the will to support dismantling a 100-year-old system, multi-pronged system, employing nearly 300,000 people (voters), on a multi-billion dollar budget that benefits Congressional districts from Florida to Hawaii, and from Maine to California? Doing away with something as sacred as VA, even though it has significant flaws in its health care and benefits services, is asking a lot of a Congress that is reluctant to do much of anything of merit in the past two or three decades.Partial-privatization advocates like Linder suggest VA retain its core medical competencies—trauma care, prosthetics, and rehabilitation, for example—and open up the private care market to the balance of the nation’s 22 million veterans. But polls and research don’t bear out the need for such cherry-picking care. Veterans on the whole are not dissatisfied with their VA care and many veterans recognize that the stories of wait lists so long that veterans die before they are seen don’t represent the average veteran’s experience.But more than that is the problem of what I call “Records re-absorption” once a move to privatize VA got underway. It’s one thing for a major health care consortium (and it would have to be a consortium—no one healthcare organization has the total scope of abilities and resources to take over VA) to build a non-federal management structure to operate the medical side of VA.The nation’s largest healthcare corporations are familiar enough with the brick and mortar and management of hospitals to figure out how to operate the medical structures—the basics—currently operated by the federal government. What I don’t believe they have any proven track record on is transitioning a two-headed (VA and DoD) federally-created health care records over to a private heath care records’ management system which has to incorporate a veteran’s military medical records history as well.Even VA and the the Department of Defense haven’t arrived at an efficient record’s transfer system that allows for the seamless shifting of active-duty medical records to VA’s medical records databases. If you need evidence of that, just look at this partial list of speakers at the most recent (April 20–21, 2017) Military Electronic Health Care Conference in Washington, D. C.I. Achieving an Interoperable Electronic Health Record – Government & Military Needs, Programs and Opportunities“Not Everything is Computable: Archiving and Sharing the DoD Health Record”■ COL JOHN S. SCOTT, USAInformatics Policy Director, Health Affairs, Department of Defense, Office of the Assistant Secretary of Defense, Health Affairs, Uniformed Services University of the Health Sciences“MHS GENESIS: Driving Successful Business Transformation”■ DR. PAUL CORDTS, M.D.Director, Functional Champion, Military Health System, Defense Health Agency“Achieving Interoperability Among DoD, VA and Private Sector Partners”■ MR. LANCE SCOTTDefense Medical Information Exchange (DMIX)“Advancements in Health Data Interoperability and the Impact on the Veterans Benefits Management System”■ MR. THOMAS MURPHYPrincipal Deputy Under Secretary for Benefits, Department of Veterans Affairs Benefits Administration (VBA) and■ MR. BRAD HOUSTONDirector, Office of Business and Process Integration (VBA)“Interoperability 2020- Why Data Exchange is Not Enough”■ MR. KEN RUBINDirector of Standards and Interoperability, Veterans Affairs Health AdministrationI know some of these speakers, and they’ve been doing hard work in the vineyards of progress toward a seamless VA-DOD health records interoperability for years! In the 1980s, when I was on the staff of the House Veterans Affairs Committee, an Army general, a well-respected military physician, came to us with his idea for a medical identification card that would hold all a soldier’s (I’m using “soldier” to cover, generically and in a gender-neutral way, all branches of the military, rather than adding sailor, airman, marine, coastguardsman every time) active duty medical history. The card would stay with the soldier when he or she left the military and was eligible for VA care. The information on the card would then be “read” by the VA system, and all the appropriate boxes in the veteran’s VA medical history would be properly filled in with the previous active-duty history.A wonderful idea, and although it was about two decades ahead of its time in terms of chip storage and read/write capabilities, it should have been embraced and worked on. But neither our committee or the folks in the Pentagon could get enough energy behind the concept to really put the proper work into it. Despite come-to-God meetings in the Oval Office where more than one president has commanded the Secretaries of Defense and Veterans Affairs to get their act together and work together to come up with a joint-records-sharing plan, the real work has eluded both departments.The irony is that VA has a perfectly fine electronic records management system, one that is doctor-nurse-patient friendly, and completely transportable. During Hurricane Katrina, veterans who were evacuated from the New Orleans VA care area, had their health care records in place no matter where they went in escaping the storm’s path. That was 12 years ago. Even medical imaging records—X-Rays, CT scans, MRI’s—can be passed along to another VA Medical Center as needed.Look at the world of the private physician working through a private healthcare system. In all likelihood, they have a proprietary health records system that utilizes lap-tops, desktops, and a linked central server. My primary care physician and his practice are set up that way. If they are affiliated with a local hospital (and most are) or hospital system, they may have additional access protocols shared between their practice’s office and the hospital inpatient system’s. But that is not always the case.A doctor I spoke with in reference to this Quora answer, discussed the challenge of working with veterans’ health records.“I always look at hardcopies, paper printouts, of any records that they have brought with them,” he said, referring to new patients coming from the military. “If they have imaging,” he continued, “I look at the disks as well. There is absolutely no crossover between the military medical record system and ours. (my italics) Patients are often under the illusion that our system can directly access medical record systems at other practitioners offices, or even the hospital as well, but our systems have no such access.”With respect to the specialized coding system used by physicians—referred to as CPT and ICD 10—the physician I spoke with said, “As far as what coding system the military may use for their diagnoses and procedures, I would imagine that they use the same CPT terminology for procedures and ICD 10 as we do. But anything that came from anywhere else, military or otherwise, would have to be entered manually.” (my italics)Which should make anyone who supports privatizing VA healthcare think long and hard about re-absorbing veterans medical records into a privatized system when even VA and DoD haven’t been able to work out the transfer kinks. A lot of progress has been made, don’t get me wrong, but countless taxpayer dollars have been expended in the quest for records “jointness” and still more will be spent before anything approaching full transferability is achieved. Just because Amazon can deliver products to your doorstep by drone in under 30 minutes does not mean a similarly aggressive and consumer-savvy healthcare network will be able to deliver better healthcare to a veteran in anywhere near such a timely manner. The veteran healthcare learning curve will be exceedingly steep, and, I think, prohibitively expensive.A privatized VA healthcare system would, in my opinion, be a crippled and vision challenged beast from the very start. The private companies running it would not see anywhere near the profits they seek (or suggest to their stockholders); the veterans using it would, in all likelihood, have more, not fewer, time, records, and care obstacles placed in their way; veterans’ service organizations—like the VFW, the American Legion, the Disabled American Veterans and many other similarly chartered advocacy organizations—would lose much of their grip on VA; Congress would have to cede some authority (which it hates to do), and therefore would find new ways to meddle in the process; and non-veteran healthcare consumers would see their doctors’ offices filling up with veterans who, in all probability, would have “move-to-the-front-of-the-line privileges” as part of the privatization mandate, and that would never end well for either side.