Yes: Give VA funds to vets and let them decide what hospitals to use
It’s disgraceful that we’re still debating how to fix the dysfunctional Department of Veterans Affairs health care system. It ought to be shut down.
No other public servants, active or retired, are forced to go to government-owned hospitals for care. So why are veterans?
Public disgust with the veterans health system came to the fore in 2014 amid reports that at least 40 veterans had died while waiting for care that took too long to get.
Subsequent research found the problem was systemic: On average, veterans were having to wait three months just to see a primary care physician, while other Americans typically waited three days, less if they were sick.
The rot in the VA system goes much deeper, and much further back, as the late Ronald Hamowy, author of “Government and Public Health in America,” documented in a 2010 Independent Institute study.
In 1949, for example, a commission led by former President Herbert Hoover criticized VA plans to spend more than $1 billion on new hospitals — almost $10 billion in current dollars —while existing hospitals were underutilized and the Army and Navy also were building facilities.
After all, building VA hospitals is not a medical necessity; it’s a jobs program, intended to curry favor with local members of Congress and assure the VA’s place at the public trough.
After the 2014 scandal, Congress decided to throw $17 billion more at the failed agency. Some $10 billion of the total was allocated to a new program that would enable veterans to use private doctors and hospitals when they couldn’t access the VA system.
Branded Veterans Choice, the bailout was camouflaged as a way of providing veterans with additional health care options outside the government bureaucracy.
In a practical sense, though, it does no such thing because many private providers won’t see VA patients, knowing the agency doesn’t pay its bills in full or on time.
Moreover, the private option is available only to veterans who live more than 40 miles from a VA facility or those who have waited more than 30 days for a VA appointment. Further, the private care is still largely coordinated by the VA, which in most cases handles scheduling of appointments and patient records.
One year after Veterans Choice was rolled out, the number of veterans waiting to be treated for everything from Hepatitis C to post-traumatic stress hadn’t gone down. In fact, it had increased 50 percent, according to testimony from VA leaders to the House Committee on Veterans Affairs.
Fewer than 2,000 of the 23,000 new VA employees hired after the funding surge were doctors, a July 2015 report by independent watchdog group Open the Books showed.
Despite all the additional money and new hires, the number of employees in positions of accountability — such as inspector general, auditor or quality-assurance officer — actually declined.
Put simply, the VA responded the way government bureaucracies always do: The additional funding exacerbated the VA’s worst excesses rather than motivate better performance.
As for Veterans Choice, the misnamed reform has entangled more private doctors and hospitals in yet more frustrating paperwork.
The Veterans Choice card forces doctors and hospitals to submit claims to the same inefficient government bureaucracy that can’t provide care in its own facilities.
The VA health system does not need more money. Rather, veterans need more freedom to make their own health care decisions. Give the VA’s hospital budget to the veterans; let them decide which hospitals to use.
No: Fix, don’t kill, VA system
The federal system that cares for millions of our veterans is badly broken, but dumping the problem in the lap of private medicine won’t fix it.
The endless problems and scandals at the Department of Veterans Affairs have renewed calls for creating a voucher system that would transfer VA health care to private facilities, and the incoming Trump administration has indicated it might try to create a system that would allow veterans to choose between VA care and private care.
Giving veterans vouchers for private care seems like a quick and easy fix. But in practice, the vouchers would be inadequate and would become increasingly so over time as veterans financially unable to supplement the vouchers would struggle to get essential care.
Further, switching to vouchers would involve an enormous, years-long transformation that would expand an already bloated bureaucracy, leaving it dangerously exposed to fraud.
We don’t need more of that. The VA system already represents government bureaucracy and inefficiency at its worst.
For example, at the Edward Hines Jr. VA Hospital in Chicago, only a quarter of the 4,230 employees actually provide primary medical care. What’s everyone else doing?
The VA’s problems are not due to a lack of money. While the department’s budget has doubled over the past several years, its patient load has only expanded by a third. Meanwhile, administrators are being excessively rewarded.
The VA dished out more than $400 million in bonuses in 2011, according to Military.com, a veterans organization. At the Phoenix VA, one in five employees received bonuses in 2013, with a total payout of $337,885.
And as we know, bonuses haven’t done much to improve efficiency.
Rather than create more of a mess by scrapping the VA altogether, what we really need is to tap the nation’s best organizational minds for ideas to truly reform the VA’s medical system and the department as a whole.
A step in the right direction would involve any panel or commission working on VA reform considering the key provisions of a Senate bill that would make it easier to fire senior VA executives, give the VA secretary expedited authority to hire and fire executives, and shorten the removal and appeals process for all VA employees.
Another focus should be the system’s doctors, who are too few in number and are underpaid compared to private-sector physicians.
Fixing the VA will take huge political courage but it simply must be done.
John R. Graham is a senior fellow specializing in health care reform at both the Independent Institute in Oakland, Calif., and at the National Center for Policy Analysis in Dallas. Readers may write him at 100 Swans Way, unit 200, Oakland, CA, 94621. Whitt Flora is an independent journalist who covered the White House for The Columbus Dispatch and was chief congressional editor for Aviation Week & Space Technology magazine. Readers may write him at 319 Shagbark Road, Middle River, MD, 21220.