A Better Veterans Affairs
April 22, 2018
Surveys indicate that most of the 9 million veterans in the VA healthcare network are satisfied with the care they receive. But, the system is not without its problems – including aging facilities and inefficient practices. These problems came under a microscope in 2014 after scandal over unauthorized waiting lists and long-delayed care. As a result, these problems were the subject of both a major consultant study and a report by a congressional commission. I know that in the wake of this scandal, it is important to realize that our actions regarding the VA’s problems today will determine whether the nation meets its obligation to our veterans tomorrow. I also realize that there is real danger for our veterans in the approach our president is taking.
Some context would be helpful here. Some years ago, a researcher described VA health care as providing “the best care anywhere.” Recently, many major hospitals in the country have caught up with the advances that Veterans Affairs pioneered, like the use of electronic medical records. Over time though, lack of sufficient investment in the VA’s infrastructure has compounded some of its challenges with providing care as efficiently as possible. In recent years, we’ve all heard stories about problems at individual VA hospitals, as well as accounts about inefficiency in the system at large. Some of the issues that VA hospital administrators must contend with are problems common to medicine generally, but underinvestment makes these problems worse. Hospitals and medical centers – whether VA or private - need to keep making improvements to assure that they’re providing high quality care and doing it efficiently. With many older hospitals and some very inefficient practices, the VA system still has work to do.
The Wrong Solutions
It was clear in 2014 that a solution was needed to fix the serious access problems many veterans were experiencing. In response, Congress passed legislation that allowed vets to get care in their community in situations where Veterans Affairs couldn’t provide timely care in its own facilities, or in cases where vets had to travel long distances to get to the nearest VA facility. This “solution” didn’t work very smoothly, but, now Veterans Affairs does rely much more on contracting for care than it had in the past. However, the fact that this program worked in certain situations doesn’t mean that it can provide our veterans with the best care universally. Unfortunately, those advising the president on veterans’ affairs are pushing an agenda that would have the agency continue to contract-out far more care and services. There are real dangers in that approach. It puts veterans’ care on a slippery slope that can easily go too far, and that would likely lead to closing VA facilities and privatizing veterans’ care completely. Unfortunately, those advising the President have a “vision” that’s much more about hostility to government than about providing the best service to our veterans. These critics really want to kill the VA health care system.
Consider the parallel we’ve seen in Ohio, where instead of investing in new plants, new equipment or worker training, many manufacturers contracted-out work to overseas suppliers, and closed plants. These companies have abandoned their workers, and “rewarded” consumers with lower-quality products. I will work hard to stop the government from doing the same thing to our veterans.
What Veterans Groups Think
The president’s prescription for change is to require Veterans Affairs to offer veterans their choice of care in the private sector, even if an excellent VA clinic or hospital is close by. You might ask, what’s wrong with that? Plenty, according to membership organizations that actually represent and assist veterans, like the American Legion, Veterans of Foreign Wars (VFW), and Disabled American Veterans (DAV), who see this “choice” leading to VA health care becoming a giant insurer, paying bills rather than caring for veterans who often have complex, chronic health problems. The Legion, VFW, DAV, and other major veterans’ service organizations strongly oppose veterans affairs moving further in that direction. They know that is this happens, veterans would ultimately lose out on the essential care only the VA can provide. This care includes specialized services that are unique to the VA system. Without these services, veterans would be getting poorer quality care, and they’d end up with less choice rather than more.
As the VFW’s Director of Legislative Affairs, Carlos Fuentes, pointed out in testifying before Congress last year, “The VA health care system delivers high quality care and has consistently outperformed private health care systems in independent assessments.” Among the VA systems’ important strengths is its integrated system of care. VA clinicians coordinate the care of their patients, using a common electronic medical record. As Fuentes testified, wide open choice brings fragmentation of care – independent doctors who don’t coordinate and communicate with one another, with a risk of poor outcomes as a result.
Why We Need Veteran-Specific Care
What’s lost if the VA were no longer providing care? People forget, or may not know, that Veterans Affairs has some unique capabilities that aren’t widely available elsewhere. For example, VA health care has special expertise in treating post-traumatic stress disorder and military sexual trauma that can’t easily be found in the private sector. Treatment for veterans experiencing this trauma is extremely important, especially among those who have served in war zones! The VA system is also quite unique in integrating mental health care and primary care services throughout its national system. In contrast, many parts of the country, including our district, are plagued by very limited access to mental health care services for those who need them. Furthermore, several years ago, Veterans Affairs launched an interdisciplinary approach to pain-management that has provided alternatives to reliance on opioids. We must ensure that our veterans have access to this treatment.
The Bottom Line
Am I arguing against ANY contracting? Definitely not! If a VA facility in Ohio can’t provide an eligible veteran with necessary specialized care, or if that facility can’t provide quality care, it makes sense to arrange for another conveniently located provider to administer treatment. But those pushing for more and more contracting, beyond these clearly beneficial cases, are ducking VA’s problems and are not posing real solutions.
The good news is that there’s a clear path forward. Veterans Affairs, like other large health care systems, must streamline operations; eradicate inefficiencies; continue to foster high quality improvement; and, where prudent, make investments in modernizing facilities. Those are the kinds of reforms that an independent congressional commission, the Commission on Care, made in its report in June 2016. Unfortunately, the President is apparently unaware of the report, and certainly hasn’t read it. When these reforms can’t be made, contracting out makes sense, but when we can invest in a better stronger path forward, that should be our primary approach.
I certainly will not minimize the Department of Veterans Affairs’ problems. But, I worry that we don’t hear a great deal about the strengths of the VA system. Yet these strengths are a key to the care that Veterans Affairs provides. Yes, we need to see more improvement in tackling VA problems, and I’m committed to pressing for greater efficiency and system reforms. But we ought to pay special attention to organizations like the American Legion, VFW, and DAV, when they warn against glib “solutions” that actually threaten to dismantle a system that serves our veterans well. So I join the leaders of veterans’ service organizations, and veterans across the country, in calling on the President to stop the push for privatization, and in asking him to work with us to strengthen and improve the VA health care system.