Doing Right by Our Veterans
The VA health care system treats some 9 million veterans annually.
Surveys indicate that most are satisfied with the care. But the system is not without its problems – including aging facilities and inefficient practices. Its problems came under a microscope after a 2014 scandal over unauthorized waiting lists and long-delayed care, and these problems were the subject of both a major consultant study and a report by a congressional commission. How we address the VA’s problems today will determine whether the nation meets its obligation to our veterans tomorrow. And there’s real danger for veterans in the approach being taken by the president, who campaigned on the promise that he’d do “great” things for our veterans.
Some context would be helpful here. Some years ago, a researcher described VA healthcare as providing “the best care anywhere.” Many major hospitals in the country have since caught up with advances that Veterans Affairs pioneered, like the use of electronic medical records. Over time, lack of sufficient investment in 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, when veterans at numerous VA facilities faced long wait times for VA care, that a solution was needed to fix the serious access problems many veterans were experiencing. Congress responded, passing 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. But if a little medicine is helpful, it doesn’t follow that you should quadruple the dose! Yet that seems to be the direction in which President Trump is heading! Those advising the President on veterans’ affairs are pushing an agenda that would have the agency 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 lead to closing VA facilities and privatizing veterans’ care completely.
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 abandoned their workers, and “rewarded” consumers with lower-quality products.
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 healthcare system. Their 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), and who see “choice” leading to VA health care becoming a giant insurer, paying bills rather than caring for veterans who often have complex, chronic health problems. In essence, those with the President’s ear are promoting a course likely to lead to privatization of the Department of Veterans Affairs. The Legion, VFW, DAV, and other major veterans’ service organizations strongly oppose VA moving further in that direction, because they know what veterans would ultimately lose. They’d lose access to specialized services that are unique to the VA system, in many instances these veterans would be getting poorer quality care, and ironically – without access to VA care any longer -- they’d end up with less choice rather than more.
Am I arguing against ANY contracting? Definitely not! If a VA facility in Ohio can’t itself 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 are ducking VA’s problems, not posing real solutions.
The good news is that there’s a clear path forward. Veterans Affairs, like other large healthcare systems, must streamline operations; eradicate inefficiencies; continue to foster continuous, 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.
Why We Need Veteran-Specific Care
Veterans service organizations know what would be lost through privatization. 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.
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. We know this far too well in Ohio.
I certainly will not minimize the Department of Veterans Affairs’ problems. At the same time, I worry that we don’t hear a great deal about 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.