Mend VA by improving what it does best, less of the rest
If anybody had been inclined to dismiss the scandal at the Department of Veterans Affairs as overblown, they’ll have to think again. Failures in its health care system are severe and systemic, according to an authoritative new report. Blame for this will need to be apportioned, but far more important is to fix what’s gone wrong.
The agency’s inspector general reported Thursday that veterans waited 115 days on average for their first primary care appointment at a VA health center in Phoenix, not the 24 days staff first claimed. The problem goes beyond this one facility. The report concluded that inappropriate scheduling practices are “systemic” throughout the agency.
This information, together with the distressing details of veterans who died or suffered while waiting for treatment, has prompted the agency’s head, Eric Shinseki, to resign. By itself, that won’t put things right.
What will? One approach, advocated by Sen. John McCain and others, is to give veterans “the right to choose where and when they get their medical care.” House Speaker John Boehner has called for privatizing the VA, and House Veterans Affairs Chairman Jeff Miller wants the agency to pay for veterans to get private care if they wait more than 30 days for VA care.
Veterans groups counter that the VA is uniquely suited to deal with their health needs, such as trauma-related injuries, prosthetics and mental health. They argue the influx of new veterans following the wars in Iraq and Afghanistan means the agency’s health care services need more money, and they warn that diverting resources would put that care at risk.
The best way forward is to combine the two approaches: Strengthen the VA’s ability to do what it’s good at and widen veterans’ access to services that don’t demand its expertise.
To start, that means differentiating between primary and specialty care. The inspector general’s report focused on wait times for primary care, suggesting that’s where the most pressing shortage is. If so, the VA could address much of the problem by paying for primary-care visits with private doctors when timely appointments aren’t available at its own facilities.
Veterans would continue to rely mostly on VA doctors for specialty care. Congress should ensure those specialists are available by providing more funds where they’re needed.
For this to work, effective cost control will be crucial. The VA could save money by building a network of civilian health care providers. Tricare, which provides health benefits to some retired military personnel, pays for outside care when appointments aren’t quickly available at military facilities. And it controls costs by imposing maximum allowable charges through its network of outside providers.
Because the VA serves so many veterans, building a similar network might be a slow and daunting task. There’s an alternative — another government-run health care program with excellent cost management and a nationwide network of participating physicians. It’s called Medicare. If the VA can’t offer prompt care, veterans could be given access to Medicare’s network of primary-care providers, reimbursed by Medicare at Medicare rates, with the VA covering the cost.
The VA has let veterans down. Firings and resignations won’t put things right. Better to honor veterans by embracing new ideas for their care.