Our Veterans Deserve Real Health Care Choices
Late last month, Veterans Affairs Secretary David Shulkin offered a plan to let veterans escape the VA's beleaguered health system.
His proposal would expand the agency's existing Veterans Choice Program — an initiative that was supposed to allow veterans to seek care from private health care providers if they face long wait times or live too far away from a VA facility. Under Choice 2.0, as he called it, all veterans would have this option.
But the Choice program needs more than an upgrade, as a recent report from the Veterans Affairs' Inspector General makes clear. Thanks to cumbersome rules and bureaucratic incompetence, the investigation found, wait times were sometimes worse for Choice patients than for those who stayed inside the VA.
In other words, even when the VA health system sends patients elsewhere, it still keeps veterans from getting timely medical care. It's time to fully voucherize the VA — and give America's veterans direct control over when, where and from whom they seek and receive treatment.
Congress established the Veterans Choice program following a 2014 scandal in which VA staff were caught falsifying data to hide the long — and sometimes deadly — wait times at many government-run clinics.
The initiative allowed veterans who lived too far from a VA facility — or were already facing a wait time of more than 30 days — to use a "Choice" card to obtain care from a private provider within an approved network.
Sounds straightforward enough. But the VA created serious bureaucratic hurdles for Choice participants. According to the Inspector General's report, before patients could use their Choice card, they had to "navigate through Choice's authorizing and processing procedures," including "eligibility reviews, decisions to opt into the program, and transfer of medical documentation."
The Inspector General examined a 10-month period, from November 2014 to September 2015. At the end of that period, 35% of requests for outside care had not yet been accommodated. The 98,000 requests in that group had been in limbo for an average of 72 days.
Patients who did receive care from an outside physician waited an average of 45 days for the privilege.
Worse, when the VA failed to pay a Choice provider in a timely manner, veterans themselves could be held personally liable for their medical bills. The problem was so prevalent that the VA created a dedicated hotline for enrollees at risk of an adverse credit report because of delayed Choice payments.
The Inspector General blamed the excessive waits on an "inadequate network of providers." But those networks were small because of the administrative regulations associated with the program, as well as the agency's low reimbursement rates.
The VA's incompetence didn't end there. An additional $2.5 billion allocated to the agency was supposed to go toward hiring more doctors in areas with the worst wait times. But according to a report from NPR in January, the VA spent that money on other projects and hired the same number of new doctors it would have without the extra funding.
In short, the VA spent $12.5 billion without improving the quality of care that our nation's wounded warriors receive.
A real "choice" program would give veterans vouchers to take to doctors of their liking — not require them to wait a month for federal approval.
President Trump has proposed a similar reform giving every veteran "the choice to seek care at the VA or at a private service provider of their own choice." That would, he said, "force the VA to improve and compete if the department wants to keep receiving veterans' healthcare dollars."
Democrats and some veterans' groups decried Trump's plan as "privatization" — one of the few curse words left in Washington.
It's no wonder Shulkin — an Obama appointee to the VA in 2015 — vowed during his recent confirmation hearing that the agency "will not be privatized on my watch."
Shulkin's Choice 2.0 proposal seems to strike a balance between full voucherization and the status quo. But as the original Choice program demonstrated, splitting the difference will only make matters worse.
It's time our veterans had a genuine escape hatch from the VA and its inept bureaucracy. They've waited long enough.