Privatizing the VA
The Department of Veterans Affairs is once again in need of someone to lead it. The president’s last nominee, Dr. Ronny L. Jackson, withdrew his name from consideration last month [April 26] after a flurry of allegations regarding his professional conduct as White House physician.
Dr. Jackson’s demise came just weeks after the previous VA secretary, Dr. David Shulkin, was forced out, in part because of his own ethical lapses.
The VA desperately needs a leader who will fix its failing health care system. That will require expanding the ability of veterans to seek care outside the VA system, in the private sector.
Neither Dr. Jackson nor Dr. Shulkin was the right person to lead the federal government’s second-largest bureaucracy. That’s because neither is sufficiently supportive of the only thing that can save the VA’s failing health system: Privatization.
In March, the agency’s inspector general issued a devastating indictment of a VA medical center in Washington, D.C. The report detailed staffing shortages, unhygienic medical supplies, tens of millions of dollars in waste and a systemic failure to “consistently deliver timely and quality patient care.”
This past December, USA Today reported that the VA had been hiring personnel with revoked medical licenses since 2002. Rep. Mike Coffman, Colorado Republican, described the agency as a “dumping ground” for doctors who had experienced malpractice complaints or had been sanctioned for providing poor care.
Two years ago, a former VA official said that one of every three calls into the system’s suicide hotline doesn’t get through to a professional. Instead, callers are shuttled to backup personnel with less training.
Worse, the VA appears to be trying to hide problems like these rather than fix them. VA medical centers across the country have been caught manipulating official data to make wait times appear shorter than they actually were.
In another March report, the agency’s inspector general investigated wait times at more than a dozen facilities across North Carolina and Virginia. Officials had reported that just 10 percent of patients had to wait longer than a month to receive care. In reality, one-third had to wait that long — three times the official estimate.
The VA’s performance seems to be worsening even as taxpayers spend ever-more money on it. Since 2001, its annual budget has almost quadrupled, to $186 billion, as of last year. President Trump has requested over $198 billion for 2019.
Put simply, the VA status quo is delivering poor care to veterans at high cost to taxpayers. Injecting competition into the market for veterans’ health care would flip that status quo — and result in better care at lower cost.
Giving vets vouchers, for example, would empower them to take control of their care. Doctors and hospitals would compete for vets’ business, driving quality up and cost down in the process. Such competition would reward excellence and, equally important, weed out corruption and waste.
This isn’t a radical proposal. The VA already runs a small-scale privatization operation, the Veterans Choice Program. Right now, the VA foots the bill for veterans to visit private providers if they are facing a wait time of over a month or live too far from a VA facility. Veterans are only responsible for their normal VA copayment.
The voucher program is popular. In 2016, there were over 25 million veteran appointments with private providers. Today, roughly one-third of all VA appointments occur within the private sector.
The program’s popularity could explain why the program keeps running out of money. Without congressional action, the program’s funds will dry up by the end of the month.
As another example, the House Veterans’ Affairs Committee recently advanced a bill to boost veterans’ access to private care. The reform, called the VA Mission Act, would increase the number of veterans able to seek care from private sector health specialists.
Dr. Shulkin blamed his ouster on his opposition to further reliance on the private sector to deliver veterans’ care. In a defiant opinion piece, he wrote that privatization is “aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”
The opposite is true. Empowering veterans to seek health care in the private sector would free them of the endless waiting, the poor quality and the rank incompetence that plague the publicly run system.
The next VA secretary should strive to make sure that all veterans have the option of obtaining care from private health care providers.