Thursday, January 12, 2017

Veterans Deserve Better Health Care

(A version of this column was syndicated by the Tribune News Service.)

President-elect Trump has nominated David Shulkin, MD, to be the next Secretary of Veterans Affairs. In 2015, Doctor Shulkin was nominated by President Obama to be Under Secretary of Health in the VA (the position he currently holds). It is an interesting choice, not only because Mr. Trump is calling on an Obama appointee to take the top job in the VA, but also because it recognizes veterans’ health care is the major pain point in the department.

Can veterans hope for better reform than just more tinkering with the current bureaucracy? Or will they have the opportunity to liberate themselves from it? No other public servants, active or retired, are forced to go to government-owned hospitals for care. Why veterans?

Public disgust with the veterans’ health system came to the fore in 2014 amid reports that at least 40 veterans had died while waiting for care. Subsequent research found that the problem was systemic: On average, veterans were having to wait three months just to see a primary-care physician, while other Americans typically waited three days, less if they were sick.

The rot in the VA system goes much deeper, and much further back, as the late Ronald Hamowy, author of “Government and Public Health in America,” had documented in 2010 Independent Institute study. In 1949, for example, a commission led by former President Herbert Hoover criticized the VA’s plans to spend more than $1 billion on new hospitals (almost $10 billion in current dollars), despite the fact that existing hospitals were underutilized and the Army and Navy also were building hospitals. Building VA hospitals is not a medical necessity, it’s a “jobs program” intended to curry favor with local members of Congress, assuring the VA’s place at the public trough.

After the 2014 scandal, Congress decided to throw $17 billion more at the failed agency. Some $10 billion of the $17 billion was allocated to get veterans appointments with private doctors and hospitals when they couldn’t access the VA system. Branded Veterans Choice, the bailout was camouflaged as a way of providing veterans with additional healthcare options, outside the government bureaucracy.
On paper maybe, but in a practical sense it is no such thing because many private providers won’t see VA patients, knowing that the agency doesn’t pay its bills in full or on time.

Moreover, the private option was available only to those veterans who either lived more than 40 miles from a VA facility or faced a wait of more than 30 days for a VA appointment. However, the private care would still largely be coordinated by the VA, which in most cases would be involved in scheduling and management of patients’ records.

One year after Veterans Choice was rolled out, the number of veterans waiting to be treated for everything from Hepatitis C to post-traumatic stress hadn’t gone down, it had increased 50 percent, according to testimony from VA executives to the House Committee on Veterans Affairs.

According to a July 2015 report by Open the Books, an independent watchdog group, fewer than 2,000 of the 23,000 new VA employees hired after the funding surge were doctors. Despite all the additional money and new hires, the number of employees in positions of accountability (such as inspector general, auditor, or quality-assurance officer) actually declined.

Put simply, the VA responded the way government bureaucracies always do: The additional funding exacerbated the VA’s worst excesses, rather than motivating better performance. As for Veterans Choice, the misnamed reform has entangled more private doctors and hospitals in yet more frustrating paperwork. The Veterans Choice card forces doctors and hospitals to submit claims to the same broken-down government bureaucracy that can’t provide care in its own facilities.

Just like the veterans who have to wait months to get treated, their private providers have to wait months to get paid. The misnamed “reform” has allowed the waiting-list disease to spread beyond the VA’s walls.

The VA health system does not need more money. Rather, veterans need more of the freedom for which they fought on our behalf. Give the VA’s hospital budget to the veterans; let them decide which hospitals to use.

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