More private health care access could ease VA’s burden

June 14, 2014 

Acting Secretary of Veterans Affairs Sloan Gibson visited Fayetteville last week to address long wait times at the Fayetteville VA Medical Center. His solution was familiar and inevitable: Spend more money.

Gibson pledged $7.4 million more to cut Fayetteville’s wait times – some of the longest in the nation – by paying for veterans to receive care from private providers. Those millions are needed in Fayetteville, but the money will be a mere drop in the overall system. The VA has 341,000 employees and operates 150 hospitals and 1,000 clinics that care for 8.4 million veterans. The department’s annual budget now exceeds $150 billion – more than double the $71 billion it spent in 2005.

The problem in Fayetteville and across the nation isn’t too few resources at VA hospitals. It’s too many veterans seeking treatment from a system that can’t keep up.

Former VA Secretary Eric Shinseki tried to introduce efficiency and accountability. He set a 14-day deadline for the VA to provide service to veterans seeking care. But that ambitious goal was unreachable given the demand. Some hospital administrators responded by altering records to cover up the long wait times.

Last week, the Senate passed a measure to speed medical care for veterans. The legislation, which passed 93-3, sets a two-year period during which veterans who live more than 40 miles from a VA treatment center or have been waiting more than 30 days for an appointment can go to a private doctor at the VA’s expense.

The Congressional Budget Office estimates that the expanded access will draw more veterans into the system and increase the amount of VA care received by about 60 percent. The CBO estimates the cost at $50 billion. The House has passed a similar bill, and the two are expected to be reconciled and a final bill sent to the president before the July 4th recess.

The nation has a solemn obligation to provide whatever is necessary for veterans who have suffered service-related injuries. The problem is that the “sacred obligation” has expanded to more veterans than the system can accommodate. Indeed, it is the American impulse to be generous toward our veterans that has led to the current charges that the VA has been callous toward them. Services have expanded even as the overall ranks of veterans have declined 17 percent since 2000. Vietnam-era veterans are having age-related medical issues, and more than 3 million veterans have been added since the first Gulf War of 1991.

The nation cannot ignore its obligation to its veterans, but pumping money into the VA may not be the best way to meet it. With the Affordable Care Act now joining Medicare, the United States is building a system of broad and affordable medical care.

Many veterans with private health insurance don’t see a need to use VA medical services. The focus of VA changes should be on expanding that group by integrating veterans’ medical care into the health care system used by most Americans.

But the change will take time. Henry Aaron, a health policy expert with the Brookings Institution in Washington, said the ideal solution to the VA’s troubles would be shifting more veterans to a “well-functioning national system. The (health care insurance ) exchanges could develop into that, but that’s going to be the work of decades, not the next year or two.”

The movement toward more veterans being cared for through private providers has received a strong emergency push from the House and Senate. The next step is for the federal government to expand not only the options of care, but also the cost savings that could come from bringing veterans more fully into the private health care system.

Veterans groups may be skeptical, but they shouldn’t be. An eventual increase in the blending of private and VA services will ensure veterans quality medical care without increased costs and without the wait.

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