The good news after the departure of VA Secretary Eric Shinseki over the wait-list fraud scandal is that a new consensus has developed on Capitol Hill that veterans should have the option to choose outside providers for their medical care. The bad news, at least at the moment, is that no consensus exists on what conditions should trigger that, or whether there should be conditions on choice at all. Sen. Bernie Sanders (I-VT), who heads the Senate Veterans Affairs Committee, has only recently and grudgingly accepted that a private choice should exist at all, and he wants to limit it to the crisis at hand. Sen. John McCain wants it to be a permanent option, and their competing bills will come to the Senate floor over the next few weeks:
For some lawmakers, this is a temporary solution while the VA fixes larger systemic issues. Sen. Bernie Sanders, I-Vt., the chairman of the Senate Veterans’ Affairs Committee, said on “Face the Nation” Sunday that he will introduce legislation this week that allows any veteran who is in a long waiting line for care to seek treatment at a community health center, military hospital or private doctors.
The bill will also give the VA the authority to immediately remove executives who have performed poorly, authorize the agency to lease 27 new health facilities in 18 states, and use emergency funding to hire new doctors, nurses and other providers. That, Sanders believes, is the root of the problem.
“What is very clear to everybody right now is that in many parts of the country, the VA simply did not have the doctors and the staff to make sure the veterans got timely care. The system was then gamed, which is absolutely reprehensible, which must be dealt with through criminal prosecution and bureaucratic reshuffling. But we need to make sure that that never happens again,” he said. …
In a separate interview, Sen. John McCain, R-Ariz., suggested what might be a more permanent solution to the agency’s problems.
Some VA facilities are “unique and wonderful” for treating military-specific issues like traumatic brain injuries, post-traumatic stress disorder, prosthesis and other war wounds, but shouldn’t always be relied on to provide veterans with more routine care, McCain said.
“Why should a veteran have to get into a van and ride three hours to get to Phoenix in order to have routine medical care taken care of? Why doesn’t that veteran have a card and go to the caregiver that he or she needs and wants?” McCain said. “That’s the solution to this problem, this flexibility to the veteran to choose their healthcare, just like other people under other healthcare plans are able to do.”
Sanders plans to offer his own bill that seeks to solve the “short-term need” while efforts at larger reform play out:
“We are going to introduce legislation, either [today] or Tuesday, which addresses the short-term need to make sure that any veteran who is on a long waiting line will be able to get the care that he or she needs, either at a private facility or a community health center or Department of Defense base,” said the chairman of the Senate Veterans Affairs Committee, and a Vermont Independent, on CBS’s “Face the Nation.”
McCain and others are looking at private choice as a long-term solution to the problem, but perhaps as a conditional choice in some proposals:
House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.) is working on legislation that would allow VA-eligible veterans to seek care outside the system if they have to wait more than 30 days to seek medical treatment. The idea of at least partly privatizing veterans’ health care, or at least giving them the option to go outside the system, is popular among members of both parties.
“VA has a very important role,” Miller told reporters last week. “There are so many things that VA does well and only VA can do and that’s to care for those who have in fact borne the battle, that have the wounds of traumatic brain injury and post-traumatic stress, amputations, spinal cord injuries. The VA should be able to take care of those. But there are some things that you can do in the private sector and the veteran needs to have the option.”
McCain and Richard Burr have not yet released their proposed plan to reform the VA, but patient choice is supposed to be its centerpiece, and probably won’t include conditions on that choice. At least, that was McCain’s proposed reform in 2008, while Barack Obama argued that more money and better management was all that was needed to reform the VA. McCain won that argument by default over the past month, but it’s still not clear that he will have the votes for his original private-sector partnership proposal.
Here’s the problem with the conditional approach. All due respect to Rep. Miller and Sen. Sanders, but how exactly do they plan to measure wait times in order to allow veterans to exercise a conditional choice? Perhaps they missed this in the news, but the VA has been falsifying wait times for years now, and it seems doubtful that the culture will transform to that degree overnight. What happens if a veteran seek private medical care while the local office rigs the wait lists to show less than 30 days of wait time? Do they deny coverage of the private care and bill the veteran for the services?
Let’s build the private option into the system unconditionally, and give our veterans the choice they fought to allow the rest of us to enjoy. The competition will produce more reform at the VA than a thousand Congressional bills will produce, and it will allow the VA to focus on its expertise in service-related illnesses and injuries.