Where it breaks down badly, especially out West and in other sparsely populated parts of the country, is in the provision of urgent and emergency care where the distance to any suitable hospital, let alone a V.A. hospital, can be great. We should think about giving veterans in these situations something like a Vetacare card, which could be used for urgent or emergency care, or both, and subsequent hospitalization if needed. This would allow for more immediate treatment, and the V.A. could be billed directly.

Congress and the V.A. need to decide whether to revert to the days of yesteryear, when the V.A. took care only of patients’ service-connected conditions, along with providing a safety net for our most impoverished veterans — or to try to re-establish a more universal program that utilizes the current system’s strengths while repairing its weaknesses. If so, it is likely that many medical centers would need more financial resources in addition to administrative reform.

Any scandal that befalls the V.A. necessarily lands on the party that is in the White House. As this is an election year, we can expect that there will be significant pushback to delay and limit the discovery of negative information — which is why I expect my suggestions to be vehemently opposed by the White House and the V.A.’s upper management.