We spend an inordinate amount of time talking about the various scandals engulfing the VA in general and the abysmal healthcare received by our veterans in particular, but solutions thus far have been hard to come by. Tinkering with the existing system and replacing bad actors seems to be simply nibbling around the edges of the problem. There have been improvements in some areas, but wait times for veterans remain unacceptably long and the quality of care available in some regions is still far below where we need to be. Is it time to scrap the entire system and start over with something new?

That seems to be the general idea behind a bill being introduced by Cathy McMorris Rogers this month. She’s proposing that the entire healthcare arm of the VA be essentially shut down and transferred into a new nonprofit corporation. (Government Executive)

A member of the House Republican leadership on Tuesday introduced a bill to completely overhaul the way veterans receive health care, in part by turning the Veterans Affairs Department’s health care component into a government-chartered nonprofit corporation.

The Caring for our Heroes in the 21st Century Act, introduced by Rep. Cathy McMorris Rodgers, R-Wash., the chairwoman of the House Republican Conference, would create the Veterans Accountable Care Organization to manage the VA’s brick and mortar health care facilities. It also would launch the Veterans Health Insurance Program to manage VHA’s insurance programs, creating two separate entities to handle VA’s payer and provider functions.

The bill, which she introduced as a “discussion draft,” would seek to expand choice for veterans by creating a “premium support” model to receive care from non-VA sources. Critics contend that premium support is a voucher system that cuts benefits and leaves veterans on their own to receive care.

There’s always a certain appeal to the idea of just burning the whole system down and starting over with something new, but that approach carries its own host of problems. Any transition that massive will require a substantial amount of time to implement and the first question to answer is whether or not a legion of veterans will be left with no care as the shift is made. Also, how much of this approach would truly amount to a new broom sweeping clean? It seems inevitable that a “transfer” to a non-profit would require most of the existing people and resources to be carried over to the new system. They’d simply be paid and administered under a different name.

That’s not to say that there wouldn’t be improvements in the process. Removing the VA’s healthcare component from its current nest would place all the workers and executives outside of the government workers’ unions and the reach of the MSPB. At a minimum, this would make it easier to fire and replace bad actors and hopefully get some competent and accountable people running the show. But is that enough to fix what’s truly undermining the system?

I’m not completely opposed to the idea of an entirely fresh start rather than attempting to repair what we have now, but if we’re going to go that route, have we given up on the idea of something truly radical? One of the constantly repeated suggestions we hear in terms of improving veterans’ healthcare is to make it easier for them to quickly access a doctor at a civilian hospital when they can’t be promptly seen at a VA center. For some reason that’s been tough to implement across the board. So if we’re willing to consider a radical change, I have to ask yet again why we aren’t looking at scrapping the VA healthcare system entirely and simply putting VA funding toward paying for veterans’ care at the same medical facilities everyone else uses. That could shrink the VA massively, reducing their role to one of record keeping and processing requests and payments, along with periodic inspections to ensure the proper care is being delivered. This isn’t a far cry from the idea of eliminating Obamacare entirely and just sinking that money directly into healthcare premium payments for the poor in existing insurance systems. Give all the eligible veterans a healthcare card which they can present at any doctor’s office, hospital or other medical facility and have the VA pay the bills. As for the existing VA hospitals and medical centers, convert them to public facilities which everyone can use.

Is that really all that crazy? And would it cost that much more than we’re spending already?