Conditions at some Department of Veterans Affairs medical facilities are almost too horrifying to believe.

The VA facility in Manchester, N.H., featured conditions that were likened to those found in the Third World – with a fly-infested operating room and surgical instruments that were covered with rust and blood.

One whistleblower at the Cincinnati VA hospital described filthy instruments with bone fragments attached.

Despite these serious problems, Manchester and Cincinnati received good ratings from the VA according to internal rankings. These are not the kinds of stories you should be hearing at the VA’s best hospitals.

We know about these rankings only because, in 2016, USA Today published a previously secret internal VA list that ranked the VA’s major medical centers from one to five stars – with one being the lowest ranking and five being the highest. VA Secretary David Shulkin subsequently decided to release the list of major medical centers annually.

We applaud Shulkin for taking this step and for increasing transparency at the VA. But this year’s rankings show that while there may have been some incremental improvements, many major medical centers still need serious work.

Using a scoring system that takes into account dozens of factors such as wait times and death rates, three Tennessee hospitals, three Texas hospitals, two California hospitals, and one in Arizona received the worst rating from the VA – one out of five stars. Two medical centers in Texas and two in California received a one-star rating for the second year in a row. Additionally, the infamous Phoenix VA hospital – where it was revealed in 2014 that dozens of veterans died on secret wait lists – also received a one-star rating.

The Memphis VA hospital was described by a former employee as a “house of horrors.” The El Paso VA facility has abysmal patient satisfaction ratings and led Rep. Beto O’Rourke, D-Texas, to urge the VA to partner with private-sector providers for routine care.

The continued problems at these hospitals are unacceptable and no veteran should be forced to use a VA medical facility with an extended record of failure.

The Veteran Choice Program, while well-intentioned, has failed to offer most veterans more choice because it has kept the VA as a gatekeeper, standing between veterans and the care they need. The VA needs to get out of the way. The veteran, not VA bureaucrats, should be at the center of the VA healthcare system.

The VA should continue to be there for veterans who need it. Many veterans have received excellent care at VA facilities and those who wish to continue to receive care directly through the VA should retain that option.

But if a veteran believes the VA cannot provide the care they need in a timely or convenient fashion, they should have options outside of the VA.

This is an idea supported by large majorities of both veterans and non-veterans. About 80 percent of veterans surveyed in July said they support having “more choices over their health care” outside of the VA system.

No one should have to confront a life-threatening emergency in a hospital with rusty, blood-stained medical instruments, or deal with a bureaucracy that puts patients at the bottom of the priority list.

Our veterans have waited long enough for real reform at the VA. Congress should act decisively and enact bold reforms to give veterans more control over their healthcare at the VA – they deserve nothing less.

Dan Caldwell, a Marine Corps combat veteran, is the executive director of Concerned Veterans for America.

If you would like to write an op-ed for the Washington Examiner, please read our guidelines on submissions here.