Many Department of Veterans Affairs hospitals should close and the department should focus on its original mission to care for those disabled in war, while reallocating the rest of its funding to partially subsidize routine medical care for other veterans at ordinary doctors’ offices.
Those were the conclusions of a six-month analysis by a bipartisan group of political leaders, veterans affairs officials and healthcare experts.
The population of veterans will shrink from 24 million in 2009 to 16 million by 2029, and money is being wasted maintaining hospitals that are largely empty, even as the private health sector has grown rapidly.
Those private hospitals could absorb most veterans, who would pay a deductible or co-pay with the VA paying the bulk, similar to insurance, the panel organized by Concerned Veterans for America concluded, and VA hospitals should be closed under a process similar to the military’s Base Realignment and Closure process.
But bureaucrats have fought to keep the facilities open — and refocused on ordinary medical care, rather than combat wounds, to fill them — in part because they provide jobs. Members of Congress with facilities in their districts have also resisted closing them because it could be painted as eliminating jobs, said congressional leaders who spoke at the unveiling of the report Thursday.
“The VA should be there for [traumatic brain injury], amputees, those combat specific injuries that should be VA’s core competencies. For everything else, there’s outside hospitals,” said Rep. Duncan Hunter, R-Calif., who fought in Iraq.
“It’s much less expensive. Then you don’t need the hundreds of thousands of people processing paperwork for your case… You could cut 250,000 [employees] out of the VA.”
Stewart Hickey of the veterans group AMVETS said “the bureaucracy is there to defend the status quo, to protect the jobs, unions. The VA should be for veterans, not for the VA.”
Half of veterans experienced long wait times, one-third had very long drives to veteran-specific hospitals, three-quarters thought bureaucracy was the problem. Eighty-eight percent thought they should be given a choice to use ordinary doctors, the report found.
The former members of Congress and policy experts said they were better positioned to chart a future for the VA than the VA itself because the VA has not been honest in assessing itself and because it has a vested interest in preserving the status quo.
In addition to manipulating metrics, “They do not attempt to measure the problems of access to care that drive many veterans away from the VA. Nor do they measure the views of those who do not utilize VA services because of their poor experiences,” the report found.
House Majority Leader Kevin McCarthy, R-Calif., said “we should all agree to be honest about where we are. So many times when I try to get an answer on a VA back claim, they hide it.”
Rep. Jackie Walorski, R-Ind., said her Veterans Affairs committee has always fully funded the VA, but when serious problems like incompetence and malfeasance surface, the VA always says more taxpayer funding is the answer.
Because veterans don’t have the option of using ordinary hospitals, the VA doesn’t have a market incentive to improve, said Concerned Veterans’ Darin Selnick.
He said that military members don’t enlist so that they will get free routine medical care at VA hospitals for life. “They’re 20 years old, they’re bulletproof.”
Instead, VA has had mission creep to begin providing routine care rather than combat-related wounds, and that creep has benefited VA employees more than veterans. The bureaucracy is now “buckling under its own weight,” commenters said.
The report found that “the Veterans Health Administration does not suffer from a lack of funds. However, too large a proportion of its funds are spent on underused facilities. This problem not only constrains the VHA’s ability to devote resources to patient care; it also stymies efforts to allow veterans to seek care outside the VA.”
Sen. Marco Rubio, R-Fla., said “I can’t believe one person got fired [in the Phoenix wait-time manipulation scandal] and they just say they need more money.”
Sen. John McCain, R-Ariz., said “haven’t we got a pretty good track record that unless fundamental reforms are made, just throwing more money at it isn’t the answer?” McCain questioned why going to ordinary doctors works for Medicare patients, but wouldn’t work for veterans. “Bureaucracies have a tendency to protect their turf.”
VA Secretary Robert McDonald did not attend, but told organizers that “reforming the VA healthcare cannot be achieved by dismantling it. [The plan would] contract out VA’s sacred mission” and deprive veterans of specialized care.”
McCain said that response “flies in the face of” the proposal, which says that VA would still provided specialized care, but veterans would have the option of seeking routine care at other hospitals, and the choice would force VA to compete and treat veterans as customers, not just numbers.
