Two years after a scandal engulfed the nation’s veterans hospitals, with reports of long waiting lists, cooked appointment books and patients dying while they waited for care, a commission created by Congress has delivered a plan to transform the Veterans Affairs Department over the next 20 years.
Its 300 pages, released on Wednesday, are a chronicle of failings at the Veterans Health Administration, the part of the V.A. that handles medical care. The debate over the report’s many judgments and prescriptions is just beginning. But the commission’s ambitious work brings two immediate thoughts to mind.
First is a fresh awareness of the danger of quick fixes. After the furor of 2014, which forced the V.A. secretary, Eric Shinseki, to resign, Congress swiftly passed a law and gave the V.A. 90 days to carry it out. It offered a seemingly straightforward solution to long-delayed appointments — allowing patients who have to wait more than 30 days or live more than 40 miles from a V.A. hospital or clinic to see private doctors.
But that hastily created program, whose management was outsourced to private contractors, with confused and conflicting rules, only made things worse. “In execution,” the commission wrote, “the program has aggravated wait times and frustrated veterans, private-sector health care providers participating in networks, and V.H.A. alike.”
That leads to the second thought: the danger of jumping to the wrong conclusions. The V.A. is troubled, no question. But the commission properly stops short of recommending a solution dear to ideologues on the right, which is to dismantle one of the largest bureaucracies in American government — one with a critically important mission — and hand the wreckage to the private sector.
For all its problems, the V.A. is not failing in the area that matters most: delivering excellent, integrated health care to a population with many challenging medical needs. The overall quality of its clinical care is high, as good as and often better than what the private sector can offer. And for veterans with complex, combat-related wounds — spinal-cord injuries, traumatic brain injuries, severe burns, amputations, post-traumatic stress disorder, or the combination of grave injuries called polytrauma — there is no substitute for the breadth and specialized competence of the V.A.
Those who delight in accounts of big-government ineptitude and inefficiency will find lots to savor in the commission report. The commission acknowledges that V.A. care can be inconsistent, with the lack of access to doctors being the agency’s worst management failure. It recommends overhauling the agency’s leadership structures, reforming eligibility requirements, investing in buildings and updating information technology, among other things
But its primary recommendation is to greatly expand access by creating “integrated, community-based” health care networks that all veterans can use, bolstering the Veterans Health Administration with doctors and hospitals from the Defense Department, other federally funded providers, and local ones.
It’s unclear how that new public-private agglomeration is supposed to work, but getting those devilish details right is crucial. Veterans’ advocacy groups are right to be concerned that shedding patients and services to the private sector may ultimately weaken the V.H.A.
Given the egregious gap between the need for medical care and the supply of doctors and providers, there is clearly a role for qualified private health care providers to pitch in. But privatizing the V.A. — throwing wounded veterans upon the vagaries and mercies of corporations, co-pays and premiums — is no solution.