Give veterans a choice in their care
It's disgraceful that we're still debating how to fix the dysfunctional Department of Veterans Affairs health care system. It ought to be shut down.
No other public servants, active or retired, are forced to go to government-owned hospitals for care. So why are veterans?
Public disgust with the veterans health system came to the fore in 2014 amid reports that at least 40 veterans had died while waiting for care. Subsequent research found the problem was systemic: On average, veterans were having to wait three months just to see a primary care physician.
The rot in the VA system goes much deeper, and much further back, as the late Ronald Hamowy, author of “Government and Public Health in America,” documented in a 2010 Independent Institute study.
In 1949, for example, a commission led by former President Herbert Hoover criticized VA plans to spend more than $1 billion on new hospitals — almost $10 billion in current dollars — while existing hospitals were underutilized and the Army and Navy also were building facilities.
After all, building VA hospitals is not a medical necessity; it's a jobs program, intended to curry favor with local members of Congress and assure the VA's place at the public trough.
After the 2014 scandal, Congress decided to throw $17 billion more at the failed agency. Some $10 billion of the total was allocated to a new program that would enable veterans to use private doctors and hospitals when they couldn't access the VA system.
Branded Veterans Choice, the bailout was camouflaged as a way of providing veterans with additional health care options outside the government bureaucracy.
In a practical sense, though, it does no such thing because many private providers won't see VA patients, knowing the agency doesn't pay its bills in full or on time.
Moreover, the private option is available only to veterans who live more than 40 miles from a VA facility or those who have waited more than 30 days for a VA appointment. Further, the private care is still largely coordinated by the VA, which in most cases handles scheduling of appointments and patient records.
One year after Veterans Choice was rolled out, the number of veterans waiting to be treated for everything from Hepatitis C to post-traumatic stress hadn't gone down. In fact, it had increased 50 percent, according to testimony from VA leaders to the House Committee on Veterans Affairs.
Fewer than 2,000 of the 23,000 new VA employees hired after the funding surge were doctors, a July 2015 report by independent watchdog group Open the Books showed.
Despite all the additional money and new hires, the number of employees in positions of accountability — such as inspector general, auditor or quality-assurance officer — actually declined.
Put simply, the VA responded the way government bureaucracies always do: The additional funding exacerbated the VA's worst excesses rather than motivating better performance.
The VA health system does not need more money. Rather, veterans need more freedom to make their own health care decisions. Give the VA's hospital budget to the veterans; let them decide which hospitals to use.
John R. Graham is a senior fellow specializing in health care reform at both the Independent Institute in Oakland, Calif., and at the National Center for Policy Analysis in Dallas.