Should the Veterans Health Care System be Privatized?

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Veterans Should Enjoy the Same Health Care Options as All Americans

Avik Roy 11:00 PM

When Senator Bernie Sanders proposed a plan entitled “Medicare for All,” he electrified progressives who regard Medicare as the health reform benchmark. Senior citizens enrolled in Medicare enjoy the security of knowing they can receive quality care regardless of their health or financial status. They have the option to receive care from private physicians and private hospitals. They even enjoy the option of deputizing private insurers to administer their Medicare benefits.

So why does Sanders oppose giving veterans those options?

The problems with veterans’ health care were brought to the fore in 2014, when whistle blowers found that a number of Department of Veterans Affairs facilities were denying care to veterans in need, and concealing those denials to watchdogs in government.

The common sense response of most Americans — and most veterans — was simple: Give veterans who can’t get convenient care from the V.A. the option of obtaining that care from private doctors, hospitals and insurers.

A poll by Concerned Veterans for America and the Tarrance Group of more than 1,000 veterans found that 88 percent agreed that eligible veterans should be given the choice to receive medical care from any source that they themselves choose. And 95 percent agreed that it was “extremely” or “very important” to have the option to seek the best possible care, even if that care was provided by a non-V.A. facility.

There are plenty of veterans who are happy with V.A. health care. And those who have been lucky enough to stay off the V.A.’s waiting lists often do well. But why on earth would we deny other veterans the ability to seek care from qualified private providers, when those on Medicare, Medicaid and Obamacare can? Even the Veterans Health Administration’s own employees enjoy a vast array of private health care and coverage options that are denied to the veterans they ostensibly serve.

We hear a plethora of excuses from opponents of reform. Antagonists say that veterans can only receive good care in a closed system, in which veterans are forbidden to seek care from other sources. The naysayers shriek about “privatization,” as if health care delivered by private physicians is something to be feared. And they claim that if some veterans seek care from private sources, those that prefer the traditional V.A. will receive inferior care.

Modern proposals to reform the V.A., like the one recently put forth by Representative Cathy McMorris Rodgers (R.-Wash.), address these objections. They devote public resources to improving the quality of traditional V.A. care, while also giving veterans the option to seek coverage and care from well-established, high-quality private sources.

Those who are ideologically committed to believing that government services are always better than private services may be unwilling to consider evidence to the contrary. And leaders of public-sector unions oppose allowing veterans to seek care from private hospitals instead of public ones, because they’d receive less income from workers’ dues. But for everyone else, the right answer is obvious.

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The Veterans Health Care System Is Being Unfairly Attacked

Phillip Longman 11:00 PM

Most Americans these days have never served in the military. Fewer still have received care in a Department of Veterans Affairs hospital or even known someone who has. This gap between military and civilian life creates an opening for a powerful array of interests intent on eroding public support for our veterans health care system.

The enemies of the V.A. include the Koch brothers who, fearful of the spread of socialized medicine are funding a well-coordinated campaign (including support for the group, Concerned Veterans for America) to discredit its only true example in the United States, which is the veterans health care system. And they include giant corporate health care systems that stand to gain billions in taxpayer dollars from the privatization or outsourcing of veterans health care.

For these reasons many Americans would do well to scrutinize whether what they may think they know about V.A. health care is true. For example, it will surprise many to learn that more than 60 peer-reviewed studies, including a recent RAND report commissioned by Congress in the wake of the V.A.’s “scandal” in 2014, show that the quality of V.A. care is comparable to, and in many key areas superior to, that offered by private providers.

Another recent study comparing quality metrics in mental health found that "in every case, VA performance was superior to that of the private sector by more than 30%.” The Veterans Health Administration also offers “best care anywhere” when it comes to preventative care, outpatient processes and outpatient outcomes.

How is this possible? The V.A. has a near lifetime relationship with its patients, which gives it incentives, often lacking elsewhere in U.S. health care, to invest in its patients’ long-term health. Moreover, under the V.A. model, the different specialists involved in a patient’s care work as a team, using a common electronic medical record and evidence-based protocols. With its lack of profit motive and ability to operate as a system, the V.A. avoids most of the redundant treatment and fragmentation of care that has made contact with the rest of the health care system the third leading cause of death in the U.S.

This is one reason why all the major veterans service organizations strenuously oppose privatizing the V.A. Another is that simply handing veterans a voucher would not only result in an unsustainable explosion in costs but would lead to the closing of many V.A. facilities, including those specializing in combat-related traumas and disabilities. This would give veterans fewer “choices” not more. Where it lacks capacity, the V.A. already makes extensive use of private doctors, and has plans to build much larger networks of integrated community providers in the future.

To be sure, V.A. care does have many deficiencies, but the next time you hear about one, ask the “compared to what” question. Congressional grandstanding and sensational headlines notwithstanding, wait times at the V.A., for example, are generally in line with those experienced by patients in private health care systems. Most of what’s wrong with the V.A., like a severe shortage of primary care doctors, reflects larger problems with the deeply dysfunctional U.S. health care delivery system as whole.

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Fix Veterans Care Using the Best Research Available

Avik Roy 11:00 PM

Giving veterans access to America’s world-class hospitals — nonprofit institutions like Massachusetts General Hospital and the Memorial Sloan Kettering Cancer Center — is not a corporate conspiracy. Nor is it a conspiracy to give veterans the option of choosing alternative health plans, like those offered by nonprofit Blue Cross entities.

I co-chaired Concerned Veterans for America's Fixing Veterans Health Care Taskforce alongside a former Democratic congressman, Jim Marshall of Georgia; a former Senate Majority Leader, Bill Frist of Tennessee; and Michael Kussman, who ran the Veterans Health Administration from 2007 to 2009. Representative Marshall received a Purple Heart for his service as an infantryman in Vietnam. Dr. Frist worked for nine years as a cardiac surgeon at the Tennessee Valley V.A. Dr. Kussman retired from the Army as a brigadier general. These individuals dedicated months of their lives, without pay, to producing the recommendations found in our 102-page report, "Fixing Veterans Health Care: A Bipartisan Policy Taskforce."

We thoroughly reviewed the historical and scientific evidence regarding V.A. health outcomes. So did the independent assessment of V.A performance requested by Congress in 2014. Our conclusions and theirs were the same: that many veterans receive quality care from the V.A., but that many do not — especially those who are forced to languish for months on V.A. waitlists.

In his book, "Best Care Anywhere," Phillip lionizes the work of Kenneth Kizer, who fought hard against inertia at the Veterans Health Administration in the 1990s. But in the years after Kizer's departure standards once again eroded. “V.A. officials have not been as closely focused on data, results, and metrics — performance measurement—as they once were,” Kizer told the New York Times in 2014. “The culture of the V.A. has become rather toxic, intolerant of dissenting views and contradictory opinions. They have lost their commitment to transparency.”

So what exactly is it that we and others have proposed to address these problems? First, grant the Veterans Health Administration status as a government-chartered, nonprofit institution that operates without the micromanagement of politicians. Second, turn the V.A.’s network of hospitals and clinics into the nation’s leading accountable care organization, giving it the tools it needs to not merely match, but exceed the patient-centered performance of leading private institutions like the Mayo Clinic and the Cleveland Clinic. Third, offer those veterans who want it the option of private coverage and care. Fourth, devote more V.A. resources toward veteran-specific issues, like P.T.S.D. and traumatic brain injury. According to analysis by a respected economist who advises the Congressional Budget Office, we can enact these reforms without increasing the V.A.’s costs.

Reforming the V.A. in these ways affirms plain common sense. It’s supported by the best research on health reform. Most important, it upholds a fundamental American principle: that those who’ve sacrificed to preserve our freedoms should themselves have the freedom to choose how and where they get their health care.

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Letting Veterans Go to Any Doctor Just Isn’t Feasible or Desirable

Phillip Longman 11:00 PM

What if we created a new entitlement that offered any veteran currently eligible for V.A. care this new deal: Go to any doctor you like for any treatment you like and from now on the V.A. will pay the bill. This effectively is the main Republican proposal for V.A. health care, as is reflected in draft legislation now being considered in the House.

You might think that veterans groups would be eager to win such a rich new entitlement for their members. After all, under this scenario the V.A. would seemingly be turned into the kind of insurance company we would all love to have — one that didn’t collect premiums or deductibles and that didn’t require referrals or co-pays for going “out of network.” Yet as recently as last week, all major veterans organizations went on record as being deeply opposed to this proposal, and for good reasons.

They start with what the cost of such an entitlement would mean for those vets who most depend on V.A. for their health care. According to recent estimates by the Commission on Care, a veterans health care plan that offered enrollees an unconstrained choice of private providers would cause federal spending on veterans health care to at least double by 2019, and maybe triple, over what it would otherwise be.

By 2034, the cost of V.A. health care under this scenario could be as high as $450 billion, compared to a baseline of less than $100 billion. Most of this exploding cost would come from veterans currently covered by private health care plans who would quickly switch to the much more attractive, taxpayer-financed package available from the V.A.

How would Congress pay for this exploding cost? Mainline veterans service organizations like the American Legion and Disabled American Veterans have enough experience in Washington to know that all the new spending would crowd out funding for V.A.’s core mission, which is to serve veterans who have service-related disabilities or who are indigent. Veterans hospitals and clinics would have to close to cover the cost of providing a very generous health care plan to vets who don’t currently use the V.A. and who in most instances don’t need or want the specialized model of care it offers.

Another reason veterans service organizations oppose this proposal is that they know by their own experience that V.A.’s integrated model of care is often superior to that available in the private sector, and especially when it comes to treatment of people suffering the visible and invisible wounds of war. According to a recent RAND study, only 13 percent of private mental health care providers, for example, follow evidence-based protocol for treating the often unique health care needs of those who have served in the military.

Most veterans advocates, including myself, strongly support the V.A.’s making greater use of high-performing health care networks of private providers in areas where the V.A. needs to improve capacity and access. But these networks need to be tightly integrated and coordinated into the V.A.’s existing model of care, both to control cost and, even more important, deliver the quality of care veterans deserve.

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Congress Could Expand Choice and Keep Costs Down

Avik Roy 11:00 PM

It’s never hard to find influential officials in Washington who oppose change and accept unfairness. Fixing Veterans Health Care contains a 20-page analysis of how a bill like Representative McMorris Rodgers’ can improve quality without increasing costs. Congress can expand choice knowing that most veterans — and Americans — want more options.

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