Replace the Veterans Health Administration with Veterans Insurance

By Joanne Suder

About a year ago, the scandal surrounding the deaths of veterans waiting for care from the Veterans Health Administration finally publicly exposed the VA‘s ineptitude. Since then, Congress conducted inquiries, the FBI commenced investigations, the secretary for Veterans Affairs resigned, and some regional directors were fired. Nearly anyone with any modicum of power in Washington, D.C., vowed to fix the VA, yet, as The Baltimore Sun reported Friday, thousands of former service members still face treatment delays.

The problem is this: The VA is simply too large and too bureaucratic for reforms to have any real effect. It’s time to abolish the VA.

When Congress established veterans hospitals in 1917, the scheme made sense. After World War I, a massive influx of soldiers returned to the United States, and many had suffered injuries necessitating continuing medical care. Furthermore, as health insurance was in its infancy, most people paid for care out of pocket. To compound matters, many people had difficulty accessing medical care, especially in rural areas, and specialized care for individuals with disabilities was virtually nonexistent. Thus, government-operated medical facilities and disability programs made perfect sense — in 1917.

This system kept expanding. World War II brought in another massive influx of new patients into the VA. Congress also gave the VA new responsibilities, including research and military cemetery administration. Each subsequent conflict added yet more veterans eligible for services. Moreover, although the VA was originally intended to treat veterans with service-related disabilities, the system began providing primary care to veterans with no service disability and family members. In short order, the VA became the country’s largest medical services provider.

Some government publications claim that the VA provides some of the most cost-effective, efficient care of any U.S. provider. Some of that cost effectiveness derives from statutory price controls on prescription drugs, damages caps on lawsuits against the federal government and Congress-dictated funding.

But that cost effectiveness has its own cost. Support staff for the VA earn from $20,000 to $165,000 a year less than their private-sector counterparts. A cardiac surgeon who earns $99,000 to $385,000 a year at the VA could earn $421,000 to $556,000 in the private sector. With such wage disparity, it’s not surprising the VA acknowledges its staffing deficits — it needs 10,000 more support staff and 1,500 more physicians. Moreover, the VA suffers from a shortage of facilities. In recognition of this, a 2014 overhaul of the VA called for opening 27 new clinics.

The most recent VA debacle underscores the system’s complicated, unmanageable structure — one that hinders efficient operation, as well as supervision and accountability. Thus, it’s not surprising that veterans have died due to the VA’s poor care quality.

Numerous attempts have been made to resolve the VA’s quality problems. The VA’s budget is probably not an issue, given that it’s grown threefold, from $49 billion in 2001 to $154 billion in 2014. In the late 1980s, the VA was restructured and elevated to a cabinet-level department to ensure visibility. Indeed, some reform is proposed every few years, but systemic problems persist.

Given decades of failure, it is time to abolish the VA and create a better solution. Fortunately, other solutions have existed and worked reasonably well. Medicare and Medicaid function as insurers, as opposed to direct providers, thus giving beneficiaries access to the same providers who serve many Americans.

The government should give eligible veterans insurance-like benefits, enabling veterans to choose their providers and have the government pay. Veterans would not face long appointment wait times or be relegated to substandard care. Further, veterans could seek convenient services rather than driving long distances. In many respects, this system would be familiar to many veterans — the GI Bill’s education benefits allow veterans to choose the school, and the government pays tuition.

Moreover, an insurance scheme recently was created to address the VA’s lack of facilities and distances veterans must travel. In 2014, the Choice Card program was launched, permitting veterans who live more than 40 miles from a VA clinic to use private medical care. It’s time for such a program to be the standard, not an exception.

Implementing such a model would be radical and enormously challenging. However, history has shown that VA reforms are ineffective. Replacing the VA with a single-payer model, proven effective with Medicare and Medicaid, is in our veterans’ best interest.

Joanne Suder is chief attorney at the Suder Law Firm, PA, which concentrates in medical malpractice, personal injury and plaintiff’s sexual abuse cases; her email is joanne@suderlaw.com.