Privatize the VA?
by Elana Duffy
Whenever I talk about struggles with the VA medical centers, there are two responses I get.
“Oh that is such a shame. We really need to do better for the veterans.”
“Why don’t you just get private insurance?”
There’s been a lot of talk lately about privatizing the U.S. Department of Veterans Affairs, most recently with the elections and cabinet selection. And while the debate rages around me, I tend to respond to these comments with the same exasperated resignation because neither of these seem productive to me in the world of the New York Harbor VA medical system. Yes, it is a shame when we don’t receive care we are promised from our government. Yes, VA could stand a world of improvement.
But the answer is not to outsource or privatize VA care (including my own private care). At least this should not be the long-term answer, and it definitely should not be a government answer. The VA system, from education to burials to healthcare, should work and it is possible to make it so. There will be interim periods in making it work, steps to improvement that may not be perfect. But a complete healthcare solution for service-connected injuries is what we deserve and what we deserve to expect from our government.
Of course, it’s no secret that VA has encountered growing pains and are slow to counter the challenges. According to the National Center for Veteran Analysis and Statistics, the number of patients requiring VA medical care increased exponentially with the onset of two combat theaters. This overloaded a system designed for visible wounds and general hospital care that could not quickly adjust after decades of caring for a steadily aging, consistent population. Once you add on everything else VA is responsible for, such as the upgraded GI Bill and Vocational Rehabilitation, increasing needs for burial and legal benefits, and updates to federal regulations and you have a rightful mess. This problem started by failing to project for substantial growth, and then compounded over many administrations. So yes, it’s hard and the generals and others placed in charge could not overcome the deficits. But to give in would be like getting beaten back several times from an objective and saying, “Oh this is hard. Forget it; let’s just ask the Kiwis to come take the hill for us.”
But if we give up the hill to the Kiwis – or VA healthcare to the private sector – we are denying a problem that will only become bigger, more expensive, and in the long run harder to fight.
I see both the problems and the attempts at solutions all the time, particularly in my primary care facility in Manhattan. Many large VA hospitals, including mine, are teaching hospitals where patients see new residents every year despite having complex challenges. Yes, I audibly sigh when meeting my fourth neurologist in as many years and having to again start with “So back in 2005 there was this roadside bomb…” But residents save money, and some are very adept at finding new solutions to old problems as they have access to current research. And I would rather have three residents and only sit in the waiting room an hour than one doctor and wait three hours.
So there are solutions. Are there improvements within those solutions, such as finding a way to overlap residents for some continuity or having a neurology clinic more than once a week? Certainly, but they are there.
Ask most veterans who use VA regularly, in fact, and each can probably give at least one solution on cutting waste. For instance, I recently went for a re-evaluation when I needed something updated with compensation and pension. I had an appointment with a doctor I’ve never seen, updating them on symptoms I just saw a doctor for a week prior. Why didn’t my regular neurologist just fill out the form during the last visit? They know my history and symptoms, so why rotate another doctor into compensation and pension for appeals and re-evaluations? There are hundreds if not thousands of questions like this every day across the country.
Then there are technology solutions, like scheduling and reminders on automated systems and better integration of websites to consolidate resources. There are personnel solutions, such as a 360-degree evaluation system with defined cut-offs for low performers. There are hospital and university partnerships that could lead to not only better qualified doctors and increased access to care, but significant cost savings.
And each of these solutions, when implemented through the federal system for which we all fought, can combined bring about innovation specific to caring for military veterans. We already see this with brain injury research and prosthetics, MRI technology and more. We would leave all of this on the table when we abandon the hard road of fixing our system in favor of what appears to be the easier path.
What we need is not a dismemberment of the system. We need to pay doctors what they are worth, cut dead weight, diversify our methods, and keep finding innovative solutions. We don’t need privatization or leaders who tell us it’s a shame. We need caring, competent individuals (military or not) with experience in multi-dimensional health and extended care systems who can build an administrative body worth continuing to fight for. No more talk of kicking the can down the road or leaving the hill for the next fighter. It’s time to do this right.
Photo credit: Benjamin Chasteen/Epoch Times