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The VA health system: Best in class and under fire

Written by Diane Archer

Some might say with good reason that the Veterans’ Health Administration or the “VA” health system is best in class–indeed, Phillip Longman, senior editor at the Washington Monthly, has written extensively about the VA, calling it “The best care anywhere.” The VA offers a national health care system with the government owning most of its care facilities and employing its 311,000 doctors and other staff. What makes the VA system so good and why is it under fire?

The VA system is the largest health care system in the U.S., covering 6.7 million veterans through a network of about 150 hospitals and more than 800 outpatient clinics. Different veterans are eligible for different levels of coverage, with veterans who were engaged in combat eligible to get the highest level of coverage. The VA does not charge a premium for coverage, but depending upon the nature of their service and injuries, veterans may pay copays. Copays tend to be low for veterans who sustained serious injuries while on active duty and are unable to find employment. Copays can be quite high for other veterans.

The VA has been praised as a model for delivery of integrated care for people with complex and costly conditions. Doctors employed by the VA can rely on an electronic medical record system that allows them to coordinate care; they use data to drive good health care outcomes. Not surprisingly, the VA gets high marks on quality relative to the private sector. And, its doctors have the expertise needed to treat a population of people with very serious conditions.  Just one example of the V.A.’s expertise–a 2005 fall-prevention program has led to many fewer veterans falling and getting a hip fracture. By contrast, most hospitals don’t provide guidance to discharged patients who were hospitalized for a hip fracture resulting from a fall, let alone collect follow-up data.

But, at the same time, the VA, like all health care systems in the U.S., is experiencing a doctor shortage. It has too few doctors and other providers to treat the growing pool of veterans, including both aging Vietnam War veterans and younger Iraq and Afghanistan veterans–and wait times to see primary care doctors are excessive. A 2014 report by the VA Office of the Inspector General documents the issues.  And, an April 2016 GAO report finds that wait times for primary and specialty care continue to be a serious concern and that the VA appointment scheduling policy needs upgrading.

To address long waits for care, just a few weeks ago, a bi-partisan Congressional Commission has made a series of recommendations. Not surprisingly, the conservatives on the Commission, along with outsiders like the Koch brothers and Donald Trump, would like to privatize the VA over the next two decades. Veterans are strongly opposed.

The Commission made many recommendations around infrastructure. Its biggest recommendation was to establish a new VHA Care System, expanding the pool of doctors and hospitals treating veterans with additional health care providers, from both government and the private sector. However, back in 2014 to address the long waits for care, Congress passed the Choice Act, which allowed veterans coverage for care from private doctors in certain situations. While this may sound good in theory, it did not work in practice. Indeed, wait times increased.

For sure, more doctors and hospitals are needed to treat veterans. But, why would relying on the private sector be a solution now, when it did not work back in 2014? We all experience long wait times to see doctors. Moreover, most primary care doctors outside the VA are not trained to treat war veterans And, commercial care brings with it large out-of-pocket costs. As Philip Longman says, “Offering unlimited, unmanaged choice of doctors and treatments would not only lead to dangerously fragmented care, it would also cost so much that in the real world, it would be a political non-starter and thus limit choice.”

There are other ways to reduce wait times for treatment. Some propose that the VA allow nurses with special expertise to practice without supervision from doctors, which is already permitted in 20 states. Or, as Longman proposes, in places where it lacks capacity, the VA could identify and contract with skilled outside doctors in an integrated fashion that allowed these providers to use the same electronic medical system as the VA doctors.

Longman sees the VA as our opportunity to move the U.S. towards a better, more cost-effective health care system. In his words, “The VA model of care, with its emphasis on integration, prevention, and evidence-based, cost-effective care, is also in the forefront of where the rest of the U.S. health care needs to go. If we lose the VA, the cause of real healthcare delivery system reform will be set back by at least another generation, with incalculably dire consequences health and finances of the American population.” Of course, moving towards a VA system for all threatens Aetna, Blue Cross and UnitedHealthcare among other big stakeholders in our health care system. And, that’s precisely why the VA system is at risk.

Here’s more from Just Care:

 

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2 Comments

  • The V.A. is a good system but if people cannot access it then it is not fulfilling its job. If we go to a single payer system we need to make sure that there are clinics or hospitals everywhere that we can access without having to wait months for an appointment. Otherwise I’m all for it.

  • The V.A. Health System is GREAT! We have been very happy with the care & expertise of many of the Doctors & staff that we have had. Our problem is the “Lousy” Means Test that we must provide every year that is not always accepted, the Government is really quick to take money due from our Social Security check even when the checks are not always made. When it is finally corrected, we do not get any of the overpayments back. And, the Eligibility Centers do not respond in a timely manner to help us get thru the system that it has not recorded our MANY responses. Also, for Vietnam Veterans — that were NOT on the ground in Vietnam have NO chance to get a pension. Even if you flew over Vietnam in a Cargo C130 to drop leaflets off in the right conditions, you cannot be compensated. When the chute of the C130 is opened, you would be most definitely in contact of Agent Orange or other chemicals that were used in the Vietnam Area. All combat vehicles that were blown up & destroyed were brought back to Okinawa to be stored. Wouldn’t all of the contaminants come along with all of the combat vehicles also? Why does no one seem to care about a Veteran during that era with constant health problems that keep escalating be continuously turned down for compensation? These Veterans were DRAFTED, they did not Enlist. They did their job & this is how they end up with constant harrassment & never-ending paperwork that DOES NO GOOD! These Veterans ALSO need help desperately!!! We MUST do better for Vietnam & ALL Veterans!!!

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