The Senate passed a bill yesterday to reform the Veterans Health Administration: It would fund the opening of new hospitals and the hiring of new doctors, offer more ways to keep VA bureaucrats accountable, do some other random grab-bag spending (in-state tuition for vets!), and, lastly, expand coverage for vets to get care outside the VA when necessary.
Congress could reasonably expect that the bill they were voting on would be very expensive, but they didn’t know just how expensive until . . . the Senate was basically already voting on the bill. Yesterday, the Congressional Budget Office announced that it believes the bill will cost $35 billion over three years, ramping up to as much as $50 billion a year if its programs are made permanent. As, of course, they will be, meaning that this is an absolutely gigantic expansion of the VA. The Committee for a Responsible Federal Budget points out that over ten years of full implementation, the VA expansion, by the CBO’s numbers, could be even bigger than the system’s current budget:
Now, as the CBO noted, their score of the VA bill is highly uncertain. All budget projections are unreliable, of course. And this one is especially so: The CBO admits they have little idea how vets will respond to the policy changes (one of the big increases in costs, they predict, will come from vets getting care at VA hospitals for which they used to go elsewhere because of supply constraints and wait times). The score is also just of the “give vets more access to non-VA care” portion of the bill, not its other spending — though that’s less of a problem since the Republican House should plan to strip out basically everything except for that.
But the fact that this gigantic price tag was delivered around 4 p.m. yesterday, when the Senate voted around 4:30, is reason enough to slow down and reconsider just what they’re about to pass. Only three senators agreed, unfortunately, all Republicans: Bob Corker of Tennessee, Ron Johnson of Wisconsin, and Jeff Sessions of Alabama.
They deserve great credit for questioning the wisdom of passing what could become a gigantic new entitlement — that wasn’t paid for in any way, because it was passed as an “emergency” budgetary measure. The VA scandals demand an immediate response, of course, but the Senate bill isn’t necessary to execute it: President Obama has already ordered that the VA expand the coverage it offers outside the system for vets waiting for care. No program like this should be passed as an emergency measure. Fixing the VA’s problems, such as they are, may require lots and lots of money — and maybe the Senate wasn’t voting to spend quite as much money as the CBO just said. But any congressman with any respect whatsoever for the concept of fiscal responsibility — not deficit hawks, just anyone concerned with how much we spend and on what — should want Congress to take time to study this issue (as, indeed, the House is planning to).
Yet Corker, Johnson, and Sessions are getting blasted anyway by the traditional vets’ groups, who have never met a VA spending or expansion bill they didn’t like. The VFW:
As encouraging as the pending legislation is came [sic] three no votes from Republican Sens. Bob Corker (Tenn.), Ron Johnson (Wis.) and Jeff Sessions (Ala.), because they put dollars and cents above the interests of the nation’s veterans.
“There is a cost of going to war that includes taking care of those who come home wounded, ill and injured, and if these three senators have determined that we can’t afford to properly care for our veterans, then they should seek employment elsewhere!” exclaimed VFW National Commander William A. Thien.
“This is a national crisis that must be fixed, period,” he said. “This is about saving lives, restoring faith, and honoring a nations’ commitment to her veterans, and the VFW fully expects every member of Congress to support the final bill, because I can guarantee you that the price veterans paid in their own blood far exceeds any price tag some members of Congress want to proclaim is too high.
This kind of outrage, for one, ignores the senators opposing the bill weren’t even necessarily proclaiming the price to be too high — they were primarily objecting that it was irresponsible to pass it quickly and without paying for it. Of course, the price might in fact be too high: The sacrifices vets have made are incalculable but the benefits we provide to them aren’t, and shouldn’t be, unlimited. They deserve the care they’re promised, but the price at which that comes isn’t irrelevant. Almost every member of Congress, bowing to the political pressure on this issue, is basically pretending it is.
The VFW expressed hope that the House and Senate will go to conference on the bills they’ve passed, iron out the differences, and send the legislation to the president’s desk immediately. This isn’t good policy, but it’s par for the course with the VA, as Yuval has explained: Groups that represent vets, like almost any special-interest group, can be quite well-intentioned but can’t reliably distinguish between their institutional interests and the actual best interests of the people they’re supposed to represent.
Representative Jeff Miller (R., Fla.), chairman of the un-glamorous Veterans Affairs Committee, has suggested he’s not going to bow to vets’ groups – the House will, at the very least, find a way to pay for the provisions they want to pass. In doing so, as NR’s editors recommend today, they should strip out a lot of the unnecessary spending in the Senate bill, do further study on whether this is going to encourage vets to get more care from the VA, and focus solely on fixing the system, not expanding it. (Indeed, if we want the system to work well, there’s actually a case for curtailing eligibility so that vets get the very best care for their service-related injuries. Democrats, the VFW, etc. consistently want to expand eligibility.)