Conservatives at least temporarily won a fight last week about how to manage health care for veterans. Unfortunately, that victory does nothing to actually improve veterans’ care. To accomplish that goal, Senator Tom Coburn (R., Okla.) has some ideas that merit consideration.
So do I.
First, as to last week’s fight: Senate Veterans Affairs Committee chairman Bernie Sanders (he calls himself a socialist, but technically he’s the independent senator from Vermont) was pushing a VA-reauthorization bill that, most controversially, would have vastly expanded the number of veterans eligible for VA health care. It sounded oh-so-wonderful. Who can argue, after all, with more benefits for veterans?
Adding eligibility for high-income vets and non-disabled vets (among others) would cause the total load on the VA health system to jump (according to the Concerned Veterans of America) from 6 million beneficiaries to upwards of 20 million. The problem, as Coburn and others noted, wasn’t just the cost. In addition to busting the budget by at least $21 billion (by Sanders’s estimate; Coburn says it would be more like $60 billion), the expansion would further strain a system that already can’t handle the patients it tries to treat.
“[The] system today can’t keep up,” Coburn said in floor debate last week.
We have 600,000 people waiting for a disability determination. . . . It’s shameful that Congress now is trying to claim credit for providing new benefits while our old promises are forgotten. And our heroes — our heroes — are literally dying at the hands of malpractice, incompetency, and delay. . . . Veterans seeking mental-health treatment still experience weeks-long delays scheduling appointments. The epidemic of overprescription of opiates — let me say that again — there is an epidemic of overprescription of opiates for those people who served our country, making them dependent addicts because we give them the wrong treatments. There’s avoidable veterans’ deaths at the VA. In a recent story by CNN on misdiagnosis and improper care — just gastrointestinal conditions — there were two-year consultation delays. Two years? To get in to see a specialist at the VA. When you’re losing blood? How do we explain that? Who’s accountable?
Coburn says we should focus on improving care for those eligible now, before we expand the provision of substandard care to millions of others. He’s right, and his argument won the day. Sanders’s bill fell four votes short of the 60 it needed to overcome existing budget caps.
The senator-physician isn’t merely content with defeating a bad idea, however. He wants to improve the current system. Toward that end, he was pushing, and will continue to push via other legislative vehicles, a series of amendments and changes in congressional oversight of the VA. One would require each VA facility to publish data on its mortality rates, mental-health outcomes, emergency-room wait times, and other measures of quality of care. Another would prohibit vast expansion of programs until the VA can meet reasonable standards of care for existing programs.
Then, for the two most important proposals from Coburn, please allow a personal digression, which is important not because of my involvement but because of the public reaction to it. I ran for Congress last year in a special election down here in coastal Alabama. (Alas, I finished fourth of nine candidates.) This is an area full of veterans, and of patriotic supporters thereof. I thus found myself speaking often of my very first job out of college, as a Reagan-administration appointee to the VA, in public affairs. I spoke of what I saw at the VA 27 years ago that was good, and what was bad, and of what lessons I thought were still applicable nearly a full generation after my experiences.
And I’d wrap up the discussion, whether in speeches or candidate forums or even a diner, with a proposal I’d been mulling for years, ever since my brief employment at the VA, an idea I’d never had any opportunity to pursue. Why not, I asked, give VA patients the same ability to find their own doctors that Medicare patients have, or that military Tricare enrollees have? If a senior citizen can carry a government-issued card and use it for service with any participating doctor or hospital, why can’t a VA patient? Why must a VA patient get care only from a VA treatment facility, even if the nearest such facility is more than 100 miles away?
Wouldn’t it mean better care, and probably less expensive care, if a qualified veteran far from a VA clinic could receive treatment right in his hometown? Let the care follow the veteran to his own doctor, rather than monopolizing it in institutions that might include some wonderful health-care professionals but are overly bureaucratized and stretched way too thin?
Inevitably — and I do mean every single time I brought this up — I was met with enthusiastic applause (or, if in smaller groups, energetic nods of approval). The idea isn’t brilliant; it’s just basic common sense.
In that light, I was thrilled last week when I began to focus on Sanders’s VA bill and found that Coburn is pushing exactly this idea. One of his proposals would create a pilot program for veterans suffering the longest wait times to gain access to non-VA providers. The second proposal would more broadly allow vets to “seek care nearer to their homes — and with providers they trust.”
These two proposals really should transcend ideology. There’s no good reason why liberals, any more than conservatives, should object to letting the portability of Medicare be a model for veterans as well.
The VA does some things, including specialized services such as prosthetic technology, very well. A lot of its employees care deeply about the ex-military personnel they serve. But where the VA fails, it sometimes fails miserably. Public policy should provide every means possible for veterans to escape such failing care.
— Quin Hillyer is a contributing editor for National Review. He can be followed on Twitter at @QuinHillyer.