The VA Isn’t Broken, Yet

http://www.washingtonmonthly.com/magazine/marchaprilmay_2016/

features/the_va_isnt_broken_yet059847.php

The long arc of the VA’s place in American life shows that the agency has always struggled against ideological enemies and against commercial health care providers who would stand to gain business from its being privatized. The only hope is that Americans will wake up in time to save the VA from those who are trying to kill it…

For example, in 2003 the prestigious New England Journal of Medicine published a study that used eleven measures of quality to compare veterans’ health facilities with fee-for-service Medicare. In all eleven measures, the quality of care in veterans’ facilities proved to be “significantly better” than private-sector health care paid for by Medicare…

In 2007, the prestigious British medical journal BMJ noted that while “long derided as a US example of failed Soviet-style central planning,” the VA “has recently emerged as a widely recognized leader in quality improvement and information technology. At present, the Veterans Health Administration offers more equitable care, of higher quality, at comparable or lower cost than private-sector alternatives.” …

And because the VA is a large, integrated system, it has the ability to coordinate care among specialists, so that patients are treated as whole persons rather than as collections of failing body parts. Though no one used the term at the time, Kizer transformed the VA into what health care policy wonks today describe as an “accountable care organization,” or ACO, in which the well-being of patients and providers are actually aligned…

“I know the veterans who are here are going to be proud to hear that the Veterans Administration is on the leading edge of change,” Bush explained, without showing any evident discomfort with praising the largest actual example of socialized medicine in the United States…

The Bush administration also reversed the liberal eligibility standards that the Clinton administration had established. No longer were all honorably discharged veterans welcomed at VA hospitals; instead, to qualify for care veterans would have to prove that they were either indigent or suffering from a service-related disability. This gave rise to much more time-consuming and bureaucratic processes, as VA employees had to determine, for example, whether a veteran’s Parkinson’s disease was due to exposure to Agent Orange in Vietnam or to some other combination of environmental and genetic factors…

Under Shinseki, the VA also fully integrated mental health professionals and substance abuse specialists into its medical home teams. This practice of treating body and mind together is virtually unknown outside of the VA because insurers, including Medicare and Medicaid managed care organizations, won’t pay for it. But the innovation was crucial in treating the VA’s patient population, 25 percent of whom suffer from chronic mental illness and 16 percent of whom struggle with addiction…

By late 2013, Hegseth and the CVA were making the case that the VA needed “market-based” reform that provided vets with more “choice” to receive care from private doctors and hospitals (though they were careful not to use unpopular words like “vouchers” or “privatize”). They were also signaling their sympathy for another abiding cause of the Koch brothers: crushing the power of unions…

The ultimate fate of the VA will likely be determined in the coming months. The Commission on Care, which has been holding hearings throughout the winter of 2016—hearings that have received no attention in the mainstream press—is scheduled to announce its recommendations in June…

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