Let's Honor Veterans With Better Access to Healthcare

It has been over 6 months since we learned about the secret waiting list forcing thousands of veterans to wait months for their doctor's appointments at the Phoenix Veterans Affairs health system. Since then, there has been a management shakeup at the VA and Congress enacted a $17 billion initiative to help reduce the backlog. The good news: waiting times seem to be down. The bad news: there is nothing to prevent delays and rationing from returning once public attention shifts elsewhere.

The VA has long had trouble providing veterans with adequate access to care, going as far back as World War II. Improper scheduling procedures are also nothing new. Reports from the VA Inspector General and other senior officials over the past decade have repeatedly criticized the VA for failing to ensure that medical appointments are made and patients are seen as promised.

An internal audit released on June 9 was particularly damning. It found that 57,000 veterans have been waiting more than 90 days for an appointment and that an additional 64,000 requested medical care but never made it onto VA waiting lists. In addition, 13 percent of VA schedulers had been told to falsify the date that veterans requested for an appointment, and 8 percent used a secret waiting list instead of the official appointment system.

The consequences of keeping two sets of appointment books can be fatal. The IG's August report found 28 patients whose treatment was delayed with potentially serious consequences, and 6 of them were deceased. In addition, 17 patients had substandard care, and 14 of those patients were deceased.

Inspector General Richard Griffin has been criticized for failing to conclude that delays at the Phoenix VA Health Care System caused patients to die. While it is true that many factors may contribute to a patient's death, the coincidence seen here is disturbing. Mr. Griffin's report provides convincing evidence that the VA health system is broken, and veterans are suffering because of it.

The spate of negative publicity spurred the VA to action. Former VA Secretary Eric Shinseki established the Accelerating Access to Care initiative in late May, which focused attention system-wide on management failures and took steps to improve access to services. Wait times fell from 51 days in May to 42 days by the beginning of October.

Congress also took action. The Veterans Access, Choice, and Accountability Act (VACA) provides $10 billion over 3 years for the Veterans Choice program, which pays for services veterans receive outside the VA system. The Act also provides $5 billion to hire more doctors and nurses, and an additional $1.5 billion to lease additional medical facilities.

VACA responded to an acute failure of the VA health system, but it stays well within the boundaries of VA's traditional approach to delivering care. The Veterans Choice program expands on long-standing policy to provide care through outside providers when the VA cannot provide necessary services at its own facilities. In recent years, about 10 percent of the VA's health budget covered the cost of non-VA care. In fiscal year 2013, over 1 million veterans received care outside the VA system at a cost of $4.8 billion.

Additional funds will help veterans gain better access to services from mainstream providers, but they will have to return to the VA health system after their immediate need is met. Ping ponging patients between providers employed by the VA and those in private practice means less coordination, more waste, and greater risk of medical errors.

Former Proctor & Gamble executive Robert McDonald, who was appointed VA Secretary 3 months ago, is attempting to shore up the current system-not surprising, given the political pressure to show that the administration is doing something. But that does not lead to longer-term reforms needed to address structural defects in the way veterans receive their care.

The reorganization announced in time for Veterans Day creates a new VA-wide customer service organization headed by a Chief Customer Service Officer who will report directly to Mr. McDonald. It remains to be seen whether this will improve service for veterans or only adds another bureaucratic layer to a top-heavy department.

Issuing new identification cards as required under VACA's Veterans Choice program is another tangible sign of action. Some veterans will be able to receive care from non-VA doctors and hospitals through this program. But that is not automatic and veterans seeking to exercise this option will continue to require agency approval.

Similarly, if recruitment efforts are successful, more doctors will help ease the workload. But increasing the medical staff does not change the culture of the agency.
None of these efforts can guarantee that the health benefits promised to veterans can be delivered without returning to long waiting lists and compromised quality. What veterans need is a real choice, not one dictated by the VA.

The fact is that most veterans can and should be fully integrated into mainstream health care. The private health sector can deal with most of the health needs of former soldiers since their ailments are shared by millions of other aging Americans. The VA should focus its resources on specialized services, including treatment for combat trauma and rehabilitation that is unique to veterans.

The mystique of a separate veterans-only health care system is a mistake. The VA health system is not meeting the needs of veterans. We can do better, but only if we give veterans the financial means and the responsibility to select their own health plan.