Veterans Affairs needs reform, not feel-good bills

With the Veterans Affairs scandal growing more outrageous every day, lawmakers have decided that swift and extensive reform is needed to resolve the agency’s problems. Unfortunately, there’s reason to believe that the bills hurtling through Congress will do little to actually improve our veterans' health care system.

Legislation passed in haste to respond to a crisis rarely results in a good outcome for those the policy intends to help. And the House and Senate’s proposed VA reforms will likely do exactly that.

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Proposed legislation would allow for a ‘Veterans Choice Card’ that provides the opportunity to receive treatment in non-VA facilities, assuming certain criteria are met. On the surface, this sounds like a plausible remedy. But it will require a massive new bureaucracy and raises a host of unanswered questions.

Who is actually eligible?  What wait time is too long?  Where would providers actually submit a bill for services?  What new technologies and software will be required to process these claims?  With needs being quite different than the traditional Medicare population, will there be the need to develop entirely new ‘pre-authorization’ and ‘utilization review’ methodologies? 

The VA medication formulary has, on average, 1/3 fewer medications included than the average commercial insurance and Medicare—how will this impact choices for patients if they end up migrating in and out of the VA system for different conditions—specialty vs. primary care, for example?

All of this goes unmentioned in the feel good bills that are receiving overwhelming support from both parties.  Given what we know about the federal government’s ability to implement massive new programs—why should veterans, their families, the provider community, and the American people have any belief that Washington can pull this off in a timely fashion—or even at all?

The Senate bill includes new ‘independent commissions’ on scheduling and ‘capital planning’, as if moving care yet another step away from patients and doctors will somehow result in better, more timely, more personalized care.  What is clear is that ever enlarging bureaucracies will seek, first and foremost, to act in a way to further consolidate and grow their size and power, at the expense of those who they were ‘created’ to help.  If the local facilities are ‘cooking the books’ and whistleblowers are regularly threatened—how possibly can a group of appointees sitting in Washington, requesting the same data that watchdogs in the Obama administration and Congress have failed to act upon, improve care for individual veterans and their families?

Spending billions more, when the VA has not been able to spend their full healthcare budget for the last couple of years, seems the height of Congressional and Obama administration hypocrisy.  Without question, the current group of veterans has an array of needs never before seen in our country’s history. 

The massive advancements in battlefield medicine, means injuries that resulted in near certain death in 2001, now are eminently survivable.  But that survival comes at the cost of huge new acute and long-term healthcare needs.  Empowering new bureaucracies, or handing billions over to private contractors to oversee new bureaucracies, has exactly zero track record of getting the right care, to the right patient, at the right time.

We must remember that it is not the ‘VA’ that is in crisis.  The real crisis is being lived every day by the men and women and their families that have sacrificed so much to defend the concept of liberty at home and abroad.  Those Americans deserve to control their own health care decisions—and not be forced to continue to surrender those rights to politicians, bureaucrats and their patrons in union leadership and big business.

Novack is an orthopedic surgeon in Phoenix, Arizona, and founder and chairman of Operation Enduring Gratitude.

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