VA healthcare system can learn from the ObamaCare repeal and replace debates
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If you love something, let it go. If what you love is your healthcare, simply leave it to the whim of Congress to make that happen for you.

So seems to be the debate surrounding healthcare these days. We seem to want coverage and choices that we can’t have, until we are presented with them, at which time we long for what was. With regard to ObamaCare, since its passage in 2010, more Americans have held an unfavorable view of the law than a favorable one.

That is, of course, until the Trump Administration and Congress got serious about repealing and replacing the law, at which time public opinion began to change.


Similar debates have taken place over the last three years with regard to reforming the VA healthcare system. While veterans service organizations have consistently stated their defense of the VA healthcare system, various proposals to privatize the system have been floated since the uncovering of the 2014 wait time scandal, in which 40 veterans died awaiting VA care.

Veterans advocates who want to preserve the current VA healthcare system can learn a lot from the ObamaCare repeal and replace debates. To this end, vigorous defense of a current system is not always the best tactic toward ensuring its preservation. To the contrary, studies have shown that public opinion tends to react against prevailing government policies.

And, more specifically, although such reactions in public opinion tend to place one party or the other in the White House, that same public opinion tends to ultimately shift against that party, creating a confusing trail of policymaking that zigzags back and forth, without ever seeming to accomplish the objectives of either side.

As outlined in the book The Macro Polity, “the most liberal presidency (Johnson’s full term ending in 1968) is associated with the greatest public reaction in the conservative direction. Similarly, the conservative presidencies of the Reagan and Eisenhower moved the public in a liberal direction.”

The Macro Polity was published in 2002, but the election of President Trump in 2016 after eight years of a liberal Obama Presidency certainly seems to verify this hypothesis, as Trump ran on the most conservative platform Republicans had seen in decades.

Applying this theory to VA healthcare, logic dictates that, as long as the prevailing government policy is preservation of the VA healthcare system, as was the official position of the Obama administration, public opinion will continue to move towards privatization, a position traditionally viewed more favorably by Republicans, including President Trump.

Of course, the inverse of this statement is also true, i.e., if given the fact that Republicans control the White House, the House, and the Senate, the prevailing government policy moves toward privatization, public opinion will most likely shift more in favor of maintaining the current VA healthcare system.

Thus, as VA talks about expanding its Choice Program and the Trump administration continues to circulate ideas around greater privatization of the Department, veterans service organizations could benefit from working quietly behind the scenes as public opinion starts to move towards their side of the debate.

Of course, although having public opinion on your side of an issue is helpful, opposition tactics alone do not win policy debates nor do they ensure a lasting and effective healthcare system for veterans or the American people.

Similar to Republicans in Congress, there are concerns that those in favor of the current VA healthcare system do not have an effective plan for truly improving access to care. As Congressional Republicans are learning the hard way, once public opinion is on your side, it is imperative to have a concrete plan of action to help it stay there, rather than appearing unprepared and thus allowing the pendulum of public opinion swing right back to where it started before the debate began.

Indeed, despite eight years of railing against ObamaCare, the American Health Care Act has been criticized as evidence that Republicans “are deliberately deceiving the American people or [showing] that they have no idea how insurance markets work.”

Similarly, if public opinion ends up rejecting plans to privatize VA, advocates should be prepared to discuss more substantive ways to improve the current behemoth bureaucracy that go beyond the typical complaints that VA is understaffed and underfunded.

Depending on how you crunch the numbers, VA’s budget has increased between 67 to 85 percent over the past eight years, and VA’s own data shows no logical pattern for its hiring of 12,000 medical staff under the 2014 Choice Act. Despite these surges in staffing and funding, the Department is still generally regarded as underperforming.

In recent testimony before the House Committee on Veterans’ Affairs, VA’s Office of the Inspector General substantiated problems with both authorizing and scheduling appointments. In other words, saying you are going to fix the VA healthcare system with more people and more money is the equivalent of saying that you are going to repeal and replace Obamacare without a plan for how to do so.

One need not venture much farther than their nearest Congressional Town Hall to know how well this plays out.

Although the fate of the American Health Care Act and any legislation regarding VA healthcare remain to be seen, it is clear that large ideological shifts in controversial policies are temporary, but the need for sustainable healthcare for veterans and the American public are permanent. Public opinion may sway, but, ultimately working to reintroduce elements of compromise to the system that are less prone to such swings in public opinion would be good for our health.

Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation’s veterans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans’ Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs.

The views of contributors are their own and are not the views of The Hill.