In Washington, where many federal agencies have become relentlessly politicized, the Congressional Budget Office (CBO) makes a serious effort to provide solid, non-partisan analysis of fiscal issues and government performance. In an era of deepening party divisions, that’s a vital contribution to the policy process. 

A CBO report published December 12 is a case in point. In assessing the question of whether health care for military veterans could be provided at less expense through the Veterans Health Administration (VHA), or through private providers, the CBO was forthright: We just don’t know. 


The CBO report, titled “Comparing the Costs of the Veterans’ Health Care System with Private-Sector Costs,” was requested by Sen. Bernie SandersBernard (Bernie) SandersWarren, Klobuchar call on FTC to curtail use of non-compete clauses RNC says it raised .6 million in February Pollster says 'it's certainly not looking good' for Trump ahead of 2020 MORE (I) of Vermont, who chairs the Senate Veterans Affair Committee and who has opposed the expansion of private competition in veterans’ healthcare. 

If Sanders and his allies were hoping to find research-based ammunition to argue that government-provided care is less expensive than a private option, this report offers them nothing to work with. 

The CBO states plainly that based upon the currently available data and research, there is “limited evidence and substantial uncertainty” about the relative costs of government and private health care for veterans. 

In offering a solid review of available research and data, the CBO admits that while some studies may purport to show lower costs in care provided by the VHA, much of the data needed to make that determination is outdated or simply doesn’t exist. Given the very different circumstances surrounding VHA care and private sector care, it’s difficult to get a clear “apples to apples” cost comparison. 

Moreover, the CBO is careful to separate out the question of costs from the question of quality—that is, just because something is less expensive doesn’t mean that it’s comparable in quality.  

That’s a critical factor to keep in mind as we come to the end of a year in which we saw a massive, nationwide patient scheduling scandal at VHA facilities. While Department of Veterans Affairs (VA) officials falsified schedule reports to make it appear that veterans were receiving timely care, many of those veterans were growing sicker and dying. 

Too often, veterans face interminable waits for basic care. A case in point, just this week, is the story of the Colorado veteran who needed simple eye surgery for his cataracts. He waited a year for the surgery. If the VHA’s supposed cost advantage demands forcing veterans to wait months or years for medical services, it would be a questionable bargain. 

Meanwhile, in other VA clinics around the nation, we’ve seen ample evidence of poor sanitation, overprescribed medications and shoddy care resulting in veterans’ deaths. Many of these facilities may well have been able to claim that they were saving money, but at what costs in veterans’ well-being and lives? 

The CBO notes one barrier to making clear comparisons between the VHA and the private sector: Unlike many government agencies, the VHA doesn’t publish the necessary data.  ”Comparing health care costs in the VHA system and the private sector is difficult partly because the Department of Veterans Affairs (VA), which runs VHA, has provided limited data to the Congress and the public about its costs and operational performance,” the report states. 

If any good is to come from this largely inconclusive report, it would be for Congress to pass legislation to require the VA to publish its data related to cost-effectiveness and efficiency, so that we can see what we’re getting for our investment in the department. 

The Department of Defense does something similar, publishing an annual report for Congress about the TRICARE health system for military personnel. A corresponding annual report from the VA on how the department spends on health care would be a good first step toward better oversight and may set the stage for clearer comparisons between VHA care and the private sector. 

Meanwhile, more data is needed on the question of comparing government costs to those of private providers. That’s one issue that Concerned Veterans for America has identified to study in our bipartisan “Fixing Veterans Health Care Taskforce,” which is currently looking at systemic solutions to the VA health care crisis. 

When Congress passed the Veterans Access, Choice and Accountability Act in July, patient choice provisions were a key component to allow veterans facing long waits, or who lived far from VA facilities, to seek reimbursed care from private providers. Greater competition has led to lower costs and better quality in virtually every other industry, so let’s see what private sector providers can do. 

In the meantime, Congress should continue to provide aggressive oversight to ensure the VA is implementing those patient choice provisions properly. Veterans deserve access to timely, high-quality care—especially if the VA isn’t providing it. 

Selnick is a U.S. Air Force veteran and served as special assistant to the Secretary of Veterans Affairs from 2001-2009. He currently serves as the executive director of the Concerned Veterans for America Fixing Veterans Health Care Task Force.