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True choice empowers veterans to make their decisions on healthcare

In recent hearings discussing the Department of Veterans Affairs budget for fiscal year 2016, VA Secretary Robert McDonald asked for the authority to repurpose the money that is allocated to the Veterans Choice Program. His main argument – that the program has been underutilized.  

This is likely true, but only because the program offers no true choice to veterans. The way the program is currently structured leaves veterans helplessly dependent on the VA to authorize their ability to exercise choice. It simply doesn’t work as intended – and veterans suffer as a result.

{mosads}It’s time to change that. The Veterans Independence Act, developed by Concerned Veterans for America’s Fixing Veterans Health Care Taskforce, flips that concept on its head and puts veterans in charge of making their own health care choices.

When we were gathering the initial data to lay the groundwork for our taskforce, we saw something undeniable: The VA bureaucracy decides which health care services veterans should have access to. From then on, we structured the Veterans Independence Act to put the veteran, not the bureaucrat, at the center of their health care decisions.

This is why in the Veterans Independence Act we proposed a system of premium support through which eligible veterans would be able to purchase any private health care insurance plan available in their state, including one provided by the Department of Veterans Affairs. This very simple concept completely changes the incentive structure and the decision-making process with veterans’ health care. It empowers the veteran and means that they would not have to wait for a VA bureaucrat to authorize their choice. In this system, the veteran is the most important person in the process of deciding their own health care.

This simple but important change is just the first step in the long road to making the veteran the center of veterans’ healthcare.

Under the current system, the VA grants veterans the ability to choose health care outside the VA medical system only if the VA is unable to provide efficient health care to the veteran, which is defined as being too far away—40 miles—or inability to offer appointments in a timely manner—30 days.  But because this would require the VA to acknowledge its inefficiencies, veterans are rarely granted that choice.  Admitting failure or its own limitations has never been the strong suit of any bureaucracy, even one that is plagued by scandals. This adds to the importance of moving the decision away from the bureaucracy and empowering the individual veteran.

A second extremely important element of the Veterans Independence Act is the separation of the payor and the provider functions at the Department of Veterans Affairs.  In the current setup, there’s an obvious incentive for the Department of Veterans Affairs to funnel people (and the funding along with them) toward VA facilities. However, by splitting the payor and provider functions into two separate institutions, the payor institution would become neutral towards where the veteran gets care, reinforcing the concept that the veteran, rather than a VA bureaucrat, is responsible for making the decision of where their health care funding dollars go.

Furthermore, under our proposal, the provider portion of the VA, or the actual brick and mortar hospitals, would have to be more responsive to two important interests: the veteran and the health insurance plans. This would drive competition, thus improving health care quality since VA hospitals would actually have to work to earn veterans as patients.

Ultimately, through the work of our Taskforce, we heard from over 1,400 veterans, VA employees, and health care experts. The provisions in the Veterans Independence Act are in tune with their uniform desires to offer veterans choice, and efficient, effective health care. This can only happen by putting veterans at the center of their health care, which is exactly what the Veterans Independence Act does.

Selnick is a veteran of the United States Air Force, was an appointee for the Bush administration at the Department of Veterans Affairs from 2001-2009 as special assistant to the Secretary, and is the senior veterans affairs adviser for Concerned Veterans for America.


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