The recent scandals at the Department of Veterans Affairs, from secret waiting lists to the abusive usage of purchase cards, show that the department is out of touch and self-absorbed, focused only on their own processes and incentives at the expense of the veterans’ needs.  

Discussions on how to change the culture at the department have focused on changing the incentives for VA employees and offering veterans a choice in where they get their health care.


The choice that the department faces is simple: Are they going to attract veterans with superior services or are they going to keep the status quo of holding veterans captive in their system? 

The current system doesn’t provide veterans with a real choice—only the illusion of choice—as that option only comes after the default VA-provided care fails. In recent discussions of the future of veterans’ healthcare in the country, a few stakeholders have presented a false dichotomy: Either keep the status quo or privatize the system.  

However, fixing veterans’ healthcare is going to require a blend of care through the VA healthcare system and the private sector. After all, even the Department of Veterans Affairs admits that it needs to reform itself and that it needs help from the private sector in serving our nation’s veterans. 

The current VA health care infrastructure is inadequate to serve our nations’ veterans—something the Department of Veterans Affairs itself has admitted. But even if the VA had no access problems, no wait lists and the scandal had never become part of the national conscience, the department will face pressure to change the way it does business soon, due to current and developing demographic changes in the veterans population:  Projections from the VA show the veteran population will decline in the coming decades, and populations are currently shifting to the growing states in the south and the west.  

Furthermore, there is one considerable change in the state of health care available in the U.S. now versus when the VA began building hospitals: The civilian infrastructure is very developed and more advanced than the VA hospitals in many areas. 

The changing context of the health care market in the country and the composition of the veterans’ population has resulted in the VA admitting that it needed the assistance of the private sector in order to provide health care services for our veterans. This impulse led to the creation of the multiple current programs that allow veterans to seek private sector health care services.  

In this regard, we need to do a better job leveraging the comparative advantages that each of the different providers bring to the delivery of veterans health care. 

To achieve this, we as a nation need to empower our veterans to choose where they would be best served. This will introduce competition into the system and, in turn, force the VA to either focus on the needs of veterans or continue with the status quo.  

The Department of Veterans Affairs faces inevitable changes to the way it operates—even if VA leaders maintain course. It is now up to VA leadership to determine if they will embrace change to become a more accountable organization—or continue on as a dysfunctional and unaccountable bureaucracy.

Selnick, 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 associate dean of VA Learning University. He is the senior Veterans Affairs adviser for Concerned Veterans for America, and was recently appointed to the Congressional Commission on Care, which was established in the 2014 Veterans Access, Choice and Accountability Act, to evaluate veterans’ access to healthcare throughout the VA system.