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‘Medicare for All’ threatens veterans health care


For years, efforts to provide veterans more health care outside the Department of Veterans Affairs have been described by critics as a plot to dismantle the VA medical system. While the recent improvements in delivery of veterans’ health care have proven those claims false, a real threat has emerged to care for veterans and military families.

“Medicare for All” proposals in Congress would establish a single-payer health care system run by the government. They would prohibit the sale of private health plans while ending employer-sponsored insurance coverage and private and public sector retiree health plans.

Although Medicare for All would leave the government-run portion of the VA system intact, it would eliminate the Department of Defense’s TRICARE program, a network of private providers and military hospitals that provide health care for 9.4 million U.S military personnel, retirees, their families and some members of the reserves.

Through TRICARE, service members and retirees have 11 plans to choose from, allowing them to tailor their coverage to their unique needs. The dismantling of TRICARE would almost certainly hurt military morale, retention and recruitment.

So even if the VA system remained in place, Medicare for All would still threaten the millions of veterans who have access to both the VA and TRICARE. Those who choose the latter, or a combination of both, would have fewer – or no — options under Medicare for All.

Worst of all, Medicare for All would undo the progress that has been made improving veterans’ health care — especially in regard to increased access outside the VA.

Although many supporters of “Medicare for All” cite the VA as a model government-run health care system, it has actually been moving toward a more free-market model.

The VA has long relied on community providers to supplement the care it provides. However, since the 2014 wait list scandal, the VA has increased its use of outside health care by over 50 percent, helping reduce wait times and improve access to care. Today, about one-third of all appointments for veterans enrolled in the VA happen outside the VA system through community care.

The recently launched Veterans Community Care Program created by the VA MISSION Act expanded access to care in the community for more veterans and created a network of local urgent-care providers that eligible veterans can visit without the burden of obtaining prior authorization from the VA bureaucracy.

Medicare for All would subvert these reforms by shrinking or eliminating community provider networks and restricting choices for veterans. It also would ignore the lessons learned from the VA over the past five years — that more choice, access and competition improve veterans’ health care by focusing on the needs of the veteran, not the bureaucracy.

How might the future look for veterans and active-duty military families under a Medicare-for-All system?

We have examples from other countries and they’re not promising.

In Canada, military veterans use their government-run health system, which ranked last among 11 Organization for Economic Co-operation and Development countries in how quickly patients get to see their family physician. In Great Britain, all veterans have to use the National Health Service and are entitled to priority access only for service-related conditions, but civilian clinical needs come first.

The United States should not go down this route. Instead, we should build on the reforms and policies that have increased health care choice and access for veterans. This will ensure VA health care will continue to improve while offering greater access to the care veterans need, when and where they need it — whether through the VA or in their own communities.

Veterans, more than most Americans, have experienced firsthand the perils of government-run health care through past deadly VA scandals.

For those who want to push a similar system on all Americans, our veterans’ experiences should offer a cautionary tale: Medicare for All ignores the lessons of the past and threatens not only the future of veterans’ health care, but care for all Americans.

Darin Selnick is the former veteran affairs adviser on the White House Domestic Policy Council and a former senior adviser to the VA secretary.


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