Almost as soon as Senator John McCain had finished working with Senator Bernie Sanders to craft the veterans' health-care bill now known as the Choice Act in 2014, the Arizona Republican set out to renege on his promise that Choice would be temporary, and began floating plans to make it permanent.
Part of the Choice Act was the establishment of the Commission on Care, whose deliberations the Prospect has covered extensively. This week that Commission is meeting to hammer out its final report, which will include recommendations about what the VHA should look like in 20 years. Instead of waiting to see what the Commission mandated by his own bill recommends, McCain has once again jumped the gun. He is lobbying hard for a bill that would not only make the Choice program permanent, but would eliminate any restrictions on veterans' access to private-sector health care.
McCain's gift to veterans is a bill misleadingly labeled The Care They Deserve Act. The subject of hearings on Capitol Hill the week of June 23, the bill would make the Choice Act-a three-year experiment enacted following revelations of delays in care at VHA facilities in Phoenix and elsewhere-permanent. Choice allows veterans to seek care from private-sector health-care providers if they face more than a 30-day wait for an appointment, or trips of 40 miles or more to the nearest VHA facility.
Under McCain's new plan, the nine million veterans eligible for VHA care would be free to use any private health-care facility or provider, for any form of service, with the federal government paying the tab-no questions asked. McCain has gathered seven other Republican sponsors for his bill, all of them pushing the new conservative narrative that the VHA is broken beyond repair. This, of course, ignores reports by a Choice Act-mandated Independent Assessment of the VHA, which documents that its veteran/patients actually receive better care, at lower cost, than millions of Americans who rely on private sector health care.
What's wrong with The Care They Deserve Act? Just about everything, which is why many veterans service organizations like the Disabled American Veterans (DAV) and Vietnam Veterans of America oppose the plan, and why the VHA's own undersecretary for health, David Shulkin, has proposed a more sensible alternative.
Economists advising the Commission on Care estimate that McCain-style privatization could triple the cost of veterans' care to almost $450 billion a year-money that would not be well spent. The VHA's clinicians and other staff specialize in the complex health problems related to military service, and deal with patients who are older, sicker, and poorer, with more mental health problems that those cared for in the private sector. The average elderly patient in the private sector shows up presenting between three to five physical problems. The "co-morbidities" of a Vietnam vet, for example, can number from nine to 12. That's why VHA primary care providers spend at least 30 minutes with their patients per visit, compared to the ten or 15 minutes allotted to patients in the private sector. Will private sector providers want to take the time to care for aging, sometimes homeless, often mentally ill, veterans? Even if they do, will they be able to detect the difference between ordinary type 2 and Agent Orange-related diabetes, or be equipped to parse the myriad symptoms of PTSD?
McCain's bill promises veterans a choice between VHA and private sector care. In reality, it would ultimately erode choice by weakening the VHA option, putting the entire veterans' health system at risk. The VHA's current budget is determined by how many veterans use the system and for what services. If far more eligible veterans start using private sector health care, there will be less funding available for VHA services that are unavailable elsewhere, and for maintaining the agency's highly specialized research and clinical expertise in military-related health problems. As funding for costly private sector care eats up more of the VHA's annual budget, there will be hospital and clinic closings, along with VHA staff layoffs. To reduce expenditures on veteran health care, Congress may also be tempted to make eligibility for veterans' health-care benefits even more restrictive than it is today.
If Congress wants to improve the VHA, it should embrace the reform proposals of Shulkin and those Commission on Care members who want to allow veterans access to private sector providers in networks coordinated by the VHA. With luck, this recommendation will appear in the Commission's June report. Strengthening the VHA, and giving veterans the choice to see outside providers if necessary, would really give veterans the care they deserve.
