As they meet again in Washington, D.C., this week, the congressionally mandated Commission on Care, tasked with determining a 20-year strategic plan for the Veterans Health Administration, would do well to heed the voices of veterans and veterans service organizations that it has too often sidelined from its deliberations.
In its April meeting, the commission heard from leaders of the largest veterans service organizations (VSOs)-Veterans of Foreign Wars, the American Legion, Disabled American Veterans, Iraq and Afghanistan Veterans of American, Vietnam Veterans of America, Vietnam Veterans of America, Paralyzed Veterans of America, Got Your Six, and Military Officers Association of America. All of them adamantly rejected the dismantling of the VHA, which had been recommended by seven of the commission members in their so-called Strawman Document.
What the VSO representatives argued for was a program like the one VA Undersecretary for Health David Shulkin has proposed. Within limits, veterans would be able see private-sector providers who have been vetted by the VHA. The VHA would still coordinate the care they receive, thus attempting to integrate private-sector providers into a larger VHA network.
What these VSOs do not want is the kind expansion of the current Choice program envisioned in new legislation proposed by Senator John McCain and sponsored by seven other Republicans. The Permanent Choice Card Act would eliminate current restrictions that limit the program to veterans who cannot get a VHA appointment within 30 days, or who live more than 40 miles from a VHA facility. Under this bill, any eligible veteran can go anywhere, to any private-sector provider, for any condition. This would lead to higher costs and, the VSOs fear, to even more limitations on access to services. Veterans with complex physical and mental conditions would receive no care coordination from the VHA which, given the reality of private-sector health care, would mean no care coordination at all.
As Rick Weidman, executive director for government and policy affairs at Vietnam Veterans of America, explained at the hearing, care coordination is critical because veterans have far more complex problems than the average private-sector patient. Which is why Weidman also urged commissioners to move beyond anonymous data when estimating future VHA use. Yes, the number of veterans the VHA serves will diminish as World War II, Korean, and Vietnam War veterans die. The veterans who still use the VHA, however, will be sicker than the average private-sector patient. Most older adults, for example, have three or more problems, while the average Vietnam veteran, Weidman reminded the commission, has nine to twelve, which are both military- and age-related. Iraq and Afghanistan veterans have even more complex conditions.
While some commissioners seemed to be listening, VSO leaders remain concerned about those who persisted in "misunderstanding" their positions, by insisting that VSOs favored removing the current 40-mile or 30-day restrictions on the use of Choice. On April 29, seven of the VSO leaders wrote a follow-up letter to the commission, making it completely clear what they and their members want: "the development of local integrated community networks in which VA serves as the coordinator and primary provider of health care to veterans; non-VA community care would be integrated into this network to fill gaps and expand access."
In a letter to sent to the commission, a veteran of the Iraq war put it even more eloquently: "Your solution of sending us to private healthcare providers is the wrong direction. … There is no private health care provider office that can offer me this type of care. So just fix our VA because it belongs to us not to the private sector."
