It’s been three years since crisis and controversy rocked the Department of Veterans Affairs (VA) healthcare system. Decisions about how to strengthen and reform VA healthcare must be made this year, as the only response enacted by Congress, the troubled Choice Act, is set to expire once funding runs out.
Central to the debate is figuring out how to provide veterans having difficulty accessing the VA with quality choices while ensuring that any choice program fits into the bigger picture of VA healthcare. As that debate is being taken up by the 115th Congress, Disabled American Veterans (DAV) is continuing its campaign to ensure that veterans’ voices are heard, particularly ill and injured veterans who choose and rely on VA.
Since the waiting list scandal at the Phoenix VA exploded, the idea of providing veterans with more choice has been at the center of the debate over how to improve veterans’ healthcare. Some politicians and political organizations have become enamored with “choice,” more interested in letting veterans purchase care in the private sector than enacting policies that will ensure the best possible health outcomes for veterans.
Unfortunately, the frequent use of the term “choice” — without any clear definition or specifics — has added to the complexity and confusion of this debate. The first step as Congress and the administration move forward on VA healthcare reform is to put choice in context and ensure that all the key players, including veterans themselves, understand what “choice” can really mean.
For example, some people have said that “choice” would allow veterans the ability to pick their own doctors. But since many doctors don’t accept “choice” payment rates, relying on “choice” could leave veterans without the ability to find a qualified physician. Some have claimed that providing all veterans with “choice” would lead to better quality healthcare. However, independent studies by Rand Corp. and others have consistently shown that VA already provides equal or better care than the private sector and that “choice” will lead to more fragmented care, which correlates with worse health outcomes.
Finally, some say that “choice” will increase access for veterans, but for millions of veterans the opposite would be true. If “choice” expands and moves more veterans to the private sector, VA would be forced to close some hospitals and clinics, and curtail medical services in others, meaning less access and less “choice” for the millions of veterans who rely on VA for most or all of their care.
After 18 months of debate, the Commission on Care reached the same conclusion as DAV, other veterans service organizations, the VA and many members of Congress — the best way to improve veterans’ healthcare is to create an integrated network combining the strength of the VA system with the best of private care. With a new president, VA Secretary and Congress in place, it’s critical that any debate over “choice” consider the cost, impact on VA and the resulting consequences for veterans, particularly disabled veterans.
As Congress and the new administration begin to debate VA healthcare reform this year, “choice” must be considered in the context of the overall VA healthcare system. Otherwise the wrong “choice” will leave America’s veterans with fewer options, not more, and poorer health outcomes.
Garry J. Augustine, a Vietnam-era combat-wounded Army veteran, is executive director of the Washington, DC headquarters of Disabled American Veterans.
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Congress must act to better the healthcare of America’s veterans