The Patriot Post® · The VA — Politics Over Problem-Solving

It’s what DC does best. First we had the March for our Lives, which was a blatantly political event masquerading as a student safety program, designed to keep the “gun control” issue alive for the November midterms. Then we got the Department of Veterans Affairs (VA) reshuffle.

It’s no secret that debate has been ongoing for years about the performance of the VA and its proper role. But what brought the discussion into the spotlight was Trump’s firing of the VA head and replacing him with his personal physician. There are so many aspects of this that it’s hard to know where to start, but how about putting problem-solving in the pace car.

If we take everyone at their word, the universally accepted goal is to give vets gold-plated health care as part of their service. They have earned it and government has always had an obligation to take care of its vets. There can be quibbles about what gold-plated means — “Is it for life?” “Is it free or heavily subsidized?” “Does it vest?” and other details — but all are under the umbrella of the government providing health care for vets. The key question then is how best to do it. Currently, the vehicle is the VA, which is at the far-left extreme of government involvement in health care in which the government is not only the single payer but also the single provider. But is the VA getting the job done?

Depending on what survey you read, what questions are asked, and what criteria are used to measure performance (medical outcomes, patient satisfaction, wait times, cost effectiveness, etc.), the answer to that question is probably not. Most issues with the VA focus on wait times and “horror stories,” and the solutions range from “more funding and better management” to “partial privatization.” The former is obvious, but the latter typically refers to providing vets the option to access health care at government expense outside the VA system under certain circumstances. While that may address some of the issues, it ducks the big-picture question of whether the VA in its current form is the optimal method of delivering health care to vets. Since that is the problem we are supposedly looking to solve, let’s take a shot at that.

First, a few facts about the VA from a layman’s perspective. From the outset of the VA, the concept of a separate government-run entity to care for vets made some sense. There were large numbers of vets with health care needs unique to military service, driven primarily by war injuries from World Wars I and II., Korea, Vietnam and the Middle East. Traditional private health care was inadequate, particularly for physical trauma war injuries and mental health issues associated with combat zone experience. Wars subsided, but over time the VA had grown into the second largest government agency with over 350,000 employees,1,200 facilities, and a budget of around $175 billion — a size that dwarfs the largest private health care system. But does it still make sense to have a VA when the health care needs for most vets have come to resemble those of the general population?

The debates over the VA never seem to address that question. Even though the arguments for more vet choice might be philosophically driven by getting government out of the health care provider business, the practical solutions always seem to assume that the VA remains in existence (at least for now), but things like vouchers for private care are provided to inject competition into the VA that will over time improve its performance. That may seem logical, but it poses an almost impossible management situation and a very real political nightmare for those wedded to the dream of single-payer/provider health care — in other words, the entire Democrat machinery.

Running even a modest health care provider system is a management challenge, but think about how you manage the VA when the system built under a monopoly all of a sudden gives its patients the opportunity to leave the network. Over time things might find their level, but in the near term vets would be more likely to suffer than benefit because the private system would be overwhelmed if a meaningful fraction of the six million or so annual VA patients left. Furthermore, the remaining VA system would be significantly underemployed, and finding the right level of personnel and facilities would be a moving target. Finally, there are so many VA facilities in so many congressional districts that rely on the funding and jobs that the political pressure to keep even a woefully inefficient system alive would be enormous.

This seems so inevitable that it might lead one to think that the pro-privatization (defined as giving vets more “choice”) crowd is cooking the books toward ultimately getting the government completely out of the provider business. But in the interim, while the private sector grows to accommodate the shift, the VA downsizes, and the political wars expand. The big losers are likely to be vets themselves. This is the argument used by the status quo crowd, including the ousted VA head. And he has a point.

We can debate whether his approach to leaving government service is the right one, and we can also debate whether putting someone who might be a great doctor but has zero management experience in charge of this Super Bowl of management challenges makes sense as anything but another step in the privatization direction. But perhaps we are asking the wrong question. Rather than trying to do the impossible by using vouchers to try to find the right balance between the private sector and the VA as a government entity, if the prior rationale for a separate government-run vet health care system no longer exists, why not just sell it? Define “privatization” the way it’s usually meant — transferring assets owned by the government to the private sector — and actually privatize the entire VA health care system.

The government would still play its current role of paying for whatever gold-plated vet health care benefits are determined appropriate, but even that could be shifted to providing vouchers for vets to buy gold-plated health care insurance as they decide in the private sector. The vets would have the ultimate choice in where to get their health care, just like private citizens. The VA system would remain intact initially but subject to the same competitive pressures as any other health care provider. There would be no reason why health care services unique to vets wouldn’t continue as dictated by supply/demand forces. And the government would benefit from reducing the deficit through cost efficiencies along with a huge one-time debt pay down from the proceeds of the sale.

I’m not trying to minimize the complexities of the deal or the political pressures that would fight it tooth and nail. But it strikes me as a far better option than trying to pretend that partial privatization will magically transform the system. Playing halfway-house games will only further the current problem of providing sub-optimal health care to our vets. It’s not working, and it’s the latest poster child for DC putting politics over problem-solving. Let’s try something different. Our vets deserve it.