Based on the bills in conference, legislation to fix the Veterans Administration healthcare system will do little more than paper over problems that result from a fundamentally bad design.
Only in Washington are bureaucratic screw-ups and malingering on a massive scale rewarded so handsomely. In the case of the Veterans Administration hospital wait time scandal, the response to unconscionable cover-ups and bureaucratic failure consists largely of—you guessed it—more money.
Firings and prosecutions may follow, because apparently, Congress will have to pass a law to smooth that process.
What?
Only Congress could come up with a solution to healthcare wait times that essentially asks veterans to keep calm and carry on with the corrupt and unaccountable system responsible for the problem. Not only that, but the same bumblers who brought us this shameful episode get $500 million to hire new doctors and untold billions more to build new hospitals.
Never mind that in the proposed legislation, now in conference committee, there are provisions for those who wait a certain amount of time for an appointment or who live a certain distance from VA care to visit private doctors.
The question no one seems to be asking is why?
Why do we need a separate healthcare system for veterans?
No one seems to have a good answer, but it's a question never asked in Congress, where they put out fires with money instead of water.
Too Many Inpatient Beds
Political expediency is why the question of whether there's even a need for a separate healthcare system for veterans anymore hasn't come up. Yet private hospitals are as equipped as any VA hospital to handle most veterans' health needs.
Besides that, in many parts of the country, there are too many inpatient beds. Why not make that wait-listed patient volume available for everyone?
Further, what does helping veterans pay for college have to do with how long they're waiting for medical care? Most voters probably have no problem helping vets pay for college, but what is this provision doing in a bill meant to solve the problem of long wait times, management corruption, and cover ups?
Sen. Tom Coburn, M.D. (R-OK) released a report on the scandal this week. It is a compelling and disgusting reading.
For all of Medicare's problems, when's the last time you heard about beneficiaries complaining about wait times? (They, of course, obtain their healthcare services from private, as opposed to government, facilities.) The answer is rarely to never, partly because Medicare is a relatively good and fast payer, and partly because physician access is directly tied to reimbursement.
Medicare wait times average around 18 days for five specialties: cardiology, dermatology, obstetrics-gynecology, orthopedic surgery and family practice. And Medicare is accepted in 76% of physician offices, according to healthcare search and consulting firm Merritt-Hawkins. If you use the VA for care, depending on where you are, you could wait months and even die while waiting for an appointment.
Medicare Alternative?
It's in private healthcare's best interest to get those patients in the door as soon as possible. It may be more expensive and less coordinated than VA care, (it is an integrated system) but that's certainly debatable. It's hard to coordinate care if the wait list is so long you never get in to see a doctor. Besides that, most veterans who use the VA for their care are already Medicare-eligible.
Medicare Advantage patients seem to be pleased with their healthcare overall. Why is a similar structure for veterans not an option? Structured properly, it might cost less, and it seems logical that patients would be better treated. Who cares if the patient in the next room is Aunt Jane instead of G.I. Jane?
I doubt veterans really do. Like anyone else, they want access to healthcare when they need it. The VA has failed miserably at this very basic function. And not only has it failed, it has covered up the failure until a few whistleblowers finally had enough.
Even if veterans' out-of-pocket costs at this time may be higher than if they used VA services, that problem could be corrected much more efficiently than the rushed-together bills currently in conference committee.
To be fair, the legislation temporarily (for two years) authorizes patients seek private health care if they reside more than 40 miles from a VA facility or have been waiting more than 30 days for treatment. But that half-step creates as much as a $50 billion new entitlement.
And the qualifiers on distance and time spent waiting are arbitrary and meant to protect the unaccountable bureaucracy that infects the VA. Also, once it's established, do you think it will really be temporary? The income tax was supposed to be temporary too.
A Modest Proposal
How about this? Keep that provision, absent the restrictions about residential status or wait times, and cut the VA budget by $50 billion a year. Then unleash veterans and allow them to vote with their feet. After all, the VA is the institution that failed here. It should be punished where it counts—in its budget, as any private company would.
As much sense as it might make, such a solution is probably doomed—again because of political considerations. As someone wise mentioned to me recently, there's no pizzazz in common sense. Congress is fueled by pizzazz, and common sense has no home there.
If this scandal isn't enough to radically change how we, as a nation, provide healthcare to those who defended us and in many cases, are the worse off for it health-wise, it's hard to see that anything would do it.
Too bad. Appropriating money is easy. Fixing a broken system is hard. So while the culture and corruption that produced this scandal falls on individuals in the VA, the agency as a whole was simply working the angles. Congress created those, and is ultimately to blame for its lack of supervision and oversight.
That seems likely to continue, because based on the bills in conference, the legislation that will ultimately be passed papers over the problems that result from a bad design.
Philip Betbeze is the senior leadership editor at HealthLeaders.