This Veterans Day, let’s take a look at the current state of the largest health care system in the United States: The Department of Veterans Affairs. This federal agency services over 9 million of our nation’s finest veteran service members. The VA is a promise we have made to protect those who protect us.
Turmoil at the Top
Under the Trump Administration, agency leadership has been a mess. There has been continual shuffle of leadership at the top of the Department, starting with Secretary David Shulkin – a man embroiled in controversy and on the wrong end of the privatization debate. His controversy dimmed next to the catastrophic nomination of Dr. Ronny Jackson, which was followed by a back and forth, then back again between Peter O’Rourke and the current Veterans Affairs Secretary, Robert Wilkie. In August, Propublica reported how three members of Mar-a-Lago – Marvel Entertainment Chairman Ike Perlmutter and cronies Marc Sherman and Bruce Moskowitz – were using their access to influence policies within the agency.
Leadership isn’t the only problem within the Department. Veteran suicides, some on VA properties, spotlighted the need for better access to mental health services. The Mission Act was signed into law by Donald Trump in June. Building off the Choice Act of 2014, it expanded VA caregiver programs, consolidated community programs, and created a commission to assess VA facility expansions and closures.
Needless to say, 2018 was not a good year for the Department of Veteran Affairs.
What does the future of the VA hold? Secretary Wilkie has outlined four areas of focus as the Department moves forward into 2019. Customer care, implementation of The Mission Act, heath care technology modernization, and business system transformation.
Customer care should be our main concern. There’s a growing number of newer veterans entering the system adding to an aging population of pre-9/11 veterans requiring more care, and the system is struggling to keep up. Wait times within the VA have been an ongoing focus for years. For example the current wait times in the state of North Carolina have improved but are still at the following levels, according to Brian Ward, the Assistant Director of the Winston-Salem VA Regional Office:
- 90% of appointments are made within 30 days
- 35 days for new patients
- 6 days for existing patients
- 6 days for women’s care
- 5 days for mental health
Wait times vary wildly based on locations because multiple factors play into these delays, including staffing levels, facility capacities, scheduling resources, increase in the level of care, and the increase of veterans entering the system.
The solution that the current administration has pushed is increasing access to private care through the Veterans Choice Program (VCP). The theory is that an increase in private care access alleviates the pressure on the VA. In practice, it increases the cost of services and puts veterans in a system that may not have access to their complete records. More importantly, many private providers may not understand the special considerations needed when treating a veteran.
The Veterans Choice Program leads us to the next point that Secretary Wilkie is focused on, the implementation of The Mission Act. As previously discussed, which expands on VCP. However, one point within the act opens the door for further privatization.
The Mission Act has language that calls for the creation of an Asset and Infrastructure Commission. This commission is tasked to assess which VA facilities are due for remodels and closures. Similar to the Base Realignment and Closure (BRAC) commission of the past, this will lead to facilities being closed. Less facilities leads to more veterans being eligible for VCP, which in turn, leads to further privatization of the VA.
The final two priorities for Secretary Wilkie – technology and business system modernization – are focus areas that the Department of Veterans Affairs has desperately needed to tackle for decades. The systems within the VA are antiqued at best and a danger at the worst. Systems fail to connect to one another, and digital record transformation needs to continue within the agency. As the lines blur further between VA and private care, this is needed more than ever.
As this article is published, the Department of Veterans Affairs is coming under fire for missing GI Bill payments, which is being blamed on their antiquated IT system. This is resulting in thousands of veterans taking on education debt or possibly being removed from school for lack of payment.
The Path Forward
Overall, these plans to transform the VA into a modern health care system will be an expensive undertaking.
In October, during a Cabinet meeting, President Trump asked all his Cabinet secretaries to possibly cut up to 5% of their budgets to get “rid of the fat”. Secretary Wilkie has yet to detail how those cuts will affect the Department of Veterans of Affairs.
The hope is that this fat-trimming doesn’t impede the positive strides the VA has made through research. They are responsible for groundbreaking research on prosthetics, traumatic brain injury, Post-Traumatic Stress Disorder, and hundreds of studies in areas that other organizations don’t have the expertise in. We also need to ensure the funding doesn’t get taken away from mental health services and suicide prevention programs.
Accountability is key to making sure the Department of Veteran Affairs services veterans with the care they deserve. That accountability will come in the form of a Democratic House of Representatives and the Committee Chairs they will fill. Accountability also comes from the general public.
As a veteran who utilizes the Department of Veterans Affairs, I am asking you to stand up for veterans and the services we utilize. We need to strengthen the VA and focus on how to make this important service stronger rather than watered down. The way you can do that is by supporting politicians that make veteran issues a priority, understanding the bills put before Congress, and fighting to protect veteran health care by keeping the issue at the top of your list for advocacy and activism.