A Plan to Fix the VA Now That Shinseki Is Gone

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May 30 2014 6:59 PM

How to Fix the VA

But with 9 million patients, 320,000 employees, 971 hospitals and clinics—It’s not going to be easy.

140530_POL_VAHospital
If the government can't take care of its veterans, how can it take care of everyone else?

Photo by Capt. Xeriqua Garfinkel,159th Combat Aviation Brigade Public Affairs/U.S Army

President Barack Obama had no choice but to accept Veteran Affairs Secretary Eric Shinseki’s resignation. The VA inspector general’s interim report issued this week contained too many damning findings of “systemic” problems that grew under Shinseki’s watch. Key among these was the finding that the actual VA primary care wait times in Phoenix averaged 115 days—more than four times the VA’s previously reported average of 24 days. That discrepancy revealed a gap between reality and official reporting, and suggested questions about the VA’s integrity ran all the way up to the secretary’s office.

More broadly, the growing VA scandal cast doubt on the ability of the government to deliver health care, a major Obama administration priority. If the White House could not deliver on this promise to veterans, a key constituency for whom the president and vice president have frequently described health care as part of a “sacred trust,” then how could the administration be trusted to provide care for all Americans? Coming after the legal and practical challenges to the Affordable Care Act, the White House could not afford another health care failure. And so Shinseki had to go.

Unfortunately, his departure will do little to fix the broader problems in the massive VA health care system—and may even set the quasi-leaderless agency back as it waits for a new secretary to be appointed and confirmed.

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The VA is the second-largest cabinet agency, and the nation’s largest health care and benefits provider, with an overall fiscal 2015 budget of $165 billion (greater than the State Department, USAID, and entire intelligence community combined), including $60 billion for health care. The VA employs more than 320,000 personnel to run 151 major medical centers, 820 outpatient clinics, 300 storefront “Vet Centers,” more than 50 regional benefits offices, and scores of other facilities. This massive system provides health care to roughly 9 million enrolled veterans, including 6 million who seek care on a regular basis.

It’s hard to overstate the challenges of leading this massive agency: The ideal candidate would probably fuse the best traits of a general like Shinseki, a politician like Bill Clinton, and a businessman like Lee Iacocca or Mitt Romney. The systemic integrity problems in the VA’s health care system, coupled with the broader resource allocation problems they were masking, will remain for the next secretary, whoever he or she is.

Here are six ways to begin to fix the VA.

1. Give the VA the resources it needs. Even with its massive $60 billion health care budget, the VA arguably lacks the funding it needs to treat all veterans . This resource shortfall is the root cause of the scheduling shenanigans in Phoenix: If the VA had what it needed, it wouldn’t have needed to play fast and loose with veterans’ appointments. A group of veterans organizations prepares its own shadow VA budget each year; this year’s budget called for approximately $7.8 billion more in VA health funding. This money would go to hiring doctors and nurses (assuming they’re available—a national doctor shortage affects the VA too), as well as building or leasing new facilities.

2. Allocate VA resources more smartly. The veteran population is undergoing tremendous demographic and geographic change. As World War II, Korea, Vietnam, and Cold War conscripts die, the veteran population is changing to reflect the all-volunteer force we have today: smaller, more dispersed, more diverse, and increasingly concentrated in urban or coastal areas. Unfortunately, this is not where VA hospitals and clinics are located.

The VA is seeing demand from both older veterans and younger veterans. The median age of the veteran population is 64, meaning that the majority of veterans are hitting retirement age and presenting themselves to the VA with service-connected conditions compounded by age. At the same time, veterans from the Iraq and Afghanistan cohort are seeking VA care and benefits in record numbers. The next secretary needs congressional support to shrink or close underutilized VA facilities, build or lease new clinics (favoring outpatient clinics instead of large hospitals, following the overall direction of American health care), and move VA personnel between facilities to reflect where veterans live now, and where they need care.

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