Forty-four years after the legendary May 1970 Life magazine cover story first exposed the disgusting and shameful mistreatment of our nation’s Vietnam-era veterans in government medical facilities, the U.S. Department of Veterans Affairs (VA) is once again in desperate need of reform. Courageous whistleblowers have exposed systemic corruption and exposed falsified records, secret waiting lists, and delayed care — representing yet another scandalous and unconscionable neglect of our nation’s veterans.
Over the years and decades since the reforms of the 1970s, the VA’s calcified bureaucratic culture has undermined and eroded all accountability within the department. But despite the scandals throughout VA finally gaining mainstream media attention and appropriate outrage, the VA and its allies on Capitol Hill are working behind the scenes to sabotage much-needed accountability and patient choice reforms proposed by Congress.
Following passage in the House of Representatives of two Rep. Jeff Miller-backed bills to bring greater accountability and real choice to the VA, the Senate has passed its own solid, yet flawed, package.
With the competing House and Senate proposals now headed to a conference committee to be reconciled this week, it’s time to get tough. Members of Congress, veterans’ advocates, and taxpayers must remain vigilant to ensure real reform language is shielded from sabotage by bureaucratic apologists who seek to preserve VA’s dysfunctional status quo.
To avoid diluting the reform provisions, and allowing the VA to once again betray its sacred calling, conference committee members should be wary of the following three vulnerabilities to real reform:
Close loopholes and remove ambiguous language. The VA has proven in the past that, if given discretion to interpret statutory language, they’ll do so in a way that protects and rewards its bureaucracy to the detriment of veteran care. Congress should dictate strict, unambiguous, and automatically triggered guidelines to deny the department this leeway. Patient choice provisions, which would allow VA beneficiaries to seek care from private providers when facing long waits, or if they live far from a VA facility, are particularly vulnerable to sabotage.
The first example is the health care wait time standard for seeking private care. The final conference bill should reflect a clear and carefully delineated standard — say, 21 days — to define what constitutes “excessive” wait times for care. The VA should never again be permitted to set their own standard for “excessive” waits, nor should veterans require high-level approvals to seek reimbursed private care. Also, veteran wait times must be independently verified as the VA has proven time and again that it will falsify records to hide the truth. If the wait standard is not met, automatic triggers must be in place for the veteran to quickly seek other providers.
Another good example of where language must be clearly defined is the geographic standard for seeking private care. Both bills establish 40 miles as the standard for excessive travel to a VA facility; meaning a veteran can seek private healthcare options if they live further than 40 miles from a VA facility. But this begs the question: what constitutes a “VA facility” — primary hospitals or every clinic? And will individual radiuses be set according to individual veterans? If a veteran lives within 10 miles of a VA clinic, but has to receive specialized care 100 miles away, Congress must ensure that that the veteran still qualifies for other options.
Ensure timely reimbursement payments to VA providers. Private medical providers who have treated VA patients in the past tell of disproportionately long reimbursement delays — in many instances taking several months, or even years, for the VA to settle accounts. By comparison, Medicare providers are typically reimbursed within 30 days.
Delaying payments is a passive-aggressive bureaucratic strategy to undermine patient choice: if doctors know they’ll have to wait months for VA payment, they’ll be less willing to accept its patients, thereby gutting the choice provisions. Congress should mandate timely reimbursements for private providers similar to Medicare’s pace, thereby ensuring broad choice for veterans.
Limit additional spending and make it discretionary. As more veterans access the care they have earned, we recognize that expanded choice will have its costs. But if done properly, bringing an end to the days of de-facto rationing by the VA would be well worth the investment. That said, the Congressional Budget Office’s whopping $50 billion per year estimate appears to be based upon flawed assumptions about VA usage. Additionally, CBO’s score does not account for reduced costs that will come with properly implemented choice, like travel reimbursement savings and reductions in funding for VA hospitals that will see rural veterans utilizing private healthcare options closer to their homes. Fiscal hawks with sticker shock should take CBO’s estimate with a grain – if not a chunk – of salt.
More broadly, the VA is not short on funding. Its budget (now more than $160 billion annually) has grown by more than 68 percent since 2009. Even President Obama, who has had every budget request he made met, concedes that, “before we start spending more money [on the VA], our first job is let’s take care of some basic management issues that I think can be fixed.”
Nonetheless, “more money” has found its way into the Senate bill, including funding for more hospitals and the hiring of more doctors despite the fact that the VA will carry a $450 million healthcare funding surplus in to FY 2015 and currently has over 1,000 unfilled “physician” positions on their books. The VA’s problems are not underfunding nor a lack of doctors, and all other riders to this accountability and choice legislation should be removed from the final bill. Full stop.
Finally, the Senate deal codifies any additional spending as “mandatory,” while the House keeps it under discretionary purview in order to maintain Congress’s proper fiscal oversight. Recognizing that both bills will be revisited in two years, any additional outlays should be considered discretionary.
With fiscally-responsible and reform-minded members like Rep. Jeff Miller and Sens. Richard Burr, Tom Coburn, and Marco Rubio leading the charge in conference, we’re cautiously optimistic that any sabotage efforts by the VA’s apologist allies can be averted and we can get a tough VA reform bill to President Obama’s desk.
The committee can do no better than the House-passed legislation, and no worse than the Senate-passed deal—a set of parameters that should be firmly maintained. But if a deal is struck that dilutes accountability, diminishes choice, or constitutes excessive spending, my organization will oppose the deal and urge other veterans’ organizations to do the same. Too much is at stake to play games.
Any effort to reform the VA must prevent the disgraces of the 70s and today from ever being repeated. It’s up to this VA conference committee to provide the strict and clear legislative guidance to the department needed to ensure that the men and women who have served our nation in uniform finally get the timely, quality care they so richly deserve.
Pete Hegseth, the CEO of Concerned Veterans for America and a Fox News contributor, is an infantry officer in the Army National Guard, and has served tours in Afghanistan, Iraq, and Guantanamo Bay.