A Texas couple exit the Vetarans Affairs facility in El Paso, June 9, 2014.

A Texas couple exit the Vetarans Affairs facility in El Paso, June 9, 2014. Juan Carlos Llorca/AP

Don’t Dismantle VA Reform

The Commission on Care’s recommendations to fix veterans’ health care may not be perfect, but they’re a good start.

Some defenders of the status quo at the Department of Veterans Affairs are being increasingly shrill as reality threatens to undermine their talking points.

Several weeks ago, after the release of the final report of the Congressionally mandated Commission on Care, the president of the public-sector employee union American Federation of Government Employees, or AFGE, J. David Cox issued a statement calling the recommendations “horrendously anti-veteran.”

Last week, Cox doubled down on his breathless condemnation of the commission’s recommendations in an op-ed entitled simply “Don’t Dismantle the VA.” In this bizarre article, Cox begins by engaging in conspiracy theorizing about the make-up of the commission, intimating that certain members of the commission had a conflict of interest because they are executives of health care organizations and thereby stand to profit from the recommendations. Never mind that the bipartisan commission was, in fact, comprised of nine Democratic appointees, in addition to the six Republican appointees, and included the then-executive director of the major veterans service organization American Veterans, or AMVETS. And never mind that all of the health care executives that were on the commission represent non-profit health care organizations.

Strangely, Cox goes on to dismiss the term “community care” — under which, he says, “the commission recommended veterans leave their existing community-based system” — as “Orwellian,” despite the fact that VA itself uses the term and Benefits.gov uses one very like it.

Unfortunately, Cox’s inaccuracies do not end with his ad hominem attacks and misconstrued terms. His hagiography of VA ignores the many problems that have been acknowledged by honest observers on both sides of the aisle. While no one would deny that VA care is at times satisfactory, reflexive defense of VA of this kind glosses over problems that need to be addressed.  

The VA scandal of 2014 brought to light real issues that had long been recognized within the veteran community. A lack of accountability coupled with an often toxic culture and a lack of capacity in certain regions led to massive failures in VA’s delivery of health care. In fact, a 2015 the Government Accountability Office (GAO) report placed VA health care on its “High Risk List” given the number of risks associated with the “timeliness, cost-effectiveness, quality, and safety of veterans’ health care, along with other persistent weaknesses we have identified in recent years” that serve to “raise serious concerns about VA’s management and oversight of its health care system.” And an Independent Assessment of VA health care, conducted by a number of various analysts including Mitre Corp., Rand Corp. and McKinsey & Co. found that “Solving [VA’s] problems will demand far reaching and complex changes that, when taken together, amount to no less than a system wide reworking of [the Veterans Health Administration].”

The commission’s recommendation — based on a recommendation in the Independent Assessment — that the Veterans Health Administration be placed under a board of directors, which Cox attacks as “undemocratic” and “inefficient,” is, in fact not a new recommendation. Rather, it dates at least to a 2009 report put forth by a commission headed up by former VA Administrator Harry Walters and signed by representatives of the American Legion and Disabled American Veterans.

None of this is to say that the commission’s recommendations were perfect. They have many shortcomings and in a certain sense represent a missed opportunity to transform the VA into a highly-functioning, modern health care system. A better way to go about achieving that end would be to implement the reforms contained in the draft legislation recently released by Rep. Cathy McMorris-Rodgers, R-Wash. In that proposal, the VHA is transformed into a government-chartered non-profit (another recommendation from the aforementioned 2009 Walters report), and an insurance program modeled after the Federal Employees Health Benefits Program (the benefits program available to those employees that Mr. Cox represents) is established for veterans. Veterans are placed in the center of the new system in the sense that they are given the option to choose whether to receive their care from the non-profit health veterans health care organization or to utilize private health care.

Ultimately, the commission’s recommendations represent a mediocre attempt to bring needed change to an ailing government agency. They introduce good recommendations that, if implemented, would be a step in the right direction. But their failure to move from a VA-centric model to a truly veteran-centric model all but ensures that the problems we have seen will likely continue.

Shaun Rieley is an outreach and research analyst for Concerned Veterans for America. He served as an infantryman in the Army National Guard and is a veteran of Iraq.