U.S. military veterans wait in the lobby area during the grand opening of a new Veteran's Administration VA Outpatient Clinic in southeast Austin, Texas, in 2013.

U.S. military veterans wait in the lobby area during the grand opening of a new Veteran's Administration VA Outpatient Clinic in southeast Austin, Texas, in 2013. Robert Daemmrich Photography Inc / Corbis via Getty Images

Another Delay Could Scuttle Crucial VA Reform

Legislation and election timelines leave precious few months to launch a once-in-a-generation effort to reset the infrastructure that supports veterans’ health care.

There’s going to be a six-week delay in the crucial, once-in-a-generation effort to modernize and rework the Department of Veterans Affairs’ health care infrastructure. The VA secretary wants more time to discuss the recommendations his agency will send to the independent board that will set the course for VA health care for decades to come. 

This is a correct decision. The review must be done right; the consequences of failure are grave. But these six weeks must not become a longer delay. If the secretary does not keep the reform process moving, many billions of dollars will be spent on buildings instead of care – and advocates of privatization will gain the upper hand.

Dubbed the Asset and Infrastructure Review, or AIR, the Congressionally mandated process sets up an independent commission similar to the military’s Base Realignment and Closure Commission, or BRAC, which I chaired in 2005. This board will review recommendations submitted to them by VA Secretary Denis McDonough. 

Among the board’s urgent missions is identifying which of the VA’s 171 Medical Centers and more than 1,100 smaller outpatient clinics should be closed, moved, or even expanded. With a 2022 health care budget of more than $100 billion, the VA is spending too much money on bricks and mortar instead of doctors and nurses.

Many of these centers are huge, built to care for thousands of patients after the first and second world wars, when medical care was synonymous with hospital care. But in the 1990s, the VA began to move from hospital-centered to patient-centered care. Today, most veterans, like other Americans, regularly see their physicians on an outpatient basis, leaving some of these medical centers largely underutilized. 

Other changes are also driving the need to realign VA infrastructure: the veteran population is shrinking, as is the size of our military; the demographics of where veterans live has changed; and recent legislation has given many veterans the opportunity to receive care in their communities. Finally, COVID-19 has changed the entire health care industry in ways we are only now beginning to understand. 

These infrastructure changes will help ensure that the VA can continue to do its vital and unique work. Its research teams have participated in hundreds of important advances in medicine, such as the development of the CT scanner. They have created improved artificial limbs such as the Seattle Foot and were instrumental in finding a cure for tuberculosis and improving the lives of many with Parkinson’s disease. They developed the first nicotine patch and proved the value of low-dose aspirin therapy in preventing heart attacks. VA was in the forefront of telemedicine and hospital-based home care long before the pandemic changed the face of healthcare delivery. 

And for critically wounded veterans of Iraq and Afghanistan, VA developed a national system of polytrauma centers to address the devastating injuries many have suffered. 

VA’s system is especially valuable because it is able to provide specialized care for the unique medical issues veterans face, such as prosthetic care, spinal cord injury, traumatic brain injury, and mental health care. And VA welcomes all veterans, regardless of their background. 

AIR offers the possibility of a future for VA health care that will provide quality, readily accessible, cost-effective care to our nation’s veterans, while also using the resources offered by federal partners, academic affiliates, and private-sector providers. 

If more time is needed to get this review right, Secretary McDonough should take that time. But we must act. We cannot wait five or ten more years. In fact, I believe we have until June 1 to make VA’s recommendations public and to name the commissioners who will review those recommendations. 

By statute, the commissioners have one year to complete their work, and they must be held to that deadline. Otherwise, Congress will still be deliberating on their final decision in the presidential election year of 2024 – and it will be difficult for members to do what needs to be done in the face of leaders of both parties not wanting their candidate, or their party, to be considered “soft” on veterans issues. 

If VA does not successfully realign itself, VA medical centers will become museums of the past, not the guideposts for the future they should be. Let’s make the most of this once-in-a-lifetime chance to transform a cabinet department. Doing so will enable our nation to continue to meet President Lincoln’s mandate to care for those who have borne the battle and their dependents. As McDonough told Congress in December, “the decisions made...will have impacts on the lives of veterans and communities across the nation for generations to come.” 

Anthony J. Principi served as Secretary of Veterans Affairs from 2001 to 2005.