The Department of Veterans Affairs includes the largest health system in the United States and the second largest agency in the federal government. The system, which accounts for close to $200 billion in federal spending and has more than 350,000 employees, covers the health-care needs of 9 million veterans.
The idea of doing away with the entire system and turning it over to the private sector is not only frightening, it’s morally reprehensible. And yet, if some high-level VA officials in the Trump administration get their way , that’s what would happen.
I spent a year leading a bipartisan commission designed to examine the VHA. And as someone who has spent 35 years leading large, private-sector health systems in urban markets, I fully appreciate the complexity of our nation’s health-care system for veterans. No doubt the system has many problems, in large part created by constant turnover in leadership.
But the VHA also has many great strengths. The system has developed programs that address the service-connected injuries and illnesses of veterans, including for advanced rehabilitation, prosthetics and mental-health services. The system’s organizational model is also critical for the care of men and women who often have multiple injuries and illnesses requiring daily coordination of services.
For decades, the VHA has also partnered with major academic health systems across the country to have access to the best doctors, to teach young doctors about caring for veterans and to conduct research specifically focused on veterans’ needs, resulting in significant innovations in medicine and health-care delivery.
The private sector today is simply incapable of delivering such organized care for veterans, and it does not have the capacity or the sophistication in rehabilitation or mental-health services to meet their complex health-care needs.
I can understand why people may think closing the VHA makes sense — given high-profile cases of dysfunction at the agency, including the wait-time scandal in Phoenix. But it is important to listen to the veterans who are receiving care within the system and to appreciate the scale and complexity of what it delivers every day. At the same time, we should note that private-sector hospitals and health systems have their own quality and service problems, and they escape the scrutiny of the politically charged national spotlight that the VHA deals with every day.