Privatize the VA?

Privatizing the US Department of Veterans Affairs has reached the level of presidential politics. In the midst of reports, white papers, scandals, Congressional hearings, leadership changes at the top, and pushback from Veterans organizations, Veterans Day seemed like an appropriate time to fire the shot heard around Iowa and New Hampshire with many chiming in on whether all or part of the VA should be privatized. Conservatives like the idea. As you would suspect, the majority of veterans don't. Doctors don't want to work there.

Many doctors, including me, have worked at a VA as part of their residency training. The Veterans Health Administration is home to the United States’ largest integrated healthcare system consisting of 150 medical centers, nearly 1,400 community-based outpatient clinics, community living centers, Vet Centers and Domiciliaries. Together these healthcare facilities and the more than 53,000 independent licensed health care practitioners who work within them provide comprehensive care to more than 8.3 million veterans each year. I worked at the VA, in part, for the majority of my clinical career. The debate seems to revolve around a few main questions:

1. Is a separate VA system still relevant in a changing Sick Care environment?

2. Is the VA terminally wounded to the point where trying to fix it will mean throwing good money, and lots of it, after bad?

3. Would outcomes change if all or parts of the system were privatized?

4. Do we “owe” veterans a separate system?

5. If the system were privatized, would the veteran patient experience improve and what would be the costs of implementing the change? What would be the benefits?

6. Does “crony capitalism” extend not just to the medical-industrial complex, but to politically influential veterans organizations as well?

7. The VA represents 3.9% of the federal budget and employs hundreds of thousands. What would be the impact of layoffs?

8. Is the VA being used as a single payer and provider testing lab to promote a political agenda and what have been the results?

9. Can the culture of the VA be changed?

10. If the VA is privatized, will the model be extended to other federal Sick Care agencies like the Indian Health Service?

The promise of adequate care to US citizens should not stop with veterans. Now is a good time to debate the issues and make the tough choices.