I disagree with pretty much everything Donald Trump has ever said. But in calling for veterans to have more options on their doctors and hospitals, he’s got a point. Imagine, for example, the outrage if military veterans were able to receive subsidized health care at the clinic or hospital of their choosing but were then forced into a separate system of run-down, inconveniently located facilities. If the next administration rejects proposals to reform the Veterans Health Administration and instead perpetuates the current system, the effect will be the same.
Providing health care to veterans is a moral imperative and a substantial challenge. The VHA is massive, with roughly 300,000 employees, 20,000 physicians, 1,600 facilities, almost 6 million patients, and a $60 billion annual budget. The system is plagued by deep problems, including a failure to provide the kind of facilities vets need in the places where they’re needed, according to a congressionally mandated, independent assessment.
Now, the Commission on Care, formed to figure out how to do better, has recommended the right pathway forward.
One of the most important recommendations is to allow vets to receive care from VHA-credentialed community providers. A 2014 law expanded such access, but it still accounts for a small share of care paid for by the VHA. Vets need to be able to use more convenient, often higher-performing facilities beyond the VHA.
Most of what the VHA does reflects the fact that half of all veterans are age 65 or older (compared with 17 percent of the civilian population). Health care services unrelated to military experience can just as well be provided in civilian hospitals and clinics.
A fast-track process similar to the Defense Department’s successful Base Realignment and Closure system should be used to sell or repurpose VHA facilities that are no longer needed, as the Commission on Care recommends.
Both Donald Trump and Hillary Clinton agree that veterans should have more access to doctors and hospitals outside the VA system, but they seem to differ in how aggressive they’d be in facilitating such a shift.
Sometimes a shove is better than a nudge. This is one example.
Peter R. Orszag is a Bloomberg View columnist. He previously served as President Barack Obama’s director of the Office of Management and Budget.
