German Lopez voxplains Congress’ plan to fix the VA, which was unveiled yesterday with much bipartisan back-patting:
The bill sets $10 billion for a pilot program that reimburses private care for veterans who live more than 40 miles from a VA facility or experience long wait times. It also allocates another $5 billion for the VA to hire more doctors and nurses and upgrade medical facilities. And it gives the VA permission to enter into 27 major medical facility leases across the country. The bill also allows the VA secretary to quickly dismiss or demote senior executive employees for misconduct and poor performance, and it forbids the VA from attaching bonus payments to wait time goals. Legislators estimate the bill costs $17 billion. About $12 billion of that is new spending, while $5 billion will be paid for with offsets from the rest of the VA.
The idea is to improve the VA’s ability to see patients in a timely manner within the VA system. If that’s not possible or a patient can’t access a VA facility, a private option is offered as an alternative. In any remaining situations where the VA can’t get patients into care quickly, there will also be less of a financial incentive to manipulate records. And it will be easier for the VA secretary to hold those who continue engaging in fraudulent behavior accountable, even if they hold senior positions.
But Vinik worries that the “fix” might not fix much:
Most of the political press has greeted this bipartisan breakthrough with cheers, but it’s not clear that this legislation makes sense. Earmarking money to hire more medical personnel is undoubtedly important, but Phil Longman, who knows more about the VA system than almost anybody, told me recently that allowing veterans to seek non-VA care could undermine the system. Excellent VA hospitals, which already have a lack of patients, may be forced to close if veterans go elsewhere. The current deal only sets up a two-year pilot program, but Republicans will certainly look to extend it before it expires. As Longman warned, this legislation, which the House and Senate are expected to pass later this week, could be a “Trojan horse” for privatization.
Drum’s just encouraged that Congress managed to do anything at all:
All things considered, it would be a good sign if this bill passed. The VA, after all, isn’t an inherently partisan issue. Just the opposite, since both parties support vets about equally and both should, in theory, be more interested in helping vets than in prolonging chaos for political reasons. In other words, if there’s anything that’s amenable to a basically technocratic solution and bipartisan support, this is it. In a way, it’s a test of whether our political system is completely broken or just mostly broken. “Mostly” would be something of a relief.
That doesn’t really reassure Waldman, though:
Take a look at what characterizes the VA issue. First, there was a dramatic and troubling scandal. Second, the scandal involved victims that everyone in both parties wants to be seen supporting. Third, the way to fix the problem, at least in the short term, was fairly obvious. Fourth, that solution involved at most some mild ideological discomfort for both parties, but nothing they couldn’t tolerate. Finally and most importantly, addressing the problem involved zero political cost to either party. How often does an issue like that come around? Once or twice a decade? But that, apparently, is what’s required to actually pass meaningful legislation to get government functioning properly.
Previous Dish on VA reform here.
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