By Suzanne Gordon
The American Prospect, Tapped Blog, Aug. 16, 2016
When the House Veterans Affairs Committee holds a hearing on September 7 to assess the future of the Veterans Health Administration, federal lawmakers would do well to consider recent reports that challenge the continual drumbeat of negative and often unfair coverage and congressional criticism of the VHA.
One report, from the RAND Corporation, said that while there were differences in care and leadership culture across the system, researchers “did not find evidence of a system-wide crisis in access to VA care.” In fact, the report identified congressional policies as one of the main barriers to VHA improvements (despite the Veteran Affairs Committee Chairman Jeff Miller’s apparent belief that firing VHA leaders is the solution to any access problems). The report noted that “inflexibility in budgeting stem[med] from the congressional appropriation processes,” and concluded that the hastily designed and implemented Veterans Choice Program, “further complicated the situation and resulted in confusion among veterans, VA employees, and non-VA providers.”
Though it received no media attention, another positive report on the VHA came this month from the Joint Commission, the independent nonprofit that accredits U.S. hospitals and health-care organizations. After surveying the VHA between 2014 and 2015, the commission found improvements in access, timeliness, and coordination of care, as well as in leadership, safety, staffing, and competency.
Finally, the Association of VA Psychology Leaders, the Association of VA Social Workers, and unions representing VA employees issued a policy brief opposing the Commission on Care’s proposal to create a new VHA Care System, which would ultimately channel up to 60 percent of eligible veterans into private-sector health care. Two independent national groups, the American Psychological Association (APA) and the National Association of Social Workers, also signed the policy paper.
In an email, Heather O’Beirne Kelly, the APA’s lead psychologist on military and veterans policy, told The American Prospect that the APA “is opposed to the primary recommendation of the Commission on Care’s report, which we feel would in effect disassemble one of the most successful, innovative features of current VA care: the primary care/mental health integrated approach.”
Every report on the VHA over the past two years has documented that the system provides care equal to or superior to private-sector care, and have spotlighted significant improvements in problematic practices that led to two years of scandal-mongering on Capital Hill and in the national media. But instead of lauding the VHA for its progress and working to sustain the system, federal lawmakers and critics are quick to jump on any hint of a glitch and lambast the VHA for not changing more rapidly, steadfastly ignoring the fact that changing the culture of any institution, particularly that of America’s largest health-care system, must take years.
Sustained improvement will also require transformations in the congressional budgeting process and dramatic shifts in health-care policy. As The New York Times reported in 2014, shortages in the physician workforce have made lengthy waits to get an appointment “the norm in many parts of American medicine.” If Congress is serious about protecting veterans, it must immediately appropriate more money so that VHA can offer salaries competitive with those in the private sector, as even the Commission on Care recommends, and allocate more medical residency training slots to primary, geriatric, and palliative care.
The narrative of a VHA that is broken beyond repair that the news media and some federal lawmakers insist on does not acknowledge that the VHA is a national or global leader in fields like telemedicine, mental health, primary and geriatric care, and reducing opioid use. Why would anyone want to work in a system depicted as broken beyond repair, doomed to disappear, and filled with demoralized staff? That overwrought story discourages nurse practitioners, social workers, psychologists, and other professionals from working at the VHA.