Controversy is swirling around the excessive wait times for medical appointments at the Veterans Health Administration (VHA), where some veterans may have died waiting for health services on secret lists that clinics maintained to hide long delays. The revelations sparked bipartisan outrage, embarrassed the White House, and have led some lawmakers to argue that the government can never effectively deliver health care services.
But a closer examination of the problems plaguing VHA, along with interviews with veterans and their advocates, reveals a far more nuanced and complicated picture of the successes and failures of the nation’s largest integrated health care network. While veterans have struggled to gain adequate access to care since the Kennedy administration, plagued by staffing shortages, delays and funding shortfalls, the health services they do receive are the best in the nation. That dynamic has pushed many veterans into a love-hate relationship with the organization they depend on.
“Most veterans are very pleased with the care they receive, but when it comes to standing in line, they do and should rightfully expect to be seen as quickly as possible, especially if the wound, illness or injury could worsen,” Joe Davis, Public Affairs Director for Veterans of Foreign Wars (VFW), said.
He pointed to the annual Independent Budget, a dream budget published by four leading veteran organizations. It has consistently found that the VA serves as “a model health-care provider that has led the way in various areas of medical research, specialized services, and health-care technology.” It provides “quality and expertise on veterans’ health care” that “cannot be adequately duplicated in the private sector” and has become “the most efficient and cost-effective health-care system in the nation,” the document notes. A 2005 survey from the RAND Corporation similarly found that “VA patients were more likely to receive recommended care” and “received consistently better care across the board, including screening, diagnosis, treatment and follow up.” The VA also outperforms the nation’s health care system in delivering chronic and preventive care, treating diabetes.
A 2013 survey released by the U.S. Department of Veterans Affairs found that 93 percent of veterans who use the VA health care system have a favorable impression of it. A forthcoming independent survey of veterans scheduled to be released next month by Iraq and Afghanistan Veterans of America (IAVA) will echo that sense, a spokesperson for the organization confirmed to ThinkProgress.
In fact, even lawmakers who are traditionally hostile to government sponsored health care recognize the importance of the VA’s health benefit.
Though he shut down the government in October in an effort to derail the Affordable Care Act, Sen. Ted Cruz (R-TX) proudly supported piecemeal legislation to fully fund the VA, arguing during his talkathon that “the VA is a vital government system, it is a promise we have made and it is unrelated to Obamacare.” That same sentiment has been echoed by the likes of Mitt Romney, Newt Gingrich, Rick Perry, Rick Santorum, Michele Bachmann and Weekly Standard editor Bill Kristol — all of whom have championed the VA health care system.
Ultimately, the problem is one of access, not care — and it’s been plaguing the agency for decades.
“This is not a new problem, this is a decades old problem,” Lauren Augustine, an Iraq War vet and Legislative Associate with IAVA, said. “And yet it hasn’t been adequately addressed because it keeps happening. There’s a lot of problems with access,” she admitted. “The VA has very outdated technology that it uses to not only work with veterans, but schedule appointments with veterans.”
The agency did not fully implement digital processing of claims nationwide until 2013 and, Augustine noted, uses a “trying process” to employ new staff, contributing to the lack of providers. Davis, of the VFW pointed to crumbling and underfunded facilities, arguing that the provider shortage at the VA is no different than the doctor and nursing shortages plaguing the rest of the health care system.
In March, the nation’s leading veterans organizations — the authors of the Independent Budget — expressed alarm that Congress and the Obama administration are underfunding the VA’s construction accounts, raising concerns that “the serious lack of commitment to infrastructure funding to support the system will undermine the VA’s ability to deliver those services.” President Obama’s overall budget request for VA for FY 2015 is approximately $4.5 billion less than what the groups recommended for overall discretionary spending, though the administration has increased the VA budget by 58 percent since 2009. During the same time, as the administration made it easier for veterans to receive compensation for post-traumatic stress disorder and exposure to Agent Orange, and brought troops back from Iraq and Afghanistan, claims soared.
The tension between poor access and quality care is all too familiar to Patrick Murphy, a former Pennsylvania Congressman who is active on veterans issue and is a Senior Fellow at the Center for American Progress. Murphy was at the VA in Philadelphia just last week and noted that the facilities “truly have some of the best doctors and nurses around.” But he’s also all too familiar with the struggles some face in receiving treatment.
As a result, Murphy is calling on Obama to use his executive powers to temporarily expand the Patient-Centered Community Care (PCCC) initiative, which allows VA medical centers to purchase non-VA medical care for Veterans through contracted medical providers when VA care is not readily available. That, along with structural reforms to address staff shortages that inspire doctors to see the VA as a public service, could go a long way toward ensuring that all veterans have access to some of the best medical care in the world.
Update:
This article has been updated to clarify that the VA fully implemented digital processing of claims in 2013. It embraced the technology in 2010.