President Obama and Veterans Affairs Secretary Robert McDonald. (Dennis Brack/ European Pressphoto Agency)

Veterans who are seeking care for everything from post-traumatic stress disorder to cancer may face even longer wait times in the coming years for help from the overburdened Department of Veterans Affairs, according to a highly critical 4,000-page VA-commissioned study of veterans health care.

The report finds that VA facilities cost twice the normal amount for public facilities, a claim that is likely to reignite a debate about moving toward privatizing some VA services. The findings also contradict the department’s claim that most patients are satisfied with the care they receive.

The wide-ranging study was commissioned after VA’s largest scandal sparked national outrage and shook up the agency tasked with caring for former troops.

[Read the full report here]

The study represents the best collection of information and analysis of the care system for veterans since at least the Dole-Shalala report in 2007, said Phillip Carter, a veteran and senior fellow and counsel at the Center for a New American Security.

“It’s an enormous report that shows the range of stresses on the VA, from demographic change among veterans to leadership and culture challenges within the VA health system,” Carter said.

“The big questions are whether [Veterans Affairs Secretary Robert] McDonald’s reform efforts are enough to fix these issues, and whether these reforms have enough time to work before a new leadership team takes over VA in 2017,” he added.

The report says that on six of 10 patient-centered measures, patients in VA hospitals on average reported significantly less-favorable experiences with the care they received than did patients in non-VA hospitals.

It also includes quotes from employees highlighting the need for whistleblowers to be protected and to feel secure in shining the light on problems. VA employees’ fear of retaliation led to the wait-times scandal last year, veterans groups and VA employees say.

“At almost every facility visited, at least one leader interviewed mentioned that risk aversion and a reluctance to ‘speak up’ were a significant issue. . . . This culture permeates across all levels — from the front-lines, to Medical Center leaders, to people at the VHA Central Office — and it contributes to a lack of innovation and best-practice dissemination across the organization,” the report says.

The report also says: “VHA providers are expected to see between 10 and 12 patients per day. In the typical fee-for-service care model in the private sector, it is common to plan for 24 visits per day.”

House Veterans’ Affairs Committee Chairman Jeff Miller (R-Fla.) and Senate Veterans’ Affairs Committee Chairman Johnny Isakson (R-Ga.) released a joint statement on the report, which was done as part of the Veterans Access, Choice and Accountability Act of 2014.

“When we requested an independent assessment over a year ago, many of the failures at individual hospitals were well-documented. However, we all feared that they were just the tip of the iceberg,” the statement said.

The “in-depth review justifies those fears, and validates Congress’ efforts for years to investigate and uncover the many serious issues preventing the Department of Veterans Affairs from providing America’s veterans with quality, timely healthcare. The VA can no longer deny that its problems, as outlined in this report, are deep-seated and systemic,” the statement continues.

The statement added that the agency is “challenged on every level.”

“This is not just another report to sit on a shelf collecting dust,” the statement says. “Failing to act on its findings would be a great disservice to the men and women who have worn the uniform and to the values that make our nation great.”

Concerned Veterans for America, a politically right-leaning group that has been pushing to have VA hospitals compete for patient business with private health-care providers, said the report was “yet another indictment of the VHA’s current inability to deliver timely, quality health care to our nation’s veterans,” and called for nothing less than a “system-wide reworking.”

Former VA secretary Eric K. Shinseki resigned amid the national scandal over veterans’ health care. His replacement, McDonald, has promised wide-ranging reforms. Veterans groups say that McDonald is working hard to make the changes, even if they have been slow to trickle through the enormous health-care system, the largest in the country.

The report was paid for and commissioned by VA, but it was conducted independently by the Rand, McKinsey and Mitre corporations.