A congressionally mandated commission offers two views of health care provided by the Department of Veterans Affairs (VA).

Care for veterans is “in many ways comparable or better in clinical quality to that generally available in the private sector.”

At the same time, VA health care, operated by the department’s Veterans Health Administration (VHA), needs “fundamental, dramatic change — change that requires new direction, new investment, and profound reengineering.”

The statements seem to clash, but they both can be true as the 300-page Commission on Care report documents. The point is, no matter how good the care, it could be much better particularly when it comes to access.

The 12-member commission, appointed by President Obama and members of Congress, said access to health care is the VA’s “most public and glaring deficiency.” Access was at the heart of the scandal over the cover-up of long wait times that two years later continues to rock the department and led to the resignation of the former VA secretary.

The commission’s first recommendation is to create a system of “high-performing, integrated, community-based health care networks.” Increased use of community-based providers would right “a misalignment of capacity and demand that threatens to become worse over time. Some facilities and services have low volumes of care that can create quality concerns, and in high demand areas, VHA often lacks the capacity to avoid lengthy wait times and other access issues.”

Community-based providers include VA facilities, “Department of Defense and other federally funded providers and facilities, and VHA‐credentialed community providers and facilities,” according to the report.

The same law, known as the Choice Act, that created the commission encouraged broader use of private-sector health care by veterans. Approved during the heat of the scandal in 2014, it allowed the use of private health care by veterans who live at least 40 miles from the nearest VA facility and who cannot be seen within 30 days.

But the “design and implementation of the law have proven to be flawed,” according to the report.

Instead of making things better, “in execution, the program has aggravated wait times and frustrated veterans, private-sector health care providers participating in networks, and VHA alike.”

Rep. Jeff Miller (R-Fla.), chairman of the House Veterans’ Affairs Committee and a prime mover of the Choice Act, said the report “makes it abundantly clear that the problems plaguing Department of Veterans Affairs medical care are severe.”

One problem is the management of the private sector provision he pushed was contracted out to two companies, “thus blurring lines of responsibility and leaving both patients and providers confused about who exactly holds responsibility for what.”

Another issue is a shortage of health care professionals and support staff. Too few support staffers means “doctors and nurses often escort patients; clean examination rooms; take vital signs; schedule; document care; and place the orders for consultations, prescriptions.”

The commission also cited a 2007 VHA report that found racial and ethnic health care disparities. The new report said the department should establish “health care equity as a strategic priority.”

On the workforce, the report suggested placing VHA employees under a section of the law, known as Title 38, which would allow the agency greater flexibility in pay and hiring and firing. Currently, many of those staffers are under another section, Title 5, which “was not created with a modern health care delivery system in mind,” according to the report.

VA Secretary Robert A. McDonald welcomed the report, saying many of its recommendations are in-line with his efforts “to transform the VA into a Veteran-centric organization.” Now, according to McDonald’s statement, 90 percent of veterans surveyed say they are “‘satisfied or completely satisfied’ with the timeliness of their appointments.”

“However, until all Veterans say they are satisfied,” he added, “I won’t be satisfied. Nobody at VA will be satisfied.”

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