Bill Frist, a Republican, represented Tennessee in the Senate from 1995 to 2007 and was Senate majority leader from 2003 to 2007. Jim Marshall, a Democrat, represented Georgia in the House from 2003 to 2011.
Imagine how we would meet the service-related health-care needs of military veterans if we had a clean slate and were considering the question for the first time. The answer is obvious. Just as we do with veterans’ educational benefits, we would use the private sector. We would never create something like the Veterans Health Administration (VHA) that exists today.
But we are not writing on a clean slate. The United States owns and operates the highly bureaucratic and inefficient VHA, a legacy institution that badly needs reform. Last year’s legislation expanding health-care choice for select veterans and holding senior VHA executives accountable was a step in the right direction. But some of its key measures are temporary or are not being fully utilized or implemented efficiently.
If endless funding, more personnel or piecemeal reforms were the answer, the VHA wouldn’t be failing. Since 2006, the budget for the Department of Veterans Affairs, which oversees the VHA, has ballooned by a staggering $91 billion, and the VA has added 101,000 employees. This growth has coincided with worsening care for a shrinking veterans population. Bolder reforms are sorely needed to improve the convenience, timeliness and quality of care received by veterans with health needs resulting from their service.
We think there are two ways to confront these challenges: Implement piecemeal reforms to tinker with the current system, or advance fundamental reforms that use new incentives, real accountability and veterans’ choice to challenge — and transform — an underperforming system. We enthusiastically choose the latter.
For the past six months we have undertaken a comprehensive study of veterans’ health care as the leaders of the bipartisan Fixing Veterans Health Care task force, which was convened by the national veteran advocacy organization Concerned Veterans for America. The task force had a clear charge: Identify challenges to veterans’ health care, and propose concrete fixes centered on the veteran, not the VHA bureaucracy. Thursday, we released our report.
This mission led us to a number of core principles, including putting the needs of veterans ahead of the needs of the system; prioritizing veterans with health needs connected to their service; empowering veterans to choose where they receive care; overhauling the VHA to ensure that it can compete with the private sector; and grandfathering current enrollees into today’s system.
Our task force coalesced around a package of three major reforms we’re calling the Veterans Independence Act:
●Give veterans the option to seek private health coverage using VA funds. Veterans should have the choice to spend their service-connected funding wherever they choose. Veterans’ education benefits are an attractive model for the type of reform we propose. Through the GI Bill, eligible veterans can use taxpayer dollars to pursue education at the accredited academic institution of their choice. The VA determines eligibility, ensures that academic institutions meet certain standards and monitors the payment process. The VA does not, however, require veterans to receive their education through a “Veterans University” or otherwise specify which schools veterans can attend.
●We should restructure the VHA as an independent, government-chartered nonprofit corporation. Today the VHA has to deliver health care while constrained by bureaucratic and political priorities. Becoming an independent entity that competes for customers would liberate the VHA to make its own decisions on personnel, facilities and priorities — all in the interest of serving eligible veterans better. In addition, separating the VHA into two entities — as a provider of health-care services and as a separate payer of health-insurance premiums and claims — would streamline operations and eliminate perverse incentives.
●Refocus veterans’ health care on those with health needs connected to their military service. The VA’s original mission was to provide health care for those who bear the physical and mental scars of war. However, for decades, often in order to justify its existence, the VHA has expanded eligibility beyond service-related health needs. We strongly believe veterans with service-connected health needs should be prioritized, permitting the VHA to focus on providing quality and timely care to eligible veterans who need it most.
As a former VHA staff surgeon (Frist) and a former U.S. Army Ranger (Marshall), we joined this task force because we believe in the VA’s mission. In learning about the history of the agency and its many iterations, it was easy to see how the VHA’s current configuration grew out of legislation passed to address immediate needs and competing election cycles. The best way to “fix” the VA is to focus on Abraham Lincoln’s promise “to care for him who shall have borne the battle,” not the agency that dispenses his benefits.