Anthony J. Principi served as secretary of Veterans Affairs from 2001 to 2005 and was chairman of the 2005 Base Realignment and Closure Commission.


The Department of Veterans Affairs in Phoenix. (Matt York/AP)

Last month, President Trump nominated Navy Adm. Ronny L. Jackson to be the 10th secretary of veterans affairs. As the fourth VA secretary, I wish him well.

The agency is not broken, as many outside commentators seem to think. The department provides world-class health care to more than 6 million patients every year and disability compensation to more than 4.6 million veterans. It administers nearly 3 million home loans annually, is helping nearly 950,000 veterans attend school and maintains 135 cemeteries as national shrines.

However, Jackson would face significant challenges. The agency is in desperate need of restructuring. The president’s budget request for fiscal 2019 for Veterans Affairs is $198.6 billion — more than three times what it was in 2004 when I left the agency . This is despite the fact that there were 26 million living veterans in 2004 and 20 million today.

With courage, Jackson, Congress and the administration could stop the continued upward spiral of VA appropriations. Here’s how:

First, close unneeded facilities. The agency is no longer a hospital-centric organization; the department’s health-care offerings have been significantly decentralized. Dollars that could be used for 21st-century health care are instead used to maintain outmoded infrastructure. We are spending too much money on bricks and mortar rather than doctors and nurses. A bipartisan proposal omitted from the omnibus funding bill would have provided a systematic review of VA’s infrastructure with recommendations on closing or modifying old facilities and opening new ones where needed. It should be revived.

Second, refocus the compensation system. The spouses of heroic men and women killed fighting in Iraq and Afghanistan receive the same level of death and indemnity compensation as those of my comrades who die of prostate cancer later in life that may be unrelated to their service in Vietnam many years ago. Such inequalities will cause the American people to question the entire rationale behind the veterans disability compensation system, which is still based on principles developed in 1917.

We need a compensation system that understands today’s economic realities. It should promote wellness and reintegration into the workforce, not isolation from it. And it should meets the economic and quality-of-life needs of veterans permanently disabled by their service.

Third, consider fully integrating the health-care systems for the VA and Defense departments. The cost of running the two systems, which serve the same people at different points in their lives, now costs taxpayers more than $125 billion annually. The ongoing effort to move the health-care systems of both departments onto the same electronic medical record system is encouraging, but that is only the first step.

We need integrated management systems, increased purchasing clout for pharmaceuticals and medical supplies, jointly developed community-provider networks, and the opportunity to share high-cost medical equipment and health-care facilities. All of this will save taxpayers money and allow both systems to refocus their efforts on providing world-class care.

Finally, better integrate private providers into the VA health-care system. We cannot and should not privatize care for veterans. VA plays an important role in spinal cord injury, mental health, medical education and research. But as a task force suggested in 2016, we could give every eligible veteran the opportunity to receive health care from private providers, while also giving them the option to use the VA health system if they so choose.

What we must do is create a balanced public-private partnership under the control of an agency that insures we provide the highest quality of care — and timely access to that care. The Veterans Choice Program was not intended to privatize the veterans system; it was to ensure that community care would be accessible for veterans who would otherwise have to wait more than 30 days or drive more than 40 miles for care. Congress could expand that program further.

Maybe not today, but soon, the combination of decreasing numbers of veterans and increasing costs will draw the attention of budget-cutters on both sides of the aisle on Capitol Hill. Those who resist needed reforms should know that if the agency does not change, its future is in doubt.We need to fix the problems VA faces and not simply throw money at them.

We need to ensure Abraham Lincoln’s 1865 commitment “to care for him who shall have borne the battle, and for his widow, and his orphan” is preserved in our generation and for generations to come.