VA hospital in Waco
Credit: Larry D. Moore/Wikimedia Commons

Two years ago, in the wake of a VA scandal involving employees at some VHA hospitals fudging data over long wait times, Congress passed legislation that attempted to reform the system. It did so in two main ways.

First, it created a so-called “Choice Program,” whereby vets who live more than 40 miles from a VA facility or had to wait more than 30 days for an appointment would be eligible to receive care from private doctors outside the VA system. This was widely seen as a trial run at outsourcing most or all VA health care

Second, the law empaneled an independent Commission on Care to study the VA and recommend sweeping reforms, with privatization very much on the agenda. Indeed, representatives from two Koch brothers-allied pro-privatization groups were given seats on the commission, as were several executives from major medical centers that stand to profit from outsourcing VA care. The fix, it seemed, was in.

Neither the Choice Program’s implementation nor the Commission on Care’s deliberations has gotten much coverage in the mainstream media. But as regular Washington Monthly readers know, we’ve been watching both very closely indeed.

Among other things, we reported that research commissioned by Congress and ratified by the Commission concluded that while the VA has major problems, such as severe shortages of some doctors, VA health care nevertheless performs as well or better than the private sector on nearly every metric of quality, including average wait times to see doctors.

Meanwhile, the presidential candidates also took positions on the VA issue. Donald Trump’s campaign backed aggressive privatization. Hillary Clinton, by contrast, announced her opposition to privatization but support for expanding existing “purchased care” programs wherein the VA contracts with outside providers to alleviate care shortages but maintains tight oversight to guarantee information-sharing, care integration, and quality and cost controls.

On Wednesday, the Commission released its final report. To the surprise of most observers, the commission rejected privatization as the solution. While detailing a host of serious failings with the VA, the report notes that “care delivered by VA is in many ways comparable or better in clinical quality to that generally available in the private sector.” It concludes that the new Choice Program was “flawed” in both its design and execution, adding that “the program has aggravated wait times and frustrated veterans, private-sector health care providers participating in networks, and V.H.A. alike.” Rather than wholesale outsourcing, the report recommends addressing issues of access by “standing up integrated veteran-centric, community-based delivery networks,” a plan roughly similar to the one Hillary Clinton had called for.

The lead editorial in yesterday’s New York Times sums up the commission’s report thusly:

The V.A. is troubled, no question. But the commission properly stops short of recommending a solution dear to ideologues on the right, which is to dismantle one of the largest bureaucracies in American government — one with a critically important mission — and hand the wreckage to the private sector.

In addition, the report calls for Congress to create an independent governing board to assume overall leadership of VA. Such a board could be a force for good or mischief depending on who’s on it; or, more likely, a Potemkin village, since Congress is unlikely to agree to cede any of its power to micromanage the VA to some board.

More interestingly, the report also recommends Congress create a separate commission to consider changing VA eligibility requirements. The aim would be to both simplify the often-onerous process vets must go through to get into the VA system, and to explore allowing individuals who do not currently qualify for VA health care—veterans’ family members, people on Medicare–to “buy into” the program using their existing insurance. The latter idea would not only provide more patients for the VA in underutilized facilities but could act as a kind of “public option” not unlike the proposal that Hillary floated this spring to allow 50-65 years old to buy into Medicare. But instead of subsidizing corporate medicine, as Medicare essentially does, a VA-style public option would strengthen the VA.

Longtime Washington Monthly readers may remember that senior editor Phil Longman, author of the definitive book on the contemporary VA, proposed a version of this idea back in 2007 as an alternative path to universal health care. That this idea has now found its way into the commission’s recommendations is no coincidence, since Longman was a member of the commission and a major force in shaping its outcome.

We’ll have more to say about this landmark report in the coming days. For the moment, I just want to note this stunning defeat of conservative anti-government ideology and savor an important victory for evidence-based good government.

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Paul Glastris

Paul Glastris is the editor in chief of the Washington Monthly. A former speechwriter for President Bill Clinton, he is writing a book on America’s involvement in the Greek War of Independence.