As the nation celebrates Veterans Day, the future of the health care system, upon which over nine million veterans depend, is in doubt. A variety of bills in Congress are calling for the full or partial privatization of the Veterans Health Administration (VHA)—the nation’s largest and only fully integrated healthcare system.
The Trump administration has taken an ambiguous position on VHA privatization. While insisting that he does not want to privatize the VHA, President Trump says he wants to triple the number of veterans who receive private healthcare. More disturbing is the fact that VA leadership is starving hospitals and programs of needed resources and staff. The VHA, for example, currently has over 34,000 vacancies. With the support of many Democrats, by next year the VHA as we know it may be on its way to extinction.
As Congress and the press litigate the future of the VHA, they continue to have the wrong conversation based on a total misrepresentation of the VHA’s record in providing quality care to veterans. The truth—documented by study after study—is that the VA healthcare is not only equal, but also often superior to that provided by private sector hospitals and doctors. As we have written in a report on the VHA for the American Legion, in many areas—mental health and coordinated, team-based primary care, geriatric care, end-of-life care, and homeless programs—the VHA provides care that is unparalleled in the private sector.
The VHA has received a drubbing in the press and on Capitol Hill for its wait time problems. While it is true that some veterans have had some problems with wait times in some regions of the country, the problem was vastly exaggerated by conservative enemies of government-provided health care and has been largely remedied since. In the VHA, the average time it takes to get an appointment with a primary care doctor is five days. To see a specialist it takes about 8.8 days while, on average, veterans wait four days for a mental health appointment.
In the private sector, the average wait time for a first appointment with a physician is 24 days. One study documented that one in four Americans report that it takes them six days to see a primary care physician even when they’re sick. In Boston it can take 109 days to see a family practice doctor and almost a year to see a cardiologist who is taking new patients.
As for mental healthcare, the situation is even more parlous. Due to shortages of mental health professionals, 40 percent of those who suffer from schizophrenia and 51 percent of people with bi-polar disorder go untreated in any given year. Seventy-seven percent of US counties have shortages of psychiatrists, psychologists and social workers and 55 percent (all of them rural) have none at all.
The VHA, on the other hand, is arguably the only fully functioning mental health care system in America. It is certainly the only healthcare system in which the majority of providers deliver evidence-based therapies for PTSD, depression and other mental and behavioral health problems and the only system whose mental health professionals understand military culture and its impact on the treatment of mental illness. It is therefore hardly surprising that a 2015 study of how often appropriate drugs are prescribed to mentally ill patients found that “in every case, VA performance was superior to that of the private sector by more than 30 percent.”
Those with serious chronic and acute physical illnesses also fare better in the VHA than outside of it. One study recently documented that men with heart failure, heart attacks, or pneumonia were less likely to die if treated at a VA hospital rather than a non-VA hospital. The VHA’s model of team based care means that patients with diabetes are better coached in how to take their insulin correctly, effectively monitor their blood sugar levels, and get necessary foot and eye exams. They thus have better outcomes than patients who have private insurance or Medicare.
The VHA is also the only healthcare system that attends to the social and economic needs of veterans through things like its homeless programs, which provide not only shelter, but also social work support to follow chronically homeless veterans. The VHA has a variety of programs to prevent veteran homelessness and deal with legal issues, and uses texting to make sure homeless veterans make it to medical appointments.
As Congress and the Trump administration debate the future of the VHA, political representations must ask the question, compared to what? The assumption is that private health care is always superior to anything the government can deliver. The facts, however, tell us a very different story.