New legislation threatens to dismantle the most successful American experiment in government-delivered health care.Last June, President Trump signed the VA Mission Act, commonly considered the biggest overhaul of veterans’ health care in a generation. Mission was designed to replace the hastily enacted Veterans Choice Program of 2014, which has made it easier for veterans to get care in the private sector if they lack fast or easy access to care inside the Veterans Health Administration (VHA).
Choice was a temporary program, one that would offer supplementary private care to veterans while Congress bolstered the VA’s capacity. Yet this work has not happened. Instead, Mission is making permanent the privatizing principles set forth in Choice.
The logical conclusion from the Mission is not as its boosters claim, to shore up the VA for the future and create a system that would be “veteran centric,” but to tear down the agency, brick by brick, visit by visit. This strategy will not only erase what has been the most successful American experiment in government-delivered health care, but will also send veterans out into a private system that is more expensive, less accountable, and unable to meet their particular needs.
The key notion underpinning the Mission Act, that the private sector can offer comparable care to the VHA, is deeply flawed. Study after study (after study) has found that the VHA generally outperforms the private sector on key quality metrics, and that private providers are woefully unprepared to treat the often unique and difficult veteran patient population. The most recent evidence came in a Dartmouth College study published in December, which compared performance between VHA and private hospitals in 121 regions across the country. The results: In 14 out of 15 measures, government care fared “significantly better” than private hospitals.