As Crossfire Is Exchanged at VA, Don't Forget About the Vets
An ethics scandal is rocking the U.S. Department of Veterans Affairs, some outside groups are moving to oust the Secretary, and power struggles rage both within the VA and between VA staff and the White House. Meanwhile, the real health needs of veterans are getting lost in the fog of war. It’s time to get back on track.
At the heart of the VA fracas is an ideological clash over the future of the system: whether to preserve it largely as is or to privatize VA health care. But this approach sets up a false choice between the VA and private providers. Veterans shouldn’t have to choose one or the other, and indeed, most don’t. About half of veterans want to get care in their communities, while the other half prefer the VA. As just one example, my colleague, a U.S. Marine veteran, goes to the VA for some types of care but chooses to get mental health services from a private provider in his own community.
The views of veterans themselves should always be the VA’s North Star, and they are not willing to write off VA hospitals. Nor should they. The evidence shows, and veterans agree, that the VA generally delivers care that is at least comparable to and often better than private care. Recent research shows that private care is neither safer nor more efficient than VA care. VA health care, for example, outperforms private sector care on more than 95 percent of measures of outpatient treatment such as diabetes care and cancer screenings.
But veterans also want community-based options. For some, the nearest VA facility is too far away from home. Others want to get their care in the same place as their spouses and children; they don’t want their family’s care to be fragmented. Still others don’t want the stigma associated with getting care from the VA, especially for mental health issues. These preferences are practical, not ideological. Veterans should not be asked to sacrifice their health for an ideological agenda.
Rather than battling about where veterans get their health care, policymakers should focus on improving the quality of care for veterans — wherever they choose to get it. The VA and community-based providers shouldn’t exist in separate orbits that result in fragmented and uncoordinated care. They need to exchange clinical information, especially about prescription medications, including opioids. Furthermore, non-VA providers need cultural competency training to deliver care that better meets the needs of veterans. These are problems fixable within our current systems of care, not insurmountable obstacles that warrant blowing everything up.
Fostering public-private partnerships between VA and non-VA providers will improve and coordinate care. One such partnership has already proven successful in confronting challenges veterans and their families face. Behavioral health problems, family reintegration difficulties, and relationship problems are common in veteran families, but family members are generally not eligible for VA services and must seek care elsewhere. Northwell Health and the Northport VA Medical Center on Long Island responded by partnering to create the Unified Behavioral Health Center. They coordinated public and private behavioral health services in a single location. Veterans and their family members show up at the same door; veterans are directed to the left, civilians to the right, and everyone gets the care they need. Patients — both civilians and veterans — are showing improved behavioral health symptoms and they report being satisfied with their care.
Scandals make headlines, but they don’t make veterans healthier. The VA needs to refocus its time, talents, and resources on a coordinated system of care that is accessible to all veterans. Wars are fought over conflicting ideologies, but the veterans of those wars have already served their country. Let’s serve them by supporting a strong, accessible, and high-quality VA that works in tandem with community-based private care.
Our veterans fought to protect our lives; we shouldn’t make them fight for their own health care.
David Sandman, Ph.D., is President and CEO of the New York State Health Foundation.
