[Former Gov. Jeb] Bush, sitting in front of an untouched breakfast at an IHOP in Colorado Springs, told a group of veterans that he favors transferring some elements of veterans' care to private hospitals from government-run Veterans Affairs facilities. "This is where I think empowering people with the equivalent of a voucher that gives you the same economic benefit of receiving care inside of a clinic or a hospital," Mr. Bush said in a video of the public event recorded by the Democratic firm American Bridge. "If you had a chance to go to another place where the money followed the patient, it would give the veterans — you wouldn't have these kind of hostile reactions, my job is protected for life, don't mess with it."
On Veterans' Day 2011, then-presidential candidate Mitt Romney was in South Carolina, visiting with roughly a dozen veterans, and raised the prospect of privatizing VA care.
"Sometimes you wonder," the Republican said, "would there be some way to introduce some private sector competition, somebody else that could come in and say, you know each soldier gets X thousand dollars attributed to them and then they can choose whether they want to go on the government system or the private system and then it follows them."
Almost immediately, a spokesperson for Veterans Of Foreign Wars announced its opposition to the idea: "The VFW doesn't support privatization of veterans health care." That was that -- Romney backpedaled soon after, saying he was just kicking around a hypothetical scenario he didn't intend to pursue.
Four years later, however, the idea is apparently increasingly popular among the new crop of Republican presidential candidates.
The Florida Republican made a similar comment last month, telling a New Hampshire audience, "I know it has a pejorative for some, but I'm all in on the voucher thing."
The Wall Street Journal report added that Sens. Marco Rubio and Rand Paul have also voiced support for expanded privatization of veterans' care, which is also a top priority for a conservative group called Concerned Veterans for America, which is backed by the Koch brothers.
The fact that the political winds have shifted to this degree is itself interesting. In the last presidential cycle, Romney was kinda sorta open to the idea of privatization for about a day before the VFW scared him into reversing course. Now, we have multiple candidates endorsing the idea more forcefully and sticking to the position.
Much of this is no doubt the result of the recent controversy surrounding the VA system, coupled with Republican politics continuing to move to the right.
But if this is going to be an issue debated in the 2016 cycle, let's not forget a detail that often goes overlooked: there's a difference between the quality of VA care and the quality of the VA system in delivering that care.
As we discussed last May, there’s an apparent belief among some that veterans receive sub-standard treatment at VA facilities, but the evidence clearly shows otherwise. The editorial board of the Washington Post noted a while back that the VA system “as a whole outperforms the rest of the health care system by just about every metric. Surveys also show that veterans give VA hospitals and clinics a higher customer satisfaction than patients give private-sector hospitals.”
Those conclusions are bolstered by ample data. In 2012, RAND Corp. found in nearly every category, “VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up.” There was also Philip Longman’s 2005 report in the Washington Monthly, highlighting research from the New England Journal of Medicine, which found the quality of care in VA facilities was “significantly better” than private counterparts.
Jon Perr published a detailed Daily Kos piece on the subject last year: “Sending millions of older, sicker Americans – many of them requiring specialized care for rare and complex health problems – into the waiting arms of private insurers, private doctors and private pharmaceutical firms is a recipe for chaos and de facto rationing on a grand scale.”
As this takes root as a part of the GOP's 2016 platform, let's keep these relevant details in mind.