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The political fight over VA privatization

The question for policymakers is whether to fix the VA system or dismantle it through privatization. Republicans and veterans' groups disagree on the answer.
Exterior view of the Veterans Affairs Medical Center on May 8, 2014 in Phoenix, Arizona.
Exterior view of the Veterans Affairs Medical Center on May 8, 2014 in Phoenix, Arizona.
When I argued last week that privatizing veterans' care was a bad idea, a conservative reader pushed back. It's easy for me to say, he argued, since I don't have to "wait in line for VA care."
That's true; I don't. But there are quite a few groups that represent veterans' interests, including many who do have to wait in line for VA care, and they remain opposed to privatization, too.
The notion that privatizing veterans' care is the ideal solution is quickly rising on the list of Republican talking points. It started with Fox News and Sen. John McCain (R-Ariz.), a longtime proponent of the change, but the push has generated broader GOP support in recent days, including an endorsement of sorts from House Speaker John Boehner (R-Ohio).
"I still like the idea [of privatization], and especially now," the Speaker told reporters this week.
The basic idea will sound familiar: many Republicans like the idea of veterans receiving private care, which would be subsidized (in part or in whole) with public funds. VA facilities may still exist under the plan, but with fewer resources, and obviously fewer patients.
As German Lopez explained, veterans' advocates, who have long opposed privatization, haven't changed their minds -- they see this was an approach that would "undercut a system that specializes in veterans' needs."

If veterans opted to use private facilities instead of those the VA operates, federal officials could decide that the public system isn't covering as many patients and therefore doesn't need as much money. "The more money we spend out on the private sector on veterans, the less money there is to care for those that are within the system," says Joe Violante, national legislative director for Disabled American Veterans. Another concern: hospitals that see the general public won't have the expertise to treat the specific issues plaguing veterans. A typical VA patient "might have a spinal cord injury, plus an orthopedic issue, plus a mental health issue. They're a multifaceted patient," Carl Blake of Paralyzed Veterans of America explains. "The VA is a system constructed to provide holistic care for the life of that patient. The private system is not constructed with those ideas in mind."

If the VA system offered substandard care, this would be a very different kind of conversation, but it doesn't.
As we discussed last week, the quality of care through the VA is arguably among the best, if not the very best, available anywhere. Surveys have found that veterans overwhelmingly agree.
Again, the recent scandal is less about VA services and more about access to those services. Veterans and their families are outraged -- as we should all be -- by the delays in the delivery of treatments, not by the quality of the treatments themselves.
Suzanne Gordon had a good piece this week arguing, "[R]egardless of what went wrong at any VA facility, turning veterans over to private sector insurers and for-profit hospitals is not the solution."
To clarify an important detail, this is not to suggest the private sector can't play a role in a pinch. Indeed, the Obama administration announced over Memorial Day weekend that it would direct some veterans to private hospitals in the short term in order to "take some pressure off" the backlogged VA system. This isn't even all that unusual -- the Associated Press reported that about 90% of the VA budget is spent on VA facilities, but the rest funds care at other hospitals and clinics.
But this is about filling in gaps, not privatizing an entire medical system.
The question for policymakers, then, is whether to fix the VA system or dismantle it through privatization. A growing number of Republicans prefer the latter; veterans' groups insist on the former.