Trump policies do not aim to “privatize” the agency but simply provide veterans the best care possible
Veterans Affairs secretary: VA health care will not be privatized on our watch
We are ramping up internal VA capacity along with private referrals. Critics don’t want to lose all that VA has to offer. I don’t either, and we won’t.
s a physician, my professional assessment is that the Department of Veterans Affairs has made significant progress over the past six months — but it still requires intensive care. In order to restore the VA’s health, we must strengthen its ability to provide timely and high quality medical care while improving experiences and outcomes for veterans.
I believe the best way to achieve this goal is to build an integrated system that allows veterans to get the best health care possible, whether it comes from the VA or the private sector.
This is not a novel idea. No health care provider delivers every treatment under the sun. Referral programs for patients to get care through outside providers (known as Choice or Community Care at the VA) are as essential to the medical profession as stethoscopes and tongue depressors. But VA attempts to offer veterans these options have frequently stirred controversy.
Some critics complain that letting veterans choose where they get certain health care services will lead to the privatization of VA. Nothing could be further from the truth.
VA has had a community care program for years. Congress significantly expandedthese efforts in 2014 in response to the wait time crisis. As a result, since the beginning of this year, VA has authorized over 18 million community care appointments — 3.8 million more than last year, or a 26% increase, according to the VA claims system.
But as VA’s community care efforts have grown, so has our capacity to deliver care in-house. The VA budget is nearly four times what it was in 2001. Since then, the department’s workforce has grown from some 224,000 employees in 2001 to more than 370,000 today, according to the Office of Personnel Management. And we’re delivering 3 million more appointments at VA facilities per year than we were in 2014.
In other words, community care or private capacity and VA’s internal capacity are not mutually exclusive. We are ramping up both simultaneously in order to meet the health care needs of the veterans we are charged with serving. Our fiscal 2018 budget continues this trend. It will spend $2.7 billion more for in-house VA care, compared to a $965 million increase for community care. This means that the total dollar increase for medical care within VA is three times that of the increase for community care. Overall, when all funding sources are taken into account, we expect to spend $50 billion on health care services within VA and $12.6 billion on VA community care in fiscal 2018.
Even though these numbers make it abundantly clear VA is not at all headed toward privatization, I understand the underlying concerns of some critics. They don’t want to lose all that VA has to offer. I don’t either — and we won’t.
Many of VA’s services cannot be replicated in the private sector. In addition to providing some of the best quality overall health care in the country, VA delivers world class services in polytrauma, spinal cord injury and rehabilitation, prosthetics and orthotics, traumatic brain injury, post-traumatic stress treatments and other behavioral health programs. The department plays a critical role in preparing our nation’s doctors and nurses — 70% of whom train at VA facilities. And we lead the nation in innovation, with VA research having contributed to the first liver transplant, development of the cardiac pacemaker, advancements in treatments for PTSD, cutting-edge prosthetics, and many other medical breakthroughs.
All of these factors underscore that fears of privatization are simply unfounded. President Trump is dedicated to maintaining a strong VA, and we will not allow VA to be privatized on our watch. What we do want is a VA system that is even stronger and better than it is today. To achieve that goal, VA needs a strong and robust community care program.
Veterans deserve the best. If a VA facility isn’t meeting the community standard for care, doesn’t offer a specific service, or doesn’t have an appointment available when it’s needed, veterans should have access to care in their community.
This is precisely what they have earned and deserve. It’s what the VA is working with Congress and Veterans Service Organizations to deliver. And it’s what the system needs to remain a valuable resource for our country’s great veterans, now and in the future.
David J. Shulkin, M.D. is the ninth Secretary of Veterans Affairs.
