Carroll County Times Opinion

Charles Lane: Why vets' health care never works

The men and women who serve in the military protect both the United States' security and its values, including political liberty, free enterprise and individual choice.

How strange, then, that when their time in uniform ends, we thank them for their service and turn them over to the Department of Veterans Affairs, which epitomizes centralized bureaucracy.


The latest VA scandal involves a still-unfinished 182-bed hospital in Aurora, Colorado, that has already cost $1.7 billion and may require another $830 million from Congress. Similar cost overruns plague VA projects in Las Vegas, Orlando and New Orleans, as The Post recently reported.

Meanwhile, an investigation by VA's inspector general has found that its Philadelphia office imposed inappropriately long waits for pension claims and doctored records to cover them up, among other alleged abuses.


This comes on the heels of last year's sensational revelation of long wait times and data falsification at the VA hospital in Phoenix — which cost Veterans Affairs Secretary Eric Shinseki and several top lieutenants their jobs.

Until that crisis, ironically, VA had been perceived as a good-news story, based on a successful modernization begun under President Bill Clinton. However, recent events suggest that the agency's dysfunction is more deeply rooted than it appeared, and that maybe it's time to consider more radical surgery — if not abolishing VA, then at least abolishing VA as we know it.

Yes, there has been misconduct, dishonesty and incompetence, and the guilty must be held accountable. Fundamentally, though, VA staff and officials were responding to perverse incentives and impossible demands presented by a health-care organization that — unlike almost any other in American society — is not only single-payer but single-provider. Without market signals to help allocate resources, long waits and other patient frustrations are inevitable, no matter how sincerely, or how threateningly, Washington orders their elimination.

It's a Soviet-style structure, minus the coherence of the one-party state. Instead, VA answers to 535 members of Congress, their episodically disgruntled constituents and a plethora of veterans' lobbies, whose raison d'etre is linked to the existence of a large VA bureaucracy and whose political power is "impossible to overstate," as former George W. Bush administration domestic policy aide Yuval Levin noted in a revealing National Review article at the height of last year's scandal.

Small wonder that VA staff feel like "prisoners of a system they couldn't change," as the new secretary, Robert McDonald, said at a congressional hearing in March.

As for VA construction, undoubtedly its woes reflect a lack of institutional competency, compared with other federal agencies such as the Army Corps of Engineers, which some reformers believe should take over the job. Yet the root cause would seem to be the insistence on a dedicated system of state-run hospitals in the first place.

Even to suggest that veterans' health care should be partially spun off to the private sector — that, say, former service members should be provided a generous subsidy to purchase health insurance — is to invite a charge of callousness toward those who have sacrificed so much, or to risk being labeled a right-wing ideologue.

The strongest argument for preserving VA as-is is that we need a system geared toward ailments and injuries, such as brain trauma, that disproportionately affect vets. Yet it's worth noting that 59 percent of VA's current patient population do not have a service-connected disability, suggesting that their demands for care are diverting resources that might otherwise be used to help those who need VA the most.


In truth, no one is calling for ending the government's role in veterans' health care, just rationalizing it. Even the Veterans Access, Choice and Accountability Act, passed to deal with the scandal in Phoenix, implicitly acknowledges this need: It authorized $10 billion to help some vets bypass the clogged-up VA system and get medical care from private providers.

It's a step in the right direction, but the measure sunsets after three years. A new market-oriented policy group, Concerned Veterans for America, recently proposed splitting the VA's health program into two new entities — a subsidized health insurer for all vets and a nonprofit corporation that would run a streamlined hospital system focused on vets with service- related medical needs. The idea would be to provide a baseline of federal support, while giving individual vets a greater choice in how to allocate those resources.

Caring for our veterans is a vital national goal — far too important to be left exclusively in the hands of politicians, lobbyists and bureaucrats.

Charles Lane is a member of The Washington Post's editorial board.