Further privatize the VA? Not on my watch

Last week’s dismissal of U.S. Department of Veterans Affairs (VA) Secretary David Shulkin undoubtedly will renew the long-standing debate over privatization of Veteran healthcare. It’s no secret the U.S. Department of Veterans Affairs (VA) has had its problems, as the inspector general’s report on Shulkin’s personal use of travel funds has revealed.

Other high-profile debacles, like the wait-times scandal at the Phoenix VA in 2014 and, more recently, the staggering cost overrun of the Denver VA, have caused an erosion of the VA’s brand in the public eye. It seems as if “VA bashing” is one of the few topics in health care that policymakers, across the ideological spectrum, can agree upon today. Yet for all these administrative difficulties — real or perceived — further privatization of VA care is not the solution we need.

Here’s why. Concerns about poor VA quality of care are completely overblown. Assuredly, approvals can take time, shortages exist, lines can be long, and, unfortunately, mistakes happen – but, when examined carefully, the quality of care is as good or better as anywhere else. For years, studies investigating the VA (both by the VA and by independent agencies) have documented a quality of care equal to or exceeding those outside VA care.

In my seven years as a VA physician, I too have felt my share of frustration. But for me, making sense of the VA’s front-page, negative press has always been difficult. I ask many of my patients here at the VA how we’re doing, and most say they’ve been treated well. They’re happy, even excited, about the care they receive. The truth is that the issues at the VA are very similar to those faced by nearly every hospital where I’ve worked – VA or private.

I have spoken with many veterans who have ideas on how to make things better. Some want to see non-VA providers because of the perceived prestige of doctors in private practice. In point of fact, many VA facilities already offer these “private” specialty physician services — and have done so for years. Specialist physicians from top-ranking VA-affiliated academic medical centers often see patients at regional VA medical centers too, in essence providing the same world-class clinical care to veterans as they do at their academic offices.

For years the VA has encouraged, and paid for, the use of locally available, community-based medical services when no viable VA option exists. Privatization through VA Choice is not a new idea. However, expanding privatized VA care faces a fundamental challenge — namely how we ensure our veterans receive the same high-quality clinical care currently offered within VA networks. For many VA services facing privatization, developing a comprehensive and generalized method to evaluate quality is too complex or simply doesn’t exist. Equally challenging is how best to coordinate contracted care with existing VA services.

Sadly lost in this debate may be the will of the veterans themselves. Despite a few gripes, I’ve yet to hear veterans tell me they’d like to see the VA dismantled. Moreover, the overwhelming majority of veteran’s organizations oppose large-scale moves to privatize the VA.

We owe our lives and freedom to those women and men who, as President Lincoln once said, “have borne the battle,” and who now need our support. While administrative reforms within VA are clearly needed, hastily privatizing our veteran’s care would be a risky, and costly, mistake.

John McDougall is a VA rheumatologist and health services researcher. He lives in New Haven, Connecticut. This article was prepared by John McDougall in his personal capacity. The opinions expressed in this article are the author’s own and do not reflect the view of the Department of Veterans Affairs, VA Connecticut Healthcare System or the United States government.