Some VA hospitals could be closed.

Photographer: Scott Olson/Getty Images

Let Veterans Get Civilian Medical Care

Peter R. Orszag is a Bloomberg View columnist. He is a vice chairman of investment banking at Lazard. He was President Barack Obama’s director of the Office of Management and Budget from 2009 to 2010 and the director of the Congressional Budget Office from 2007 to 2008.
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I disagree with pretty much everything Donald Trump has ever said. But in calling for veterans to have more options on their doctors and hospitals, he’s got a point. Imagine, for example, the outrage if military veterans were able to receive subsidized health care at the clinic or hospital of their choosing, but were then forced into a separate system of run-down, inconveniently located facilities. If the next administration rejects proposals to reform the Veterans Health Administration and instead perpetuates the current system, the effect will be the same.

Providing health care to veterans is a moral imperative and a substantial challenge. The VHA is massive, with roughly 300,000 employees, 20,000 physicians, 1,600 facilities, almost 6 million patients, and a $60 billion annual budget. The system is plagued by deep problems, including a failure to provide the kind of facilities vets need in the places where they’re needed, according to a congressionally mandated independent assessment.

Now, the Commission on Care, formed to figure out how to do better, has recommended the right pathway forward.

One of the most important recommendations is to allow vets to receive care from VHA-credentialed community providers. A 2014 law expanded such access, but it still accounts for a small share of care paid for by the VHA. Vets need to be able to use more convenient, often higher-performing facilities beyond the VHA.

In moving beyond VHA-exclusive care, it’s essential to keep existing programs that are unique to veterans, including those that treat combat-related conditions such as traumatic brain injury, amputation and blindness. But veterans’ health issues are, to a large extent, the same as those of civilians. Most of what the VHA does reflects the fact that half of all veterans are age 65 or older (compared with 17 percent of the civilian population). Health-care services unrelated to military experience can just as well be provided in civilian hospitals and clinics.

What, then, should be done with VHA facilities? This is a broader question, because in general the government could do a better job of managing its physical assets. The VA is no exception. In part because of statutory restrictions, it spends more than $25 million a year to maintain more than 300 buildings that are either vacant or occupied less than half the time. Yet many VHA facilities are on prime real estate. A fast-track process similar to the Defense Department’s successful Base Realignment and Closure system should be used to sell or repurpose VHA facilities that are no longer needed, as the Commission on Care recommends.

Another good idea from the commission is to update the information-technology system.

Both Donald Trump and Hillary Clinton agree that veterans should have more access to doctors and hospitals outside the VA system, but they seem to differ in how aggressive they’d be in facilitating such a shift. Despite how much I dislike siding with Mr. Trump on a matter of nuance, sometimes a shove is better than a nudge. This is one example.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Peter R. Orszag at porszag5@bloomberg.net

To contact the editor responsible for this story:
Mary Duenwald at mduenwald@bloomberg.net