Veterans across the country are still waiting too long for medical care, a situation that drove the resignation of Veterans Affairs Secretary Eric Shinseki last week.
Now Republicans and Democrats in Congress are competing to pass laws they think will fix the problem of medical wait times and other problems at the VA. The discussion over how to reform veterans' health care is starting to sound familiar.
"Every debate about the VA becomes a parable for government's role in health care generally," says Phil Carter with the nonprofit Center for a New American Security.
"Efforts to improve and build the VA will run into opposition based on a desire to minimize the government's role in health care," Carter says. "Efforts to strip the VA or shift functions to the private sector will run into intense opposition from ... [members of] the vet community who believe the VA represents the nation's brick-and-mortar commitment to its veterans."
One measure now included in bills from both sides of the aisle aims to make firing and hiring easier within the VA's massive bureaucracy, something that veterans groups have been pushing for.
"We represent 2.5 million members who do not understand why the secretary of VA does not have the authority to manage his department as he needs to," says Louis Celli, legislative director of the American Legion. "If he needs to remove someone, if he needs to demote someone, he does not have that authority."
In his last public speech as VA secretary, Eric Shinseki said he had started the process of removing senior leadership at the Phoenix VA Hospital, where an investigation revealed that executives were lying about performance goals. But VA employees are federal workers and belong to a union — which makes it hard, even for a Cabinet secretary, to fire them.
A few opponents of the recently proposed legislation say it's already hard enough to lure top executives to the VA, and these bills could drive them into higher-paying jobs elsewhere.
Another private sector solution on the table is a sort of voucher system, which Sen. John McCain has been pushing since his presidential campaign in 2008.
"We need to allow flexibility for the veteran[s] to go to the place where they can get health care in the most efficient way possible, rather than these unconscionable delays," McCain has said. In a press conference Tuesday, in which he and several Republican colleagues introduced the Veterans Choice Act, McCain again stressed that point, saying, "It would empower veterans who can't schedule an appointment within a reasonable time, or who live too far from the VA, to exercise the choice of getting medical care from any doctor in Medicare or the Tricare program."
To address the crisis in wait times, the VA is ramping up a system that would explicitly allow veterans to get private care if they've been waiting more than 30 days for medical attention. Some in Congress have put forth measures to do the same. But that's something the VA already has the authority to do — in fact, in 2013 the department spent $4.8 billion on care outside the VA system.
While veterans' service organizations support many of the measures before Congress, the majority of such groups say the VA's medical care is excellent once vets get access to it. And they worry that the private sector doesn't have needed expertise.
"If you're a private health care company, are you going to spend money on research and development on prosthetics? Are you going to spend money on research on Gulf War illness? Probably not," says Stewart Hickey, the executive director of AMVETS, "because that's not a big group for you ... to make money." Hickey says politicians should beware of preaching full-scale privatization.
"You wouldn't want to be the congressman who said, 'I'm going to do away with the Veterans [Health] Administration,' " Hickey says.
AUDIE CORNISH, HOST:
After the resignation of VA Secretary Eric Shinseki, the question remains how to fix the health system for veterans. One option is the private sector. The Department of Veterans Affairs is already offering more patients the choice of going outside the system. And that's reopened a debate about whether the VA should look to the market for answers. NPR's Quil Lawrence reports.
QUIL LAWRENCE, BYLINE: In a civilian hospital, an executive who lied about performance goals might expect to get fired. Not at the Phoenix VA. Senior leaders there face possible criminal charges for falsifying records. But in his last public speech as VA secretary, Eric Shinseki could only say he had started the process of removing them. VA employees are federal workers and belong to a union, which makes it hard, even for a cabinet secretary, to fire them. That mystifies Louis Celli of the American Legion.
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LOUIS CELLI: We represent two and a half million members who do not understand why the secretary of Veterans Affairs does not have the authority to manage his department as he needs to. If he needs to remove someone, if he needs to demote someone, he does not now have that authority.
LAWRENCE: Several bills in Congress would change that. The bills have their opponents, they say it's already hard enough to lure top executives to the VA who could find higher paying jobs elsewhere. Another private sector idea, letting veterans see doctors outside the VA system. This all came up in an unusual late night congressional hearing last week.
THOMAS LYNCH: We are going to get these veterans care in the community.
LAWRENCE: Doctor Thomas Lynch of the VA was one of the witnesses. He said the department is ramping up a system to let vets nationwide see a private doctor if they've been waiting 30 days or more. Florida Republican, David Jolly, questioned Lynch and said this sounds like more of the same.
REPRESENTATIVE DAVID JOLLY: Really, your only indication tonight is that you're just going to try harder and put a call center in Kansas, but apply the same if needed standard that already exist.
LAWRENCE: Jolly pointed out that the VA has for years been able to send vets for private care if needed, they just don't do it much. That VA plan is a stopgap measure to deal with possibly thousands of veterans affected by the wait time scandal. Arizona Senator John McCain has been pushing since 2008 for all vets to have the option of private care. He re-introduced that idea in a bill today.
SENATOR JOHN MCCAIN: It would empower veterans who can't schedule an appointment within a reasonable time or live too far away from the VA to exercise the choice - I emphasize - the choice of getting Medicare from any doctor in a Medicare or Tricare program.
LAWRENCE: Some veterans organizations cautioned that spending the VA dollars on private care will leave the VA hospitals with fewer resources to help veterans. And most all the vets groups say they don't want to see these small ventures into the market lead to complete privatization. Stewart Hickey is with the group Amvets.
STEWART HICKEY: You probably wouldn't want to be the Congressman who said I'm going to do away with the Veterans Administration.
LAWRENCE: Hickey says the VA has to do things that would never make sense in the for-profit market.
HICKEY: If you're private healthcare company, are you going to spend my money on research and development on prosthetics? Are you going to spend money on research on Gulf War illness? Probably not because that's not a big group for you that you're going to make money at.
LAWRENCE: Hickey 's group Amvets does back some private-sector ideas, including the bill offered by Senator McCain. Hickey says it's important to remember, by and large veterans like the care they get at the VA, they just want to get it faster. Quil Lawrence, NPR News.
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This is ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.