Calls for Change
"The 2014 Veterans Affairs Department Reform Law" established the Commission on Care to develop health care recommendations and bureaucratic reforms. The report contained 17 broad recommendations, specific for health care delivery, etc.
The Commission noted the “VHA provides health care ... comparable or better in clinical quality to that generally available in the private sector, [but] it is inconsistent from facility to facility, and can be substantially compromised ....” The Commission suggested that the 2014 Veterans Access, Choice and Accountability Act should be altered to prioritize disabled veterans appointments.
Veteran Access to Care Impaired by Entrenched VA System
There have been many attempts to facilitate veteran access to health care. There was a time when a VA patient could directly access medical services by presenting at medical facility and being seen immediately. In the late 60s and early 70s, the VA addressed cost and service control by assigning gatekeeper responsibility to nurses. (Outside of the VA, gatekeepers have been designated the primary care provider to control access to further health care. The primary care provider may be nurse, physician’s assistant, clinic, or one of the physician groups designated by legislation, regulation, or insurance provider as primary care gatekeeper.) Unfortunately, introducing a gatekeeper has not altered use of services by patients, but only slowed service.
In the last 50 years, introduction of gatekeepers has shifted medical care from MDs to a variety of gatekeepers, sometimes nurses, sometimes paraprofessional medical staff, or even clerical workers with no medical expertise at all. Compounding the problem of placing gatekeepers between patients and direct medical services is the development of third-party payer systems that usurp gatekeepers’ responsibility to direct patients to appropriate health care. Patient access to medical service has been slowed down.
The VA is just one third-party payer system. (Private insurers manage the majority of non-VA health care access.) The bureaucracy retards access to service, and in the case of the VA, actually may fail to deliver service altogether, patient’s literally dying before an appointment to see an appropriate medical provider within the VA system. Recent statistics reveal that 300,000 veterans died because of the failed system.
Enabling Legislation to Change the Status Quo
Administrations have attempted to deal with deaths attributed to this failure to get veterans into the VA system and to appropriate caregivers. The results have been dismal.
Recently, there has been movement in the US government to reduce, alter, or bypass the failed gatekeeper system within the VA by facilitating local health care provision to veterans outside the existing VA system. Veterans, providers, and their communities have welcomed changes.
Besides a variety of executive actions, President Trump also signed legislation in early August allocating $2 billion to establish new VA medical facilities. The new law provides for veterans' medical care via private physicians outside the VA system, providing “immediate medical care for
The appointment process for specific health care within the VA, particularly in some parts of the system, has been broken. Some veterans were officially in the VA system, but were never allocated appointments. The referral process, the administrative process, the service accountability process, etc. were either impaired or broken altogether. Late in August, the President signed the “Veterans Appeals Improvement and Modernization Act” to “streamline the lengthy process that veterans undergo when appealing their claims for disability benefits.” Specific veteran support groups (American Legion, AMVETS, Disabled American Veterans, and Veterans of Foreign) have long been advocating for change. Now, at least 470,000 vets awaiting health benefit decisions will receive immediate attention.
Not to be overlooked in recent efforts to improve VA services for veterans is the “Department of Veterans Affairs Accountability and Whistleblower Protection Act.” The bureaucracy within the VA is very protective of its members and preservation of executive power. One of the reasons that change has come so slowly to the VA relates to entrenched power and failure of accountability measures to correct abuse. Reform legislation signed into law in June brings accountability to all employees within the VA. They may be removed, demoted, or suspended for job performance or inappropriate conduct. Moreover, the VA is empowered to claw back bonuses given to employees who have misconduct. President Trump noted that “veterans have fulfilled their duty to this nation and now, we must fulfill our duty to them.”
Implementation Giving Veterans Access to Local and Existing VA Facilities and Services
The VA is a huge bureaucratic system. Change is difficult because of mass and lethargy, but it is apparent that change is happening. The budget proposal for the Department of Veterans Affairs has delegated $13 billion dollars for medical services to veterans outside the VA system, about 7% of its total budget, but the decade's first substantial spending boost. VA discretionary spending also will increase by 6%, pending Congressional approval.