Senators kill big plan to modernize VA care but offer no alternatives

denismcdonough-150x150One of the nation’s largest health care systems had its ambitious plans to reshape itself for the 21st century torpedoed by a dozen members of the U.S. Senate, with taxpayers and veterans left in the lurch with great uncertainty about the future medical care for those who valiantly have served this country.

Just a few weeks ago, Denis McDonough, the secretary of the Department of Veterans Affairs (shown right), met a deadline from Congress to detail significant shifts in how his sprawling agency cares for former military personnel and their families.

He provided a proposal — a plan only — to shut many of the VA’s 1,200 big, aging hospitals and clinics or slash services there, shifting to smaller facilities, and refocusing the agency’s caregiving to parts of the country where its patients live. His plans and the future of VA care, which already have been under study for at least four years, were then to be taken up by a blue-ribbon group, the Asset and Infrastructure Review (AIR) Commission. The commission then would have reported back to Congress for possible action.

But a dozen senators, from both parties, put out a news release that said they were declining to appoint the panel’s members — a move that, for now, dooms what advocates have called a modernization effort for the VA, which treats many of its patients on hospital units dating to before World War II, the Washington Post reported.

Jon Tester, the Senate Veterans’ Affairs Committee chairman and a Montana Democrat, explained to the Washington Post why he and his colleagues blew up the VA change initiative:

“We share a commitment to expanding and strengthening modern VA infrastructure in a way that upholds our obligations to America’s veterans. We believe the recommendations put forth to the AIR Commission are not reflective of that goal and would put veterans in both rural and urban areas at a disadvantage.”

The senators asserted they remain committed to a “continued push” to help VA invest in “21st century [health care] facilities” for veterans. But how that will occur is up in the air.

The Washington Post reported that opposition to changes in VA care have grown for months now, as veterans in rural areas and in the Northeast and Midwest have expressed concern that agency plans would short shrift them. Unionized federal workers objected that the changes might cost jobs.

Those objecting to the VA plans, however, have put the agency in a services bind, as increasing numbers of those needing care — promised as part of a sacred trust between the federal government and those who sacrifice to defend their country — live in the burgeoning South, West, and Southwest, aka the Sunbelt. In the meantime, the VA itself has found that it is struggling to provide top-notch medical services due to its increasingly creaky infrastructure, as the Washington Post earlier has described it:

“Almost 70% of VA’s health-care facilities were built more than 50 years ago, and the buildings have a median age of 60 years — compared with 8½ years for private-sector hospitals. According to the agency’s budget submission to Congress for fiscal 2022, the health system needs $61.6 billion worth of construction today. ‘These facilities were not designed to meet modern health care standards, which limits VA’s agility and ability to meet evolving veteran care needs, and basic environment of care expectations…’”

The VA says it also must shift the way it delivers medical care because the veterans and their dependents eligible for it have different needs now, as compared with when the agency built so many of its facilities decades ago. More women also serve now in the military and their care needs are growing and different from what was provided in the past.

Agency leaders under several administrations have struggled with the challenges of providing excellent, efficient, safe, and affordable medical services to  the 9 million-plus veterans and their loved ones by an agency with a budget of $260 billion annually. In recent years, for example, the agency has sought to envision its role as Congress has opened increasing options for vets to seek private medical care.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by abuse or negligence in when getting care at a hospital or clinic run by the Department of Defense or the Department of Veterans Affairs.

Congress and the courts have made changes but military personnel, especially those on active duty, may face different legal challenges when they make claims of medical malpractice and seek justice in the civil system. They may want to consult with counsel, such as myself and my colleagues, with experience in these specialized cases.

As for the overall VA reconfiguration, it’s not right for lawmakers just to say “no” to long-running processes that they themselves have participated in and supported. What’s next?

Darin Selnick, a senior adviser for Concerned Veterans for America who led efforts at VA and later the Trump White House to create the commission, told the Washington Post that lawmakers, unfortunately, turn parochial and political too quickly for the good of veterans and the country:

“Anytime a legislator hears they might close a facility in their district they go ballistic, but if you had had a commission in place that wouldn’t have mattered.”

Chanin Nuntavong, the American Legion’s executive director of government and veteran affairs, predicted dire consequences for lawmakers’ sending VA changes into limbo and without any path forward. He told the Washington Post:

“Veterans are going to lose. Old infrastructure needs to be repaired or replaced. Veterans’ care will be degraded by a lack of technology and unsanitary conditions while construction costs go through the roof.”

We have much work to do to ensure that the country keeps its promises: to veterans, for hard-earned benefits for their services, and to taxpayers, who can’t afford to pay for antiquated, inefficient, inaccessible, costly, and potentially unsafe medical care for millions of patients. We all deserve much better and Congress needs to explain how this will occur now.

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