opinion

Dear David Shulkin: This is what real VA reform means

Ten days into the job, new Veterans Affairs Undersecretary for Health David Shulkin chose Phoenix for his first road trip.

Best to get a “realistic sense of what’s going on,” he told The Republic’s Dennis Wagner.

It was a wise choice. When examining a hurricane, it is best to look into the eye of the storm first.

Dr. Shulkin (the undersecretary is a specialist in internal medicine and son of a U.S. Army psychiatrist) understands his mission, which is to find ways to assure the millions of veterans who rely on VA services are better served. As he told Wagner, “the status quo just cannot continue.”

The key, as always, is finding the right alternative to the status quo. “Reform” can take a lot of forms, from window-dressing to earth-shaking. So, the question becomes: Does Shulkin ultimately intend to make it appear the VA has committed itself to quality health-care for vets? Or is he in the market for real reform?

VA SCANDAL:How to fix a broken system

A YEAR LATER:VA still struggles to improve care

Here at the epicenter of the VA’s patient-care scandal, the means of truly resolving questions of quality care are already apparent. They just require turning the platitudes that VA officials habitually mouth into a reality.

The VA has the ability to provide truly remarkable health care in its areas of expertise.

The agency is an acknowledged world leader in the treatment of traumatic brain injuries. Its neurologists and psychiatrists understand the effects of battlefield trauma as well as any medical organization in the world. It is the VA’s specialty. The agency should seize leadership here.

Likewise, its growing expertise in prosthetics. Two wars dominated by an enemy’s widespread use of improvised explosive devices have forced the VA to focus like never before on prosthetic innovation. It has responded heroically.

It is in the realm of care outside those areas of expertise where the VA hospital system has failed most miserably. Its administrators faked records not because they wanted vets to languish without care, but because they were incapable of providing care.

The agency is chronically short of primary-care doctors. But it also has been desperately short of specialists in the areas most commonly associated with treatment of the elderly.

Shulkin’s boss, VA Secretary Robert “Bob” McDonald, told Congress a year ago that the 300,000-employee VA needed another 28,000 medical personnel to adequately treat its patients.

Those personnel are not going to magically appear. And the VA shouldn’t try to extract them from a private health care system that — for all its serious faults — operates efficiently at the very tasks at which the VA fails.

If Shulkin seriously wishes to reform the VA, he needs to become a champion for the one reform that would make the VA an asset to sick vets:

Refashion the VA into a system that provides specialty care well, and which efficiently pays for and directs its patients into private health-care systems designed to provide the rest of the care they need.