Recently in a fanfare ceremony, President Trump signed the VA Mission Act. A cursory review reveals two important elements of this initiative:

• To consolidate all current programs and remove bureaucratic impediments currently being experienced by veterans.

• Conduct a market assessment of current VA assets, while surveying local communities to see what veterans in these areas need.

The VA Mission Act of 2018 may be trying to streamline an already convoluted bureaucracy but has not mollified those who are suspicious of these changes. The ultimate questions still remain as to who benefits financially and how does this aid in providing better care for veterans?

Congress has scurried about at times to introduce more private health care into the system. Some have used the argument that profit motive creates a more economic and efficient health care system.

That argument is fallacious. The Veterans Health Administration or just VA, is the largest integrated health care system in the United States, providing care at 1,240 health care facilities, including 170 VA Medical Centers and 1,061 outpatient sites and care of varying complexity to over 9 million veterans enrolled in the VA.

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Impressive as that may be, there are many veterans who live considerable distances from these facilities which necessitates other measures in obtaining health care. In past the VA has introduced several initiatives such as the Veterans Choice Program in an effort to lessen the burden to veterans in gaining access to health care. To use the Veterans Choice Program, Veterans must receive prior authorization from the VA to receive care from a provider that is part of VA’s network of community providers.

This can present another set of problems to those veterans who are traveling or are visiting areas where VA care is unavailable. How does one know when they are going to have an emergency?

Most private care practitioners are concerned with throughput. While VA doctors may have a heavy caseload, private practitioners may carry a much larger one. If in the future we add even more patients from the VA, the private practitioner caseload will increase along with the attendant insurance forms and other documentation necessary for billing.

The private system is already potentially in extremis. How then does adding more patients to their workload solve the problem? Even with the caseload as it stands today for veterans, most VA Primary Care Providers take their time in working with their patients. Veterans are not viewed simply as billables but as patients.

The act is also supposed to collect tasks currently accomplished by several internal organizations and in the words of the act, make it more cohesive. In other words, new or expanded organizations must be created to audit private health care providers, oversee billing and approve or disapprove veteran health care. If the objective is to make the system more efficient, good. If this is just a means of shuffling departments around without making serious changes, what’s the point other than giving the appearance of doing something?

Politicians have been eager to solve many of the issues plaguing the VA by looking elsewhere for solutions as opposed to fixing what needs to be fixed inside the VA. Few have publicly questioned what it is that has prevented the system from operating the way it is supposed to.

In 2014, Congresswoman Tulsi Gabbard held a town hall meeting at the National Guard Armory in Kapolei. During the question and answer period, she along with VA personnel in attendance were asked about the current crisis to veteran care. If the VA of 1946-1956 could handle 15 million veterans with a staff of 115,000, and do it efficiently, what was causing the breakdown when there are 350,000 VA employees to manage three-fifths the number of veterans from World War II and Korea?

No one stood up to answer the question.

Congress and those committees assigned to oversight of the VA should insist the VA become more efficient and not depend on more tax dollars to bail them out to hire more staff or spread the problem to the private health care system. Many doctors and teachers are leaving Hawaii due to the high cost of living. Dumping more patients on the civilian health care community in Hawaii could find even greater wait times for veterans. Additionally, we may discover many health care givers refusing to sign on to the VA network.

While the intent may be sincere, the consequences may be self-defeating. The VA is under pressure to deliver, and the metrics used in determining delivery in the past have been “gamed” by its own employees.

The bill still does not address the issue of access or how veterans obtain medications. And while the bill calls for what it perceives as sweeping reform, we must still deal with what is.

In the rush to solve one problem, Congress may have created even more problems. I sincerely hope the respective oversight committees keep a close watch on the implementation of this legislation.

It had been my opinion that veterans organizations should work themselves out of a job. Thankfully, organizations such as the Veterans of Foreign Wars, Disabled American Veterans and Vietnam Veterans of America, maintain their vigilance and keep Congress pointed in the right direction.

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