It’s an old refrain: run government like a business. But to the naysayer, it can sound an awful lot like a much less agreeable suggestion: turn government into a business.

That’s what a congressionally-chartered commission of reformers tasked with overhauling the way the government provides health care to veterans is up against. A subgroup of that commission has proposed what its members see as a means of harvesting the ingenuity and resources of the private sector; detractors of the proposal see only an ideological ploy to shrink the government and privatize veterans care, consequences be damned.

The battle over the proposal is likely to continue until early summer, when the full Commission on Care, created by a few paragraphs in the much larger 2014 Veterans Access, Choice and Accountability Act, produces its final recommendations on better ways to deliver health care for veterans. Already, the plan has produced significant backlash in the veterans community, prompting veterans service organizations, employee unions and lawmakers themselves to weigh in.

Strawman Report

The Commission on Care has met regularly since September, but really started garnering attention in March after seven of its 15 members released their own set of recommendations for improving health care delivery for veterans. While the full commission will not issue its final report until June 30, the subgroup released its preliminary suggestions a bit early.

The objective of the so-called “strawman report” differs based on who you ask; its authors say they were simply trying to deliver policy specifics to advance the conversation, while its opponents say the group acted in poor faith and outside the public spotlight to offer recommendations that were self-serving, politically motivated and harmful to veterans.

The content of the report itself is also a point of controversy. Opponents characterize it as a full-scale call for privatizing VA health care, while supporters say it simply offers veterans more choices and better integrates government and privately run systems. What is clear from the report is a commitment to phasing out the dominance of government-run facilities in providing care to veterans.

The report repeatedly suggests the Veterans Health Administration is broken and in “immediate need of a bold transformation.” Namely, the authors said, the Veterans Health Administration should become “primarily a payor” entity.

What is clear from the report is a commitment to phasing out the dominance of government-run facilities in providing care to veterans.

The report spells out a panoply of inefficiencies that bog down VHA: a soon-to-be declining veteran population that uses VA facilities for only some health care needs; bureaucratic hiring practices that leave critical positions unfilled; Congress serving as a biased board of directors; a dilapidated network of buildings not necessarily located where veterans live; poorly designed and outdated information systems; and an overly burdensome process for veterans looking to take advantage of existing care in the community options.

To kick off the “bold transformation,” the strawman report calls for a systematic closure of facilities deemed underutilized or obsolete. Those would be just the first to be “transitioned.”

“If veteran choice dictates it over time, the long-term goal of the transformation is the total transition to community care,” the authors of the report wrote.

If any of that sounds like privatization, chalk it up to “inartful” phrasing, according to Darin Selnik, one of the commissioners who worked on the report.

“The first draft is going to be an awkward draft,” said Selnick, a former VA political appointee under President George W. Bush and a senior adviser to the conservative-aligned Concerned Veterans for America.

The commission is tasked with creating a roadmap for veterans health care over the next 20 years, and Selnick said his group’s prognosis is simply a “trend analysis” of what is likely to occur over that timeframe. Once 51 percent of appointments take place outside of VA-owned facilities, he explained, the department would be “primarily a payor” -- but that is a far cry from privatization.

“No one is trying to eliminate any needed facilities or outpatients, nor are they trying to close them all down,” Selnick said, adding the goal is to find the “equilibrium of what the veterans population is going to be, what’s the footprint they’re going to need.”