The total VA healthcare budget for 2013 is $55 billion and that’s not enough money to get at some of the well documented concerns and controversy surrounding the system. The VA is facing criticism about long wait lists, off the book record keeping, doctor shortages, and patient safety problems.
One of the problems that hasn’t been discussed is the mismatch of VA facilities to where most veterans live. Of the approximately 20.8 million veterans living in the U.S., 9.6 million live in sun belt states. Yet only about a third of the VA’s 152 hospitals are in those states. Most VA hospitals are in the Northern and Midwest states. Florida alone is home to 1.5 million veterans and has six VA hospitals yet South Dakota is home to only 76,000 veterans but has three VA medical centers.
People move and parts of the country come in and out of favor. It’s impossible, at least financially, to move VA hospitals to parts of the country that have high concentrations of veterans living there. In 1999 the VA did try to shift operations to parts of the country that had higher populations of veterans by closing three hospitals, partially closing eight others and building three new hospitals. Now the same scenario is being revisited and the Senate recently authorized the VA to lease 26 new facilities in 18 states.
I’d like to propose an alternative. Instead of absorbing the cost of building new facilities why not pay public providers to treat veterans. In many cases veterans are seeking care at non-VA facilities out of necessity. Why not scale down the VA system and provide veterans the right to choose where they want to receive care. There are excellent hospitals across the country providing exceptional care to the communities they serve. It would seem to be more cost-effective for the VA to reimburse these hospitals for treating veterans than it would to build new hospitals. The federal government is the single largest purchaser of health care services in the country through the Medicare system and Medicare is accepted by more hospitals than any other pay source. The VA could follow suit and offer Medicare type rates for veterans who choose to seek care at facilities that are close to home and have good outcomes.
Our veterans have sacrificed for their country it’s time we no longer ask them to sacrifice where they seek health care. Why replicate a system that is already in place and has capacity to serve more and do so without wait lists.