Commentary: A better way to fix veterans' care

The Department of Veterans Affairs includes the largest health system in the United States and the second largest agency in the federal government. The system, which accounts for close to $200 billion in federal spending and has more than 350,000...


The Department of Veterans Affairs includes the largest health system in the United States and the second largest agency in the federal government. The system, which accounts for close to $200 billion in federal spending and has more than 350,000 employees, covers the health-care needs of 9 million veterans.

The idea of doing away with the entire system and turning it over to the private sector is not only frightening, it's morally reprehensible. And yet, if some high-level VA officials in the Trump administration get their way, that's what would happen.

I spent a year leading a bipartisan commission designed to examine the VHA. And as someone who has spent 35 years leading large, private-sector health systems in urban markets, I fully appreciate the complexity of our nation's health-care system for veterans. No doubt the system has many problems, in large part created by constant turnover in leadership.

But the VHA also has many great strengths. The system has developed programs that address the service-connected injuries and illnesses of veterans, including for advanced rehabilitation, prosthetics and mental-health services. The system's organizational model is also critical for the care of men and women who often have multiple injuries and illnesses requiring daily coordination of services.

For decades, the VHA has also partnered with major academic health systems across the country to have access to the best doctors, to teach young doctors about caring for veterans and to conduct research specifically focused on veterans' needs, resulting in significant innovations in medicine and health-care delivery.


The private sector today is simply incapable of delivering such organized care for veterans, and it does not have the capacity or the sophistication in rehabilitation or mental-health services to meet their complex health-care needs.

I can understand why people may think closing the VHA makes sense - given high-profile cases of dysfunction at the agency, including the wait-time scandal in Phoenix. But it is important to listen to the veterans who are receiving care within the system and to appreciate the scale and complexity of what it delivers every day. At the same time, we should note that private-sector hospitals and health systems have their own quality and service problems, and they escape the scrutiny of the politically charged national spotlight that the VHA deals with every day.

I believe our national leaders should focus on thoughtful reform and transformation, fully utilizing the work of my commission to guide a long-term process of change.

Here are four things that can be done:

First, instead of outsourcing care to the private sector, we can fully credential and train private-sector providers. This would allow us to manage private sector and VHA care in a coordinated fashion to meet all the health-care needs of veterans.

Second, give the agency an upgrade. We need to replace its aging information technology infrastructure with a commercial system designed for the delivery of complex health care. And we need to reform its human resource system, which would include increasing compensation and improving its organization to attract and retain high-quality leadership.

Third, Congress can pass legislation to objectively evaluate and plan for the future needs of VA facilities to address the significant growth in outpatient demand, to improve ambulatory capacity in the system and to close and replace some VA hospitals.

Finally, we can put in place an oversight board of directors composed of health-care experts who can govern the transformation process. Such a board could be accountable to the president to ensure accountability.


Health-care workers, especially those in the VHA, should be praised and appreciated by leaders, not berated and criticized. Providing health care is incredibly difficult work. How is the VHA going to attract great people in the environment they are working in today?

I have learned in my career as a health-care leader that high standards of performance have to be grounded in a culture of inspiration and appreciation for those who serve patients. A third of VA employees are veterans themselves; let's treat all of them with the great dignity and respect they deserve.

Nancy M. Schlichting served as chair of the Department of Veterans Affairs' Commission on Care from 2015 to 2016. This Viewpoint was selected by the Herald from The Washington Post wire service.

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