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VA reform bill welcome, but it must go beyond more money

In a rare display of compromise, Senate and House negotiators Tuesday agreed to a $17 billion bill to reform the Department of Veterans Affairs. The bill is expected to be approved by Congress before lawmakers leave for their summer recess and then quickly go to the president for his signature.

The rare congressional agreement comes amid ongoing outrage over the long waits many veterans have been experiencing while trying to get treatment as well as news reports that VA administrators created fake waiting lists to not only disquise the wait-time problems, but also to earn performance bonuses.

The main element of the VA reform bill is $10 billion to allow veterans to get health care at a local hospital if they have been unable to get a timely appointment with a VA doctor. Another $5 billion is included in the bill to allow the VA to hire more doctors and nurses and also to create 27 community health clinics.

Beyond the money, the VA reform bill gives greater authority for top officials to fire VA administrators who are not performing up to standards, and this no doubt will include those found to have created fake waiting lists to hide the long wait times.

The reform bill will have few critics because there is wide support for veterans receiving the medical care they deserve — and in a timely manner. There also should be interest in seeing the VA reform effort go beyond geting an extra $17 billion to spend.

The short-term solution to cutting long wait times by allowing veterans to get health care at non-VA health care facilities is an idea that has been talked about before. The reform bill’s funding for letting veterans get care at non-VA facilities should be viewed not as a short-term fix to the current crisis, but as an experiment that could remain in place as part of a new, flexible VA health care system.

Why not let veterans get some heatlh care services at their local hospitals? Just like the GI Bill gave veterans the option to attend any college or university, so could a health care voucher let veterans get health care at their local hospital.

The VA health care centers could then put the emphasis on becoming specialty sites with expertise in combat-related issues such as prosthetics, post-traumatic stress disorder, therapy for amputees, traumatic brain injuries, depression and other ailments tied to military service.

If ailments unrelated to combat can be treated outside the VA system, the freed up capacity could ease future VA pressures as more veterans seek treatment following their service in the conflicts in Iraq and Afghanistan.

If such a VA voucher system, which has been discussed for years, had already been in place, it’s possible the crisis related to long wait times to see a VA doctor might have never happened.

The reform bill’s $17 billion price tag will make headlines, but most observers have noted that the VA’s problems are not about money or at least about restricted budgets. Congress has always given the VA as much money, often more, than it asked for in annual appropriations. And the VA was protected from recent sequestration cuts.

It is possible that staff shortages contributed to the long wait times experienced at some VA health care centers. But the creation of fake waiting lists and gaming the system to get financial bonuses had nothing to do with money. Those problems are about the culture and lack of accountability within the VA.

Former Procter & Gamble CEO and West Point graduate Robert McDonald is expected to soon be approved as the new VA secretary. His experience outside the government could be useful in changing the VA culture and demanding accountability. The reform bill’s provision allowing for expedited firing for subpar performance could help send a culture-change message.

The VA reform bill looks like a good first step. But the message should be that it’s not just about more money — and a VA health care voucher program should get full consideration as a permanent part of a new VA health care system.

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