March 18, 2020
Kayla Williams | The Hill
Schools, offices, and other businesses are shutting down nationwide as the United States ramps up its response to the COVID-19 pandemic. As we read about the extreme strain placed on Italian hospitals, many Americans are nervous about whether or not we have adequate resources within our healthcare system to care for a large number of seriously ill patients. How all of this will play out remains to be seen — but it drives home the need to maintain a strong system of VA medical facilities nationwide.
As virtually everyone knows, VA’s primary mission is to care for those “who shall have borne the battle,” and in terms of health care, it does so both by providing direct care and by paying for enrolled veterans to get care in the community. It fulfills two other functions that affect all our lives on a regular basis: training health care professionals and conducting cutting-edge medical research.
Its fourth, and least well-known, statutorily required function is to provide backup to the DOD medical system in a national security emergency and to support the National Disaster Medical System and Department of Health and Human Services as necessary.
Given trends identified by Ken Kizer in the 1980s for other federal health systems that have only continued since, VHA remains “the federal government’s only direct response capability” for a national healthcare emergency. Ben Kesling and Abbie Bennett have delved into VHA’s level of preparedness for the current pandemic.
It’s been well-documented that VA provides higher-quality, culturally competent care to an older, sicker population at lower cost — and there are grave concerns about whether capacity even exists in the civilian sector to absorb more patients.
Closing VA facilities would lead to decreased capacity to care for veteran — and non-veteran — patients in communities around the country during public health crises.
VHA executive in charge Dr. Richard Stone has noted to lawmakers that having only about 63 percent of medical beds filled is “not an efficient use of the system.” Efficiency is a key goal of profit-making enterprises; however, profit is not VA’s mission. This crisis is driving home the importance of having excess capacity in our medical system: If a more “efficient” number of hospital beds are filled all the time, how can you accommodate a surge of patients during a crisis?
It is true that the veteran population is both shrinking and moving, leading to a situation where individual facilities may be significantly underutilized at this point. Rather than closing these facilities, lawmakers should explore innovative opportunities to enhance their usefulness to local communities. Could there be enhanced partnerships with DOD, Federally Qualified Health Centers, or Indian Health Service? Are there ways to allow VA providers to see Medicaid patients in facilities seeing dramatic reductions in the number of veteran patients? What kinds of innovative solutions exist to increase efficiently while maintaining these vitally important facilities — and capacity — nationwide?
This pandemic drives home the necessity of looking beyond immediate market forces when considering how to structure and manage a national health care system.
Pressures to privatize and close VA facilities are short-sighted and ill-informed. They disregard VA’s roles in not only providing direct care to veterans but also training providers, conducting research, and — crucially — serving us all during a national health emergency. It is a system worth saving and strengthening, not abandoning.
Kayla Williams is a senior fellow and director of the Military, Veterans, and Society Program at the Center for a New American Security. She previously served two years as director of the Center for Women Veterans at the Department of Veterans Affairs, serving as primary adviser to the secretary on policies, programs and legislation affecting women veterans. Prior to that, she worked at the RAND Corporation, where she did research related to veteran health needs and benefits, international security and intelligence policy. She is the author of “Love My Rifle More Than You: Young and Female in the U.S. Army,” a memoir of her deployment to Iraq.