When big government can’t get out of its own way

Thursday, August 27, 2015

The shocking news came over a year ago: American veterans were dying by the dozens as they languished on lengthy waiting lists, while Veterans Administration staff falsified records to hide the problem. Almost as shocking, Congress acted within four months of the first news reports about deaths of veterans waiting for care from VA medical facilities in Phoenix.

The result, the Veterans Access, Choice and Accountability Act of 2014, is a classic example of both the need for, and the limitations of, a vast bureaucracy to give people a measure of freedom.

Each point was painfully evident last week during a field hearing of the Senate Veterans Affairs Committee, chaired by Georgia’s Johnny Isakson. Those who spoke at the hearing in Gainesville on Friday demonstrated both how much pent-up demand there was for veterans’ health care beyond the VA’s capacity to deliver it, and how the VA itself has often gotten in the way of meeting that demand.

Central to the 2014 law its requirement that the VA arrange for private care for any veterans who would have to travel at least 40 miles or wait at least 30 days to get care at a VA facility. VA Secretary Robert McDonald, the West Point grad and former Procter & Gamble CEO who took office 13 months ago to right the ship, reported Friday that veterans’ appointments are up by 7 million this year — 4.5 million of them outside the VA system. By that measure, the law is working.

But to hear the litany of problems veterans have had in getting appointments even under the new system is to wonder how many more might have been served, if the bureaucracy were better at letting people out of its grip.

Many veterans eligible for choice programs are unaware of them. Conversely, many veterans who received mailings about the programs aren’t eligible.

Some private physicians are reluctant to sign on with the choice program, a couple of witnesses testified, because the VA has taken up to a year to reimburse them for care in the past. As a result, it sometimes takes veterans more than 30 days to see a private doctor.

When veterans do get an appointment, they don’t always know about it. One veteran who testified Friday, Carlos Chacha, said he missed two appointments with a rheumatologist because he was never told about them. Not surprisingly, no-shows are another reason some providers avoid the program.

Perhaps the most ludicrous exchange came between U.S. Rep. Doug Collins, R-Gainesville, and Donna Hoffmeier, a program manager with a contractor hired to arrange the private appointments, Health Net Federal Services.

Even if the VA has sent Health Net a veteran’s file for use in making the appointment, Hoffmeier said, the firm must first wait for a separate file confirming the veteran’s eligibility.

Collins: “Can VA just send Health Net … any veteran’s file?”

Hoffmeier: “No.”

Collins: “OK. So the reason they would send somebody’s file to Health Net … is because (they) are eligible for the choice program!”

Hoffmeier: “I absolutely agree with you … (but) the contract requires us to wait for that eligibility file.”

They’re both probably correct. And that’s a problem.

It’s not a problem solved by ending the choice program to simplify matters. It’s one solved by continuing to make clear that the VA’s job is to ensure the service is provided, regardless of who does it.

Come to think of it, that’s a lesson a lot of bureaucrats outside the VA could stand to learn, too.