This Veterans Day should catalyze major systemic reforms

On this Veterans Day, let’s stop nibbling at reforms within the current system. Let’s refashion the system itself.

First, consider the statistics. The U.S. veteran population is about 18.6 million. The federal government alone spends about $325 billion for the Department of Veterans Affairs and for veterans’ benefits. If that money were just spent in direct grants to veterans, it would amount to more than $174,000 per person per year, even to the ones who need no aid at all. And that doesn’t count all the money spent by state government veterans’ affairs departments or by the hundreds of philanthropic veterans’ associations and aid groups.

Granted, services obviously should be targeted to specific needs rather than just doled out willy-nilly, and budgets must account for administrative costs combined with the naturally high price of specialized care. Still, that’s a lot of money and effort being devoted to veterans’ causes — and not without considerable benefits. Nonetheless, for all that cash, an observer should expect better results than some parts of the veteran community receive.

While the Department of Veterans Affairs in recent years has noticeably improved (lessened) the wait times for medical appointments and treatments, in many cases doing better than private sector alternatives, the efficiency and level of service are notoriously spotty. Some facilities and some regions of the country do much worse than others in terms of both timeliness and quality of care.

Meanwhile, anecdotally at least, the VA is notorious for making veterans cut through spirit-crushing layers of red tape.

Meanwhile, veterans as a class face unique obstacles. Yes, veterans are generally hardy, sturdy, well adjusted: They have lower unemployment rates and are usually adjudged to be better employees — more disciplined, harder working, with more consistent results — and they actually suffer a lesser incidence of depression and anxiety than the population at large. Yet, as has been well publicized, they suffer, for obvious reasons, from the incidence of post-traumatic stress disorder that is nearly twice as high as the general population. And with some self-evident but still striking relation to PTSD, the suicide rate among veterans each year averages about 150% that of the nonveteran population.

Veterans deserve better — more bang for the buck, more effective help for the ones who do need it, wherever they are, even if they live far from a veterans treatment center.

That’s why Congress should make two massive changes to federal veterans programs. First, it should radically expand the current allowance for veterans to receive care from non-VA doctors or facilities. Right now, thanks to a bipartisan law passed a decade ago, veterans who live more than a certain distance from a VA facility or those who need medical services not provided by the VA can get the VA to pay for care from non-VA medical providers. It’s a good program, but it remains too restrictive and bureaucratic. The veteran first must secure specific “approval from your VA health team,” which can be hard to do, of course, if the VA team is far away to start with, and the rigmarole involved can be daunting.

It would be far better just to give what amounts to a portable healthcare voucher to every veteran, even those who do live within range of a regular VA hospital or clinic, along with a pre-published guide, updated annually and nonnegotiable in the interim, to how much it will reimburse for each service if the voucher is indeed used at a non-VA facility. Of course the VA should be allowed to provide guardrails against fraud and abuse, but the principle should be to provide the best care, not to monopolize the provision thereof.

The second reform, far more controversial, should be to exempt the VA entirely from civil service laws applicable to the rest of the federal workforce. Of course, some reasonable job protections should apply, but especially in service of veterans, it should be far easier to remove low-performing workers from the VA’s vast bureaucracy and to redirect that money to better benefits, not just medical but also for the VA’s education, job training, credit programs, and other services.

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There is no reason it should take 450,000 full-time employees to provide services for veterans. If salaries and benefits for even a twentieth of those sinecures were redirected to actual benefits, the difference it could make in needy veterans’ lives could be substantial.

With those two major, systemic reforms, the federal government could better live up to the late President Theodore Roosevelt’s dictum that “a man who is good enough to shed his blood for his country is good enough to be given a square deal afterwards.”