Want Efficiency? Fund the VA and Cut the Proven Waste in Privatized Veterans Care
The opinions expressed in this op-ed are those of the authors and do not necessarily reflect the views of Military.com. If you would like to submit your own commentary, please send your article to opinions@military.com for consideration.
Faithfully following orders from President Donald Trump's Department of Government Efficiency (DOGE) office, VA Secretary Doug Collins has announced that he will soon fire tens of thousands of employees at the Veterans Health Administration (VHA). He claims the system is too wasteful, inefficient and costly, and that the private-sector Veterans Community Care Program (VCCP), established under the VA MISSION Act of 2018, is both more cost effective and comparable in quality.
That's just not true. VHA health care is, on average, less costly, less wasteful and of higher quality and value than private-sector alternatives. Strengthening -- not decimating -- in-house VHA staffing and infrastructure represents the more fiscally responsible use of taxpayer dollars. It's also what the majority of the 9 million veterans it serves want.
When veterans are referred to outside providers through the VCCP, they enter, what Sen. Bill Cassidy (R-La.) accurately described at a June 2023 congressional hearing, as the perfect environment for unnecessary use of high-cost tests, procedures and extra appointments -- all billable to the government.
Studies comparing care delivered for a multitude of conditions within and outside the VHA confirm that type of private-sector waste. When ambulances randomly transported veterans to either VHA or private emergency departments, private care cost 21% more -- primarily due to unnecessary electrocardiograms, inpatient admissions, and evaluation and management services with higher reimbursement rates. Diabetic veterans rack up greater costs in the VCCP, largely from increased inpatient expenses and prescription drugs. Low-risk prostate cancer patients in the VCCP are twice as likely as those in the VHA to receive unneeded surgery or radiation, costly procedures that also carry significant risks. The private sector performs more "guideline discordant," "questionable" and "low-value" tests than the VHA, which then lead to more unnecessary services downstream, higher health-care costs and potential harm to the patient.
Overuse of neuroimaging for headache and peripheral neuropathy is far more common in the private sector than the VHA. Veterans referred to the VCCP for other imaging are more apt to have pricey MRIs than less expensive CT scans and X-rays. Even for something as straightforward as sleep apnea testing, VCCP providers are nine times more likely than their VHA counterparts to use expensive lab-based tests instead of cost-effective home alternatives.
The explanation is simple: With lax oversight, private-sector, fee-for-service incentives drive overtreatment and profit-seeking that isn't permitted in the VHA.
Collins -- and Congress -- should pay attention not only to wasteful expenditures, but also health outcomes. A growing body of research shows that, on average, veterans die at higher rates within 30 days of hospital admission when treated in the private sector across numerous conditions, including angina, stroke and heart failure, emergency care and COVID-19. Two-year survival is better for VHA than VCCP veterans who initiate chronic dialysis. VHA patients fare as good or better for inpatient and outpatient care as well, including for stroke, COPD, headaches, diabetes, depression, post-traumatic stress disorder, hypertension, urinary tract infections, knee arthroplasty and myocardial infarction medication.
To be fair, there are a few studies where private hospital care was less expensive -- for six acute conditions in one study, knee arthroplasties and cataract surgeries in another, and coronary artery bypass graft procedures in a third. But these are more the exception than the rule.
What makes VHA care generally more effective?
The "VA Advantage," as researchers call it, stems from superior care coordination and information systems tailored specifically for veterans' complex needs. VHA providers are required to learn about the conditions -- military sexual trauma and toxic exposures, for example -- from which many veterans suffer. Research shows private providers frequently fail to deliver evidence-based treatments for common veteran conditions such as PTSD and depression.
Because 100% of their patients are veterans, VHA providers have accumulated specialized expertise in veterans' problems, as well as in military culture. That simply doesn't exist in the private sector, where veterans make up less than 5% of the patient population.
Private networks don't match the VHA's team-based approach, which gives vets easy access to doctors, psychologists, pharmacists, dieticians and social workers under one roof. The VHA's one-stop integrated care reduces logistical burdens that veterans bear when they seek care across a maze of multiple private-sector facilities.
Secretary Collins' proposed workforce reduction threatens all of this. Community care has an important role to play, but, by design, as a supplement when VHA cannot furnish timely or conveniently located services.
Before making drastic VHA cuts based on misguided assumptions, the secretary must confront the evidence: Slashing VHA staff and infrastructure will harm veterans while increasing costs to taxpayers. That's not fiscal "efficiency"; it's a betrayal of our sacred obligation to those who served.
Russell B. Lemle and Suzanne Gordon are senior policy analysts at the Veterans Healthcare Policy Institute, a nonprofit, nonpartisan think tank.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
an hour ago
- Yahoo
History Shows the Danger of Trump's Health Policies
U.S. President Donald Trump and Health and Human Services Secretary Robert F. Kennedy Jr. attend an event in the East Room of the White House on May 22, 2025 in Washington, DC. Credit - Chip Somodevilla—Getty Images On May 11, 2023, President Joseph Biden ended the COVID-19 public health emergency, calling an finish to the pandemic. By the end of 2023, COVID-19 claimed the lives of over 20 million people around the world. But through international cooperation and evidence-based science, vaccines were developed and the world moved on. Indeed, perhaps the biggest success of the period was the quick production of a COVID-19 vaccine. The research behind the mRNA vaccine had been ongoing since the 1970s, but the emergency of the pandemic and international sharing of knowledge helped bring the vaccine to fruition. Today, the COVID-19 vaccine has been credited with saving 2.4 million lives around the world. But now, the U.S. is choosing competition over cooperation. With President Donald Trump's day one executive order to leave the World Health Organization (WHO)—blaming their COVID-19 response—and the shuttering of USAID, the country is taking steps towards further dividing health efforts across the globe. Here in the U.S., a sudden end to $11.4 billion of covid-related grants is stifling national pandemic preparedness efforts on the local and state levels. And most recently, Health and Human Services Secretary RFK Jr. purged experts from the CDC Advisory Committee, putting lives at risk. Historical lessons demonstrate the need for global health infrastructure that works together, shares knowledge, and remembers that pathogens do not stop at borders. White House's Pandemic Office, Busy With Bird Flu, May Shrink Under Trump One of the greatest global health achievements of all time—smallpox eradication—provides a perfect example of what can be done with independent scientific research and international cooperation. During the Cold War between the U.S. and USSR, decades of tension brought the world to the brink of nuclear war. Yet, incredibly, the nations managed to find common ground to support the efforts of smallpox eradication. Indeed, they understood the strategic benefits that came from letting public health practitioners and scientists work outside of political divides. The WHO was founded after World War II in 1948. Its formation marked a move from international health, that focused on nations, to global health, that would serve humanity first. The WHO's first eradication effort was the failed, U.S.-backed, Malaria Eradication Program from 1955 to 1969. The Smallpox Eradication Program, with intensive efforts beginning in 1967, provided a chance for redemption for the U.S. and WHO. For the United States, investing in disease eradication and poverty helped to mitigate growing backlash against the Vietnam War. In June of 1964, President Lyndon B. Johnson stated, 'I propose to dedicate this year to finding new techniques for making man's knowledge serve man's welfare.' He called for 1965—the same year he ordered ground troops to Vietnam to stop the spread of communism —to be a year of international cooperation that could bypass the politics of the Cold War. Previously, the USSR did not participate in the U.S. and WHO's first, failed global eradication plan for malaria. But upon rejoining the WHO in 1956, it was the Soviets who made the first call and investment into global eradication of smallpox in 1958. The WHO functioning as a mediator was crucial to allowing the USSR and the U.S. to work together. It allowed both nations to avoid giving credit to each other; rather success went to science itself. President Johnson called this 'a turning point' away from 'man against man' towards 'man against nature.' The limited role of politicians in the program proved to be key to its success. Scientists made decisions and worked together—no matter what country they came from—by focusing on disease and vaccination, not international tensions. The Soviet-initiated program was lead by Donald A. Henderson, a U.S. epidemiologist, who worked alongside the Russians until the last case of smallpox occurred in Somalia on October 26, 1977. During the 20th century, smallpox was responsible for an estimated 300 to 500 million deaths. Smallpox was officially declared eradicated by the WHO in October 1980, and is today still the only human disease to achieve this distinction. Less than a year after the declaration of smallpox eradication, the emergence of another pandemic, the HIV/AIDS crisis, reinforced the importance of science-first cooperation over politically-driven decision making. In June 1981, the first cases of a new unknown disease were reported in the CDC's Morbidity and Mortality Weekly Report. In short order, gay men were stigmatized and blamed in what would become one of the biggest public health disasters of all time. It took years of grassroots science-based activism to move beyond HIV/AIDS victim-blaming and find medical solutions. The Poster Child for AIDS Obscured as Much About the Crisis as He Revealed Too often, governments across the globe placed blame on the gay community for their 'sins' and did not provide needed support, leaving the sick to suffer and die. The pharmaceutical companies profited from the limited medications they had available and did not pursue sufficient development. The FDA process for new drugs was scheduled to take nine years, at a time when life expectancy after receiving an HIV/AIDS diagnosis was one year. These issues sparked activism, spawning the AIDS Coalition to Unleash Power (ACT UP) in 1987. ACT UP organizers took science into their own hands and began educating themselves. Members began reading scientific journals religiously, learning the chemistry and epidemiology of drug manufacturing and clinical trials. Members learned how to translate these dense scientific messages to educate the community members on what was—and what was not—being done to help. Because of this work, the FDA changed policies to allow for new treatments to be tested at accelerated rates in times of emergency. ACT UP was able to shift the cultural blame showing that the issue was a result of politics getting in the way of scientific advancements. By 1990, ACT UP influenced the largest federal HIV program to pass Congress, the Ryan White CARE Act. This program was a vital precursor to the 2003 PEPFAR (The U.S. President's Emergency Plan for AIDS Relief) global initiative. Both of these histories offer a powerful lesson: global health is national health, and national health is local health. With the recent funding cuts from the U.S. government, the future of global health is going in an unknown direction. And yet, the occurrence of pandemics is expected to increase in frequency due to climate change, mass migration, urbanization, and ecosystem destruction. It has been estimated that there is about a 25% chance we will have another COVID-sized pandemic within the next 10 years. No matter how secure the world makes borders, history shows that it can not protect us from disease if we do not have a strong, interconnected public health infrastructure. Luke Jorgensen is a Master of Public Health student at Purdue University where his epidemiology research examines human migration and infectious disease. Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors. Write to Made by History at madebyhistory@
Yahoo
2 hours ago
- Yahoo
4 ways Trump's ‘one big beautiful bill' would undermine access to Obamacare
Major changes could be in store for the more than 24 million people with health coverage under the Affordable Care Act, including how and when they can enroll, the paperwork required, and, crucially, the premiums they pay. A driver behind these changes is the 'One Big Beautiful Bill,' the name given to spending and tax legislation designed to advance the policy agenda of President Donald Trump. It passed the House on May 22 and is pending in the Senate. The changes also would come from regulations the Trump administration proposed in March and the potential expiration of larger premium subsidies put in place during the COVID-19 pandemic. Millions of people might drop or lose coverage by 2034 as a result, according to the nonpartisan Congressional Budget Office. Combined, the moves by Trump and his allies could 'devastate access' to ACA plans, said Katie Keith, director of the Center for Health Policy and the Law at the O'Neill Institute, a health policy research group at Georgetown University. States that run their own Obamacare marketplaces and the National Association of Insurance Commissioners have also raised concerns about added costs and reduced access. But House Republicans and some conservative think tanks say the ACA needs revamping to rein in fraud, part of which they pin on certain Biden administration changes the measures would undo. Senate Republicans must now weigh whether to include the House's proposals in their own bill, with the aim of getting it through the chamber by July 4. Here are four key ways Trump's policies could undermine Obamacare enrollment and coverage. The House-passed One Big Beautiful Bill Act, which runs more than 1,000 pages, would create paperwork requirements that could delay access to tax credits for some enrollees, potentially raising the cost of their insurance. More than 90% of ACA enrollees receive tax credits to defray monthly premiums for their coverage. There are two key provisions for them to watch. One would end automatic reenrollment for most ACA policyholders each year. More than 10 million people were automatically reenrolled in their coverage for the 2025 plan year, with their eligibility for tax credits confirmed via a system that allows ACA marketplaces to check government or other data sources. The House bill would instead require every new or returning policyholder each year to provide information on income, household size, immigration status, and other factors, starting in 2028. If they don't, they won't get a premium tax credit, which could put the price of coverage out of reach. Louisiana Legislature targets out-of-state doctors who provide abortion pills 'Everyone who wants to either purchase or renew a marketplace plan will have to come with a shoebox filled with documents, scan in and upload them or mail them in, and sit and wait while someone reviews and confirms them,' said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. She and other policy experts fear that many consumers will become uninsured because they don't understand the requirements or find them burdensome. If too many young and healthy people, for example, decide it's not worth the hassle, that could leave more older and sicker people for ACA insurers to cover — potentially raising premiums for everyone. But supporters of the House bill say the current approach needs changing because it is vulnerable to waste, fraud, and abuse. 'This would ensure that enrollees need to return to the exchange to update their information and obtain an updated eligibility determination for a subsidy — best protecting the public against excess subsidies paid to insurers that can never be recovered,' the conservative Paragon Institute wrote in an April letter to top Department of Health and Human Services officials. Today, people who experience life changes — losing a job, getting married or divorced, or having a baby, for instance — are considered provisionally eligible for tax credits to reduce their premiums if they sign up or change their ACA plans. That means they would be eligible to receive these subsidies for at least 90 days while their applications are checked against government data or other sources, or marketplaces follow up with requests for additional information. The House bill would end that, requiring documentation before receiving tax credits. That could create particular hardship for new parents, who can't confirm that babies are eligible for premium subsidies until they receive Social Security numbers weeks after they're born. Policy experts following the debate 'did not expect the end to provisional eligibility,' Corlette said. 'I don't know what the reaction in the Senate will be, as I'm not sure everyone understands the full implications of these provisions because they are so new.' It can take up to six weeks for the Social Security Administration to process a number for a newborn, and an additional two weeks for parents to get the card, according to a white paper that analyzed provisions of the House bill and was co-authored by Jason Levitis, a senior fellow at the Urban Institute, and Christen Linke Young, a visiting fellow with Brookings' Center on Health Policy. Without a Social Security number, any application to add a newborn to an ACA policy would automatically generate a hold on premium tax credits for that family, they wrote — increasing their out-of-pocket costs, at least temporarily. 'It puts consumers on the hook for any delays the marketplace is taking,' while the Centers for Medicare & Medicaid Services, which administers the ACA marketplaces, 'is cutting staff and adding a lot more paperwork to burden the staff they have,' Levitis said. Provisions in the House bill that would require ACA enrollees to provide information each year that they reenroll — or when seeking to add or change a policy due to a life circumstance — would increase the number of people without health insurance by 700,000 in 2034, according to the latest CBO estimate. The House bill would turn into law a Trump proposal to shorten the ACA open enrollment period. The start date would continue to be Nov. 1. But the window would be shortened by about a month, with an end date of Dec. 15. This affects people in states that use the federal marketplace as well as the 19 states and the District of Columbia that run their own, most of which offer open enrollment into at least mid-January. Also, as soon as the end of this year, a special enrollment period the Biden administration created would be done away with. It allowed people with lower incomes — those who earn up to 1.5 times the 2024 federal poverty level, or about $38,730 for a family of three — to sign up anytime during the year. Critics, including the Paragon Institute, argue that this enrollment opening led to fraud, partly blaming it for a steep increase last year in instances of insurance agents seeking commissions by enrolling or switching consumers into plans without their consent, or fudging their incomes to qualify them for tax credits so large they paid no monthly premiums at all. But supporters — including some states that run their own ACA exchange — say there are other ways to address fraud. 'We anticipate that much of the improper activity can be prevented by security and integrity upgrades to the federal marketplace, which we understand the Centers for Medicare and Medicaid Services (CMS) is implementing,' the National Association of Insurance Commissioners wrote in a May 29 letter to congressional leaders. The reason? Enhanced tax credits created during the pandemic expire at the end of the year. The House bill doesn't extend them. Those more generous payments are credited with helping double ACA enrollment since 2020. The CBO estimates that extending the subsidies would cost $335 billion over 10 years. The House bill instead funds an extension of Trump's tax cuts, which largely benefit wealthier families. If the enhanced credits are allowed to expire, not only would premium subsidies be smaller for many people, but there would also be an abrupt eligibility cutoff — an income cliff — for households above four times the federal poverty rate, or about $103,280 for a family of three for this plan year. Taking into account the smaller subsidies and the cliff, KFF estimates a national average premium increase of 75% for enrollees if the enhanced subsidies expire. The CBO expects that about 4.2 million more people will be uninsured in 2034 as a result. SUPPORT: YOU MAKE OUR WORK POSSIBLE This article first appeared on KFF Health News and is republished here under a Creative Commons license. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF and subscribe to KFF Health News' free Morning Briefing.
Time Magazine
3 hours ago
- Time Magazine
History Shows the Danger of Trump and RFK Jr.'s Health Policies
On May 11, 2023, President Joseph Biden ended the COVID-19 public health emergency, calling an finish to the pandemic. By the end of 2023, COVID-19 claimed the lives of over 20 million people around the world. But through international cooperation and evidence-based science, vaccines were developed and the world moved on. Indeed, perhaps the biggest success of the period was the quick production of a COVID-19 vaccine. The research behind the mRNA vaccine had been ongoing since the 1970s, but the emergency of the pandemic and international sharing of knowledge helped bring the vaccine to fruition. Today, the COVID-19 vaccine has been credited with saving 2.4 million lives around the world. But now, the U.S. is choosing competition over cooperation. With President Donald Trump's day one executive order to leave the World Health Organization (WHO)—blaming their COVID-19 response—and the shuttering of USAID, the country is taking steps towards further dividing health efforts across the globe. Here in the U.S., a sudden end to $11.4 billion of covid-related grants is stifling national pandemic preparedness efforts on the local and state levels. And most recently, Health and Human Services Secretary RFK Jr. purged experts from the CDC Advisory Committee, putting lives at risk. Historical lessons demonstrate the need for global health infrastructure that works together, shares knowledge, and remembers that pathogens do not stop at borders. One of the greatest global health achievements of all time— smallpox eradication —provides a perfect example of what can be done with independent scientific research and international cooperation. During the Cold War between the U.S. and USSR, decades of tension brought the world to the brink of nuclear war. Yet, incredibly, the nations managed to find common ground to support the efforts of smallpox eradication. Indeed, they understood the strategic benefits that came from letting public health practitioners and scientists work outside of political divides. The WHO was founded after World War II in 1948. Its formation marked a move from international health, that focused on nations, to global health, that would serve humanity first. The WHO's first eradication effort was the failed, U.S.-backed, Malaria Eradication Program from 1955 to 1969. The Smallpox Eradication Program, with intensive efforts beginning in 1967, provided a chance for redemption for the U.S. and WHO. For the United States, investing in disease eradication and poverty helped to mitigate growing backlash against the Vietnam War. In June of 1964, President Lyndon B. Johnson stated, 'I propose to dedicate this year to finding new techniques for making man's knowledge serve man's welfare.' He called for 1965—the same year he ordered ground troops to Vietnam to stop the spread of communism —to be a year of international cooperation that could bypass the politics of the Cold War. Previously, the USSR did not participate in the U.S. and WHO's first, failed global eradication plan for malaria. But upon rejoining the WHO in 1956, it was the Soviets who made the first call and investment into global eradication of smallpox in 1958. The WHO functioning as a mediator was crucial to allowing the USSR and the U.S. to work together. It allowed both nations to avoid giving credit to each other; rather success went to science itself. President Johnson called this 'a turning point' away from 'man against man' towards 'man against nature.' The limited role of politicians in the program proved to be key to its success. Scientists made decisions and worked together—no matter what country they came from—by focusing on disease and vaccination, not international tensions. The Soviet-initiated program was lead by Donald A. Henderson, a U.S. epidemiologist, who worked alongside the Russians until the last case of smallpox occurred in Somalia on October 26, 1977. During the 20th century, smallpox was responsible for an estimated 300 to 500 million deaths. Smallpox was officially declared eradicated by the WHO in October 1980, and is today still the only human disease to achieve this distinction. Less than a year after the declaration of smallpox eradication, the emergence of another pandemic, the HIV/AIDS crisis, reinforced the importance of science-first cooperation over politically-driven decision making. In June 1981, the first cases of a new unknown disease were reported in the CDC's Morbidity and Mortality Weekly Report. In short order, gay men were stigmatized and blamed in what would become one of the biggest public health disasters of all time. It took years of grassroots science-based activism to move beyond HIV/AIDS victim-blaming and find medical solutions. Too often, governments across the globe placed blame on the gay community for their 'sins' and did not provide needed support, leaving the sick to suffer and die. The pharmaceutical companies profited from the limited medications they had available and did not pursue sufficient development. The FDA process for new drugs was scheduled to take nine years, at a time when life expectancy after receiving an HIV/AIDS diagnosis was one year. These issues sparked activism, spawning the AIDS Coalition to Unleash Power (ACT UP) in 1987. ACT UP organizers took science into their own hands and began educating themselves. Members began reading scientific journals religiously, learning the chemistry and epidemiology of drug manufacturing and clinical trials. Members learned how to translate these dense scientific messages to educate the community members on what was—and what was not—being done to help. Because of this work, the FDA changed policies to allow for new treatments to be tested at accelerated rates in times of emergency. ACT UP was able to shift the cultural blame showing that the issue was a result of politics getting in the way of scientific advancements. By 1990, ACT UP influenced the largest federal HIV program to pass Congress, the Ryan White CARE Act. This program was a vital precursor to the 2003 PEPFAR (The U.S. President's Emergency Plan for AIDS Relief) global initiative. Both of these histories offer a powerful lesson: global health is national health, and national health is local health. With the recent funding cuts from the U.S. government, the future of global health is going in an unknown direction. And yet, the occurrence of pandemics is expected to increase in frequency due to climate change, mass migration, urbanization, and ecosystem destruction. It has been estimated that there is about a 25% chance we will have another COVID-sized pandemic within the next 10 years. No matter how secure the world makes borders, history shows that it can not protect us from disease if we do not have a strong, interconnected public health infrastructure. Luke Jorgensen is a Master of Public Health student at Purdue University where his epidemiology research examines human migration and infectious disease.
