Veter­ans Af­fairs seeks greater ac­cess to pri­vate care

San Francisco Chronicle - Late Edition (Sunday) - - NATION - By Jen­nifer Stein­hauer and Dave Philipps

WASH­ING­TON — The Depart­ment of Veter­ans Af­fairs is pre­par­ing to shift bil­lions of dol­lars from gov­ern­ment-run veter­ans’ hos­pi­tals to pri­vate health care providers, set­ting the stage for the big­gest trans­for­ma­tion of the veter­ans’ med­i­cal sys­tem in a gen­er­a­tion.

Un­der pro­posed guide­lines, it would be eas­ier for veter­ans to re­ceive care in pri­vately run hos­pi­tals and have the gov­ern­ment pay for it. Veter­ans would also be al­lowed ac­cess to a sys­tem of pro­posed walk-in clin­ics, which would serve as a bridge be­tween VA emer­gency rooms and pri­vate providers, and would re­quire co-pays.

Veter­ans’ hos­pi­tals, which treat 7 mil­lion pa­tients an­nu­ally, have strug­gled to see pa­tients on time in re­cent years, hit by a dou­ble crush of re­turn­ing Iraq and Afghanistan veter­ans and ag­ing Viet­nam veter­ans. A scan­dal over hid­den wait­ing lists in 2014 sent Congress search­ing for fixes, and in the years since, Repub­li­cans have pushed to send veter­ans to the pri­vate sec­tor, while Democrats have fa­vored in­creas­ing the num­ber of doc­tors in the VA.

If put into ef­fect, the pro­posed rules — many of whose de­tails re­main un­clear as they are ne­go­ti­ated within the Trump ad­min­is­tra­tion — would be a win for the once-ob­scure Con­cerned Veter­ans for Amer­ica, an ad­vo­cacy group funded by bil­lion­aire in­dus­tri­al­ists Charles and David Koch and their net­work of donors.

For in­di­vid­ual veter­ans, pri­vate care could mean shorter waits, more choices and fewer re­quire­ments for co-pays — and could prove pop­u­lar. But some health care ex­perts and veter­ans groups say the change, which has no sep­a­rate source of fund­ing, would re­di­rect money that the cur­rent veter­ans’ health care sys­tem — the largest in the na­tion — uses to pro­vide spe­cialty care.

Crit­ics have also warned that switch­ing vast num­bers of veter­ans to pri­vate hos­pi­tals would strain care in the pri­vate sec­tor and that costs for tax­pay­ers could sky­rocket.

Sup­port­ers ar­gue that the new rules would stream­line care avail­able to veter­ans and also prod the veter­ans’ hospi­tal sys­tem to com­pete for pa­tients, mak­ing it more ef­fi­cient.

“Most veter­ans chose to serve their coun­try, so they should have the choice to ac­cess care in the com­mu­nity with their VA ben­e­fits,” said Dan Cald­well, ex­ec­u­tive direc­tor of Con­cerned Veter­ans for Amer­ica.

Jen­nifer Stein­hauer and Dave Philipps are New York Times writ­ers.

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