The Veterans Health Administration (VHA) will spend $68 billion this year on its system of 150 medical centers, 1,400 clinics, and numerous other facilities for veterans. The VHA owns the facilities and employs about 320,000 doctors, nurses, and administrators to operate the system. The VHA is an outlier in American health care, as even the giant Medicare and Medicaid programs rely on services provided through privately owned and operated health facilities. The VHA system serves about 8 million veterans each year.
The VHA suffers from the usual problems of government monopolies, such as the misallocation of resources, excessive bureaucracy, congestion, and a lack of transparency. VHA's facilities, for example, are overcrowded in the states where the population of veterans is growing, but they have excess capacity in other states. Allocation of resources is based partly on political factors, not market demands.
The VHA has a huge backlog of about 900,000 pending applications from veterans, and many veterans face long waits for doctor appointments. VHA capital investment is inefficient, and often results in large cost overruns. GAO studied the four largest VHA hospital construction projects in 2013 and found that the combined costs of the projects had doubled. GAO pinned the blame on "weaknesses in VA's construction management processes."
A major scandal erupted in 2014 regarding waiting lists for VHA services. Investigators found that many veterans face excessively long waits, with some veterans dying before their scheduled appointments. VHA administrators were found to routinely falsify data to hide the long wait times. The scandal initially focused on the Phoenix VHA hospital, but investigators found that improper and fraudulent scheduling practices were a "nationwide systemic problem." A September 2015 report from the VA's Inspector General found that the agency's system for tracking patient enrollments was a mess.
A 2014 report from the Obama White House lambasted the VHA, saying it suffered from "significant and chronic system failures." The system has a "corrosive culture of distrust," "acts with little accountability or transparency," and "encourages discontent and backlash against employees." The White House report also said that the VHA has unresponsive leadership and its insularity has impeded innovation and change.
Even Sen. Bernie Sanders (D-VT) chimed in: "No organization the size of VA can operate effectively without a high level of transparency and accountability. .Clearly, that is not the case now at the VA." But the mistake Sanders and others make is to think that simple management reforms can fix such problems. They do not realize that these sorts of problems are endemic and systemic in large federal bureaucracies, particularly monopolies such as VHA.
Fundamental reforms are needed in the direction of privatizing veterans' care. In response to the crisis, Congress passed a law in 2014 that included a Choice Card allowing some veterans to go to private health facilities if they were not able to get an appointment within 30 days or if they lived more than 40 miles from a VHA facility. But Congress should take further steps in the direction of individual choice in veterans' health care. Ultimately, veterans' health facilities should be privatized, and all veterans should receive vouchers to access care at private facilities of their choice.
Government as Purchaser
The main focus of this study has been activities that the federal government should get out of completely, such as the electric power business. There are other activities that the government will continue to fund but could be partly privatized, such as veterans' health care. The Office of Management and Budget (OMB) found that about 850,000 federal workers have been "identified as performing commercial activities." Generally, such activities can be purchased from contractors, and OMB Circular A-76 describes a process to determine when that makes economic sense. The Clinton and Bush administrations, as noted, successfully privatized 187,000 units of military housing. That initiative improved housing quality, reduced housing costs about 10 percent, and cut energy use. The next president should expand such efforts.
Government as Seller
The federal government not only purchases products from the private sector, it also sells them to the private sector. But that often puts the government in competition with private firms. The USPS, for example, delivers packages in competition with FedEx and UPS. The government sells many other products as well, including maps, pest eradication services, and laboratory work. Allowing the government to sell items that the private sector can or does sell makes no sense. Congress should privatize such activities, and bar federal agencies from entering activities that private businesses perform.
https://www.downsizinggovernment.org/privatization
Norb Leahy, Dunwoody GA Tea Party Leader
No comments:
Post a Comment