Trump, Clinton, and VA Reform

Hillary is in denial about the VA’s problems; Trump at least has a plan.
November 4, 2015 • Commentary
This article appeared on National Review (Online) on November 4, 2015.

If you want to know how far out of touch Democrats have become, consider that Donald Trump is starting to make more sense on VA reform than Hillary Clinton.

Faced with the ongoing scandal of veterans’ health care, Hillary’s instinctive reaction was to defend the government bureaucracy. Appearing on MSNBC’s Rachel Maddow Show, Hillary dismissed problems with the troubled agency, declaring they have “not been as widespread as it has been made out to be.” Criticism of the VA, she maintained, was just part of the Republicans’ “ideological agenda.” In Hillaryworld, it is simply inconceivable that a government program could fail.

Hillary’s comments came just weeks after a new report from the VA’s own inspector general revealed that, if anything, the department’s problems have actually grown worse since they were first uncovered in 2010.

According to the IG, there was a backlog of some 560,000 veterans waiting for their applications to be processed as of September 2014. Another 307,000 were still on the list, though they had died while their applications were pending. That sounds pretty widespread to me.

In fact, these numbers probably understate the real problem, because, as the IG notes, the VA has failed to “ensure the consistent creation and maintenance of essential data,” which makes it impossible to know just how bad things are. For example, more than half of the pending applications were not dated, which means there was no way of knowing how long those veterans had been waiting. In addition, the IG found that VA employees had incorrectly marked unprocessed applications as completed and may have deleted more than 10,000 transactions over five years. The VA’s problems are so widespread that we can’t even tell how widespread they are.

It’s not just access to care that has become a problem at the VA, it’s the quality of the care that is provided. For instance, in a separate report, the IG found “unacceptable and troubling lapses in follow‐​up, coordination, quality, and continuity of care.” So, essentially, veterans are waiting in line for lousy health care.

Nor can the department’s problems be blamed on underfunding, as Hillary tried to do. From 2000 to 2012, VA funding nearly tripled, rising faster than both medical inflation and the increase in the number of patients. On top of that, Congress responded to news of the VA scandal in 2014 by throwing another $10.4 billion at the problem through 2016, in bipartisan legislation co‐​sponsored by John McCain and Bernie Sanders (who basically wants to turn the entire U.S. health‐​care system into the VA). If the pilot program allowing veterans unable to get a timely appointment at VA facilities to utilize private facilities is extended beyond 2016, the costs will be precipitously higher.

And, as is true for most government programs, no one is held accountable. Despite the department’s myriad problems, including deliberate fraud and the falsification of records, internal VA documents show that, as of April 2015, just three employees had lost their jobs for misconduct since the scandal broke. Even after management identified specific individuals who had hidden applications in their desks in order to artificially shorten wait‐​times, human‐​resources officials “advised them against pursuing disciplinary action.”

In contrast to Hillary, Donald Trump released a plan for VA reform last week that at least acknowledges the problems facing the system — and contains a few interesting ideas for reform, as well.

True, it was accompanied by the usual Trumpian blather about “making the VA great again.” But Trump, unlike Hillary, would punish VA employees for wrongdoing and incompetence. If there’s one thing Trump understands, it’s how to fire people.

He would also build on the 2014 VA reforms by giving veterans greater ability to opt out of the VA system if they choose. Under his plan, “All veterans eligible for VA healthcare can bring their veteran’s ID cards to any doctor or care facility that accepts Medicare to get the care they need immediately.”

Trump also promised to redirect some VA funds into suicide‐​prevention efforts and better treatment of PTSD. He also called for more services for female vets, noting, for example, a lack of OB-GYN care at VA facilities.

The biggest problems with Trump’s plan, unsurprisingly, are costs and a lack of detail. Since Trump would maintain the VA as the health‐​care system of last resort for all veterans, regardless of how long they served or whether the illness or injury was service‐​connected, his plan to expand services would almost certainly cost billions more. Trump, of course, provided no estimate of cost, but he promised, “The Trump plan will clean up VA finances so the current VA budget provides more and better care than it does now.” In announcing his plan, he said, “We’ll have money actually left over.”

So it’s safe to say that Trump’s plan has more than a few holes in it. Still, compared to Hillary’s position, it looks like a model of statesmanship.

Perhaps the next time a debate moderator wonders about a comic‐​book campaign, he should expand his view to look Hillary’s way.

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