Private veterans care? Caution: We’ve already tried it

The following op-ed by FIU history professor Jessica L. Adler was originally published in USA TODAY. Adler’s research focuses on the history of veterans’ health care in the United States as well as U.S. health, social and welfare policy, war and society, and American political development. She is completing a book about the roots of the largest integrated health care system in the United States.

Three statues portraying a wounded soldier being helped stand on the grounds of the Minneapolis VA hospital. (Photo: Jim Mone, AP)

By Jessica L. Adler

Sometimes, crisis can bring opportunity. In June, the Senate approved legislation sponsored by Sens. John McCain, Ariz., and Bernie Sanders, I-Vt., to increase funding for Veteran Affairs, build 26 facilities and make access to private health care easier.

But as the House considers whether to allow veterans to seek private care, it should bear in mind that offering treatment outside of the VA health system could also spawn new problems, even as it cuts wait times.

History provides a guide. When soldiers were discharged during and after World War I, a small federal agency arranged for those in need of medical attention to be cared for in public institutions. As early as 1918, Surgeon General Rupert Blue noted that because demand was overwhelming, hospitalized veterans were being treated in “beds in hallways, on verandas, and even in tents.”

As veterans complained of neglect, the government hastily enlisted the help of private institutions. By 1920, veterans could be treated in more than 1,900 “contract” hospitals that received a per diem fee.

But it soon became clear that deplorable conditions existed in many of those facilities. Complaints about privately administered care were so rife, and it was so difficult to oversee and manage the institutions, that the federal government attempted in the early 1920s to ensure that all veterans be treated only in public hospitals. But soon, veterans were complaining that conditions were no better.

Some of the same groups advocating for veterans now brought attention to stories of neglect. The groundwork was laid for the creation of the Veterans’ Bureau in 1921 and an affiliated hospital system that would be free from the problem of divided authority.

In the 90-plus years since, the government and its veterans — especially in the wake of wars — have been forced to reckon with changing realities: new battle tactics and weapons that lead to previously unseen injuries and illnesses; confounding questions about how to determine service connection; expanding expectations of the possibilities of modern medical care; and economic downturns that bring about budgetary constraints and increased demand for services.

Bad management has historically exacerbated those challenges.

Of course, the health care landscape looks very different today than after World War I. But there are hints of trouble ahead.

A May 28 headline in Modern Healthcare, a news outlet aimed at health care executives, announced: “Hospitals brace for billing, treatment challenges serving veterans.”

A week later, the website declared: “Hospitals concerned about reimbursement as they prepare for influx of vets.”

Policymakers should look to history to ensure that the latest tragic VA scandal does not lead to impetuous changes that compromise quality of care rather than improving it.