For VA, accountability and risk make for strange but necessary bedfellows

Tomorrow, the public and Congress will hear VA’s plan to reform healthcare for nearly 9 million veterans that will involve the expansion of non-VA community care. Like the debate that sparked earlier this week over which electronic health record system to adopt, the VA Choice Care debate on pushing more care outside of VA spans years prior to Department of Veterans Affairs (VA) Secretary David Shulkin’s leadership. 

It is a debate that has been colored by controversy as the discussion evolved from a voucher system, to privatization, to Choice Care—all of which are long decried by some as attempts to completely erode VA. Other evidence, however, belies such charges.  For instance, the secretary’s recently authorized critical clinical staffing increases in VA specialized services, the Spinal Cord Injury & Disease system of care being a relevant example.

Investment in these “foundational services” that cannot be replicated in the community signals an intent to both offer greater access to care to the majority of veterans, while building the internal capacity to care for those who exist in far fewer numbers but have the greatest and most complex medical needs.

Shulkin will soon find out that calculating your risks and remaining accountable for your promises to America’s Veterans will get harder.  Yet, for the VA, accountability and risk are strange but necessary bedfellows.  He will soon discover how strange as he faces a number of other challenges with no easy fixes. The list is long, and the toughest are at the top:

• Expanding caregiver benefits for those providing attendant care to Pre-9/11 veterans with a budget that is already cash strapped
• Removing underperforming VA employees who enjoy the protection of unions (due process policies that are weak on accountability even for the worst offenders, and a culture characterized by a “this too shall pass” mentality)
• Dealing with VA disability claims and appeals processes that are replete with inefficiencies and backlogs that show no signs of abating as more veterans, dependents, and survivors seek more benefits over the next few years

Confronting all these problems, most of which were years in the making, will not be easy and bear the weight of great accountability. But then again, so does staying the course, as past VA leaders had found out the hard way. “There are risks and costs to action,” once said President John F. Kennedy. “But they are far less than the long range risks of comfortable inaction.” 

Shulkin has embraced accountability by taking huge risks that fly in the face of convention. The question is whether the Department of Veterans Affairs is, at long last, ready to release its death grip on comfortable inaction.

Sherman Gillums, Jr. is a U.S. Marine, and the national executive director of the Paralyzed Veterans of America in Washington, DC.  As a paralyzed veteran, he also regularly accesses specialized services and monitors quality of care in the VA healthcare system.

The views expressed by this author are their own and are not the views of The Hill.