Is Department of Veterans Affairs care really ‘scandalously substandard’?

The future of the Department of Veterans Affairs, especially its VA health care system, is the subject of considerable debate and discussion on Capitol Hill and elsewhere. The system was recently called “scandalously substandard” by a member of the House Veterans Affairs Committee.

Difficulties in modernizing the department’s computerized health records system, problems with accessing care, and budget shortfalls requiring emergency appropriations have all brought VA and the level of care it provides veterans considerable unfavorable publicity and scrutiny.

VA, certainly is not perfect. The department has issues. But as a former secretary of Veterans Affairs, I am convinced the health care VA provides veterans is better than most other Americans receive.

In the most recent Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems star ratings, 79 percent of VA facilities received a summary star rating of four or five stars, compared to 40 percent of non-VA hospitals. And in CMS’s Overall Hospital Quality Star Ratings, more than 58 percent of VA hospitals received 4 or 5-star ratings, compared to 40 percent of non-VA hospitals. This is only the second year VA hospitals were included in this review, and VA outperformed non-VA health care both times.

In 2023, the Journal of General Internal Medicine and the Journal of American College of Physicians both published articles reviewing nationally peer-reviewed studies comparing VA health care to that of other providers. The studies concluded that VA health care is as good as or better than non-VA health care in the areas of quality, safety, access, patient experience and comparisons of cost versus efficiency.

Of 26 studies that looked at non-surgical care, 15 reported VA care was better than non-VA care, and seven reported equal or mixed clinical quality outcomes. Of the 13 studies that looked at quality and safety in surgical care, 11 reported VA surgical care is comparable or better than non-VA care.

VA measures customer experience and trust through the ease, effectiveness and emotion the department demonstrates in its delivery of care, benefits and services. According to Military Times, trust in VA programs has risen dramatically over the last eight years as a result of efforts by both Republican and Democrat secretaries to improve the delivery of medical and disability benefits. Overall confidence in the department among users of its services increased from just over half of users in 2016 (55 percent) to more than 80 percent in fiscal 2024.

Recently, I visited a close family member in an academic medical center (not VA-affiliated) that claims to be among the best in its region. My relative, who is unable to walk due to her medical condition, was lying in a hallway of the facility’s emergency room with virtually no privacy along with many other patients — not for hours, but for days.

These conditions would not be tolerated anywhere in the VA health care system, just as they should not be tolerated in the private sector.

VA’s reluctance to expand its community care program, which provides care to veterans through community providers when VA cannot provide the care they need in a timely manner, or if the veteran lives far from a VA facility, has also been criticized. This program’s goals are laudable, and it is a valuable tool in areas where veterans cannot easily access VA care without traveling long distances, and in places where the demand for VA services is so great veterans face long waiting times for those services.

And it is indeed showing its promise in a number of areas around the country such as Montana and the Rio Grande Valley in Texas where the department’s capability and capacity are being maximized and community care is being leveraged so that veterans do not have to go without needed care or travel unreasonable distances to receive it.

But, as with any new program, it is important to get the balance right. Maximizing the investment in VA’s direct system is critical, or unintended consequences will result. VA’s fiscal 2025 budget request allocates $86 billion for care provided in VA hospitals and clinics and $41 billion for private network care which indicates the program is being employed as it should be when needed to serve veterans.

Both play an important role; however, it would be a tragedy for millions of veterans if the VA health care system ceased to exist. There is no health system in the U.S. better attuned to or prepared for the illnesses and injuries associated with military service particularly in spinal cord injury, traumatic brain injury, addictions and mental health.

The department’s current health care priorities, including ending veteran homelessness, preventing veteran suicide and modernizing existing facilities, are praiseworthy. But whomever takes over responsibility for the department next Jan. 20 along with Congress must make courageous decisions on VA’s legacy infrastructure.

VA maintains a large number of unneeded facilities throughout the nation, many that were constructed immediately after World War II when patient care was synonymous with in-patient care. Between the community care program and the advent of telemedicine, the department has significantly decentralized its health care offerings. Dollars that could be used for 21st century health care are instead used to maintain outdated infrastructure. In 2018, Congress empowered VA to make recommendations to a commission on ways to revamp its legacy infrastructure. VA made those recommendations — and then Congress refused to ratify the commissioners’ appointments, dooming the effort.

In 2005, I chaired the Congressional Base Realignment and Closure Commission responsible for making recommendations to the president and Congress on the nation’s military basing needs and alignment to meet our future threat assessment. The commission met its responsibilities. I am confident that a VA asset infrastructure review panel would make recommendations that would help right-size the department’s infrastructure, while protecting taxpayers' interests.

Perhaps new leadership will lead VA to new heights of service to veterans and to America. But those who indict the system denigrate the hard work and dedication of hundreds of thousands of VA employees — and belittle the training of most of our nation’s practicing physicians, approximately 70 percent of whom trained at a VA facility at some point.

Worse yet, it makes many veterans afraid to visit the VA and get the health care and benefits they have earned through their service and sacrifices for our nation.

Anthony J. Principi was secretary of Veterans Affairs from 2001 to 2005.