Privatization of Veterans Health Care Is Not The Answer

By Dr. Ashwini Zenooz and Col. Greg Douquet (Ret.)

After National Security, our next President’s most important mission is to care for Veterans who have guaranteed that security. The President’s indispensable partner in this mission is the Department of Veterans Affairs (VA). Today’s VA advances on many fronts but still struggles to provide the access to medical care they deserve. The next President’s first act should transform VA into a Department we can all be proud of.

There is no more important challenge for VA than ensuring timely access to quality health care for all veterans — whether they live in large cities or in remote locations, whether they are mobile or house-bound. VA has had problems with access to care but quality of care is generally as good or better than non-VA/private sector hospitals. With Executive support and the right strategic partnerships, VA can be a model for how healthcare should be done in the future.

Our Veterans need help now and Congress and the American taxpayers are understandably frustrated and impatient, so the next Administration needs to move out rapidly. This will require a President who understands the complexities of a national health care system, how to work effectively with a vexed Congress, and has the will to see VA transformation through.

Privatizing VA isn’t the answer. Dismantling Veterans’ only specialized integrated health care system would incur unsustainable costs and lead to lower quality care and fewer services. But private sector health care providers would expand VA’s reach and ease the access problem. Our next president must strive to identify opportunities for VA to collaborate with outside health care providers when it makes sense in service to our Veterans, regardless of political resistance.

Public-private partnerships, by which the VA thoughtfully leverages the abilities of private providers, must be at the top of the next President’s agenda for Veterans health care reform. If VA cannot accommodate Veterans’ needs because the Department’s workload exceeds its in-house workforce, then Veterans must have quick and expeditious access to private sector providers. These providers must be verified capable by VA of meeting Veterans’ often complex and unique needs. VA’s voucher system, as currently mandated, is a well intentioned but ultimately flawed first step to bridging this access gap for Veterans.

In some cases, VA has made significant strides by forming private sector alliances responsive to our Veterans. VA just released data indicating that an average of 20 veterans a day die from suicide, which is a decline from previous years. Our objective as a nation must be to bring that number to zero. VA has undertaken measures towards reducing veteran suicides through innovative public-private partnerships with the Johnson & Johnson Healthcare System, the Bristol Myers Squibb Foundation (BMSF), and Walgreens, among others. Through these partnerships, funding is targeted at the community level to to develop and implement innovative models of community-based care that improve mental health and promote successful reintegration of returning veterans and their families. The resulting initiatives are evaluated by the VA to determine their impact on Veterans health and quality of life so that it can be replicated elsewhere with other VA providers.

Cancer research is another example of a public-private partnership that will ultimately lead to significant improvement in Veteran care. VA cares for 3.5% of cancer patients in the United States. Over the next two years, VA is collaborating with IBM Watson Health to identify and enhance precision medicine for 10,000 veterans who are cancer patients, which will accelerate treatment for patients with advanced cancer.

Promising starts with IBM Watson and others yield useful data that RAND has leveraged to identify the prerequisites for successful public-private partnerships. According to RAND, the VA needs champions to create effective partnerships; inspire support from stakeholders outside the VA, especially at the local level; and adapt to technological innovations, particularly with respect to information technology.

The importance of developing and nurturing fruitful public-private partnerships is just common sense. But it is also hard work. It is too easy for politicians to wield a wrecking ball against VA, and then sell off the rubble to the lowest bidders. It is a lot harder but ultimately more productive to identify the particular instances when it is appropriate to use private providers to supplement and expand upon the VA’s capabilities.

Hillary Clinton, who has a wealth of valuable public sector health experience, has made public-private partnerships a cornerstone of her agenda for Veterans health care reform. She possesses the unyielding determination necessary to ensure that our Veterans will receive increased access to services to which they are entitled, while still making certain that the VA is strengthened by strategic alliances with private providers rather than swallowed whole by big health care corporations.

Donald Trump, has in the view of many experts, tacitly endorsed the VA’s privatization. Significantly, despite his background in business, Mr. Trump’s ten-point campaign plan for the Department makes no mention of public-private partnerships, outside of blithely sending veteran care out to the community.

Ultimately, we need a President who will ensure that VA aggressively investigates and exploits all possibilities for public-private partnerships that strengthen, rather than privatize it. And regardless of whether that care is publicly or privately provided, VA must continue to be the guarantor of quality; our veterans deserve nothing less and our country would want it no other way.


Dr. Ashwini Zenooz was most recently a Brookings Congressional Health Policy Fellow at the United States Senate Committee on Veterans’ Affairs. She was previously a senior physician at the Department of Veterans Affairs and clinical faculty at Stanford Medical School.

Col. Greg Douquet (Ret.) is founder and managing partner of Red Duke Strategies, which provides strategic planning and advice to private sector, government, and non-government organizations. Before retiring, he was a colonel in the U.S. Marine Corps and chief of staff for Marine forces in Africa and Europe.

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