Our Patriots (Veterans) Deserve Better: 3 Bold Reasons Why $15 Billion Won’t Fix the Veterans Affairs (VA) and 5 Essential Fixes Including Insurance Subvention the VA Needs Now

How many more times will the VA request additional funds without addressing the root issues? The urgency of the VA’s financial crisis should concern us all and spur us to action.

Executive Summary

The VA requests $15 billion, but this is only a temporary fix for systemic mismanagement and inefficiency. This article supports former VA Secretary David Shulkin’s recommendation to implement insurance subvention and proposes urgent reforms to address inefficient resource allocation, redundant programs, and financial mismanagement, prioritizing accountability over endless funding. The VA can improve veteran services and sustain care with insurance subvention.  Check out the hyperlinks for more information inside the article, questions, and learning activities at the end to take action!

Blip-Zip Takeaways

• Insurance Subvention: Aligning funding with care delivery can create sustainable financial solutions for the VA.
• Private Sector Partnerships: Expanding access to private providers can alleviate pressure on VA facilities.
• Streamlined Operations: Cutting bureaucratic bloat is crucial to enhancing timely veteran care.

Here we Go Again: Why is the VA asking for $15 billion more?

The VA’s request for an additional $15 billion is a familiar tune from 2021. Yet, the VA’s budgetary missteps and proposed actionable solutions to ensure veterans receive the care they deserve without scrutiny, especially with document unnecessary financial bloat, should not pass.

The Department of Veterans Affairs (VA) claims it faces a historic $15 billion budget shortfall. The Veterans Affairs (VA) budget request of $15 billion to cover its shortfall is another financial Band-Aid for a system in desperate need of reform. The real problem isn’t just a lack of funds—it’s an inefficient, bureaucratic system that fails to provide timely care to veterans. The VA needs leadership and accountability, perhaps a follow-up evaluation from the Final Report of the Commission on Care, August 3, 2016, not endless handouts. Reforms that prioritize accountability will instill confidence in the public and veterans alike.

While the VA claims this funding is essential to maintaining services, a closer look reveals that the real issue lies in mismanagement and inefficiencies. According to former VA Secretary David Shulkin, the Department of Veterans Affairs (VA) could address its $15 billion budget shortfall through a strategy called insurance subvention, similar to Medicare subvention for military retirees known as TRICARE for Life. He’s right on!

A Familiar Problem Statement and Cry For More Funding

The VA’s financial crisis isn’t new, but the recent $15 billion shortfall raises deeper concerns about how effectively funds are used. According to recent reports, the shortfall is driven by increased hiring and pharmaceutical costs. However, the increased mandates, hiring, and pharmaceutical costs aren’t the root problem—it’s inefficient resource allocation, redundant programs, and mismanagement that are draining the budget. It’s crucial to address these inefficiencies before pouring more money into the system.

1. Inefficient Resource Allocation: The VA’s current budget includes significant program allocations. Yet, inefficiencies persist. For example, the VA’s administrative costs have ballooned, consuming resources that could be better spent on direct care. This is like a primary health system; corporate headquarters spend more on administration and bureaucracy than frontline medical care and operations.
2. Redundant Programs: The VA operates numerous overlapping programs that could be consolidated. For example, in 2015, the VA delivered the Department’s Plan to Consolidate Community Care Programs to Congress, its vision for the future outlining improvements for how the VA will deliver health care to Veterans. However, it has yet to be evaluated.
3. Mismanagement of Funds:  Historical mismanagement has plagued the VA, with funds often failing to reach the intended recipients. For example 2012, Congressional hearings focused on the VA’s Flawed Fiduciary System. What’s happened since? In 2019, ​the U.S. Office of Special Counsel (OSC) alerted the President and Congress to significant financial mismanagement at the U.S. Department of Veterans Affairs (VA), including more than $223 million in wasteful spending and delayed payments for veterans’ medical bills. In 2022, the Department of Veterans Affairs improperly spent or lost roughly $3.5 billion in fiscal 2022 across several programs. It is required by law to track and improve the management of Department outlays.

The VA must restructure its bloated bureaucracy, expand private-sector partnerships, and slash administrative costs to avoid future shortfalls. Addressing these inefficiencies will enable the VA to meet its budgeting goals without compromising veteran care. Next, we explore quick solutions to these recurring financial problems.

The VA’s problems are not new, and they cannot be ignored any longer. Immediate action is needed to address the root issues and prevent Future Financial Crises. The time for solutions is now!

Poor management in the VA has hindered efficient care, causing veterans to wait over 30 days for services. In 2023, there were an estimated 18 million veterans; of that, 9 million were eligible for VA care, and only 6 million were using it. This gap isn’t just a statistic; it represents real people battling mental health challenges, PTSD, and substance misuse, often in isolation. The complexity of their needs mirrors the complexity of the system they’re struggling to navigate.

So, what’s the solution? The PACT Act, which President Biden signed in 2022, is a step forward, historically expanding eligibility for VA care and increasing access to it. But it’s like placing a Band-Aid on a gaping wound. For example, sadly, the VA’s recommendations to the Asset and Infrastructure Review (AIR) Commission to modernize and realign the VA healthcare system were summarily rejected by veterans and politicians on both sides of the aisle without reading the contents. The set of recommendations could have helped the VA build an integrated, accountable community health system, thus building on the VA Community Care Networks And Covered Services by:

1. Cement the VA as the primary, world-class provider and coordinator of Veterans’ health care for generations to come.
2. Build a health care network with the proper facilities in the right places to provide the right care for all Veterans, including underserved and at-risk Veteran populations in every part of the country. Make sure our facilities and services are where the Veterans are.
3. Ensure that the infrastructure that makes up VA in the decades ahead reflects the needs of 21st century Veterans — not the needs and challenges of a health care system that was built, in many cases, 80 years ago and
4. Strengthen VA’s roles as the leading health care researchers in America and—with VA’s academic partnerships—the leading health care training institution in America.

To address this issue, the VA must streamline operations, cut red tape, and consolidate overlapping services such as those inherent in the Final Report of the Commission on Care, August 3, 2016. The system is bloated, inefficient, and resistant to leveraging private sector support, causing further delays. Here are a few observations:

1. Problem #1: Bureaucratic Bloat and Poor Efficiency: The VA is notorious for its bureaucracy, which hampers its ability to deliver timely and effective services. According to the U.S. Government Accountability Office, veterans still wait longer than the expected standards for routine, specialty, and mental health care in 2024. Throwing more money at the problem won’t fix this, as delays aren’t due to a lack of funds but a mismanagement of existing resources. Without reforms to streamline operations, more funding will only perpetuate the same inefficiencies. Solution: Cut through the red tape. The VA must restructure its bureaucratic layers and consolidate overlapping services. A leaner, more agile system will improve care flow without requiring massive budget increases.
2. Problem #2: Over-reliance on In-house Services: While the VA outperforms non-VA care in many areas, the VA stubbornly clings to its vast in-house infrastructure, limiting veterans’ access to private care options that could speed up treatment. Despite an overall decline in the U.S. veteran population, the number of veterans using VA health care has increased. While VA facilities are often under-resourced, private healthcare providers are better equipped to manage patient loads, yet the VA usually needs to outsource care. This creates a bottleneck, leaving veterans stuck in a broken system that underperforms. Solution: Expand partnerships with the private sector. The VA should leverage external providers to alleviate pressure on its facilities, especially in areas where veterans face long wait times. Integrating veterans into the broader healthcare system allows the VA to optimize its care delivery without additional funds.
3. Problem #3: Budget Confusion and Alignment: The MISSION Act, the COVID-19 pandemic, and the PACT Act have all led to record growth in community care year-over-year. At the same time, the VA is asking Congress for a substantial budget increase for 2025 but is also looking to decrease its overall healthcare workforce headcount by 10,000 through attrition. Under an accelerated PACT Act implementation timeline, all veterans exposed to toxic substances and other hazards during military service — at home or abroad — became eligible to enroll directly in VA health care without first applying for VA benefits on March. Solution: It’s not more funding the VA needs—it’s better financial discipline. Slash administrative overhead. The VA should focus on operational efficiency, reassigning funds from bloated administrative departments to critical services like mental health support and medical care for veterans. This would directly improve outcomes without any budget increases.

By acknowledging healthcare as a process rather than a location or place, cutting administrative bloat, and partnering with private providers, the VA can optimize care without a $15 billion bailout. At the same time, longer-term strategies like insurance subvention to ensure sustainable funding must be implemented in parallel.

Insurance Subvention: Long-Term Solution Starting Now

While the VA FY 2022-2028 Strategic Plan describes the significant efforts the Department will undertake through the next five to seven years to deliver tailored and desired outcomes for Veterans, the plan’s goals, objectives, and strategies do not mention insurance subvention.

The VA should explore insurance subvention as a sustainable solution that’s been recommended since 1999 through insurance subvention, allowing reimbursements from Medicare and Medicaid for veterans’ treatment. This strategy aligns funding with care delivery, improving access and service quality. It alleviates financial strain without extra congressional appropriations, offering the potential for sustainable financing and operational efficiency. This strategy has been proposed but not implemented. Here’s a summary of the value proposition:

1. Aligning Funding with Care Delivery: Insurance subvention would allow the VA to receive reimbursements from Medicare and Medicaid for treating veterans enrolled in these programs. This would align financial resources with care delivery, ensuring the VA is compensated for services provided.
2. Improving Access and Quality: The VA would be incentivized to improve access to care and enhance the quality of services to remain competitive with other healthcare options available to veterans by receiving payments from Medicare and Medicaid.
3. Historical Context and Feasibility: The concept of Medicare subvention is not new. It was proposed in 1999 but faced political and financial hurdles. Implementing it now could help correct the misaligned resource allocation within the VA system. See the figure below.
4. Financial Sustainability: Subvention could help alleviate the VA’s financial pressures by leveraging existing government healthcare programs, potentially reducing the need for additional congressional appropriations.

Transitioning from financial reforms to active health benefits and advocacy integration is crucial for veterans. By leveraging existing healthcare programs and insurance subvention, the VA can create a sustainable funding model, benefiting veterans by ensuring better access to high-quality care. However, veterans must also take immediate grassroots action through engagement with patient advocates, social media, veterans’ organizations, and legislators. They can ensure timely and improved care by raising their voices and leveraging resources like the Veterans Choice Program.

Patriots Must Take Grass Roots Action

Veterans can take grassroots actions to improve healthcare services by engaging with patient advocates, participating in veteran organizations, and contacting legislators. By leveraging social media, participating in veteran organizations, and providing constructive feedback, veterans can directly influence the system, ensuring their care improves without waiting for top-down reforms.

1. Engage with Patient Advocates: Every VA medical center has a Patient Advocacy Program to address veterans’ concerns and improve their care experience. Veterans should not hesitate to contact their patient advocate if they encounter issues with their treatment.
2. Leverage Social Media and Public Platforms: Veterans can use social media platforms like Twitter, Facebook, and LinkedIn to raise awareness about their experiences and advocate for better care. Sharing personal stories and highlighting systemic issues can garner public support and pressure policymakers to make necessary changes.
3. Participate in Veterans’ Organizations: Joining veterans’ organizations such as the American Legion, Veterans of Foreign Wars (VFW), or Disabled American Veterans (DAV) as part of the military coalition (35 members) can amplify their voices.
4. Contact Legislators: Veterans can contact their local, state, and federal representatives to advocate for better healthcare policies. For example, advocacy resources are available through the Military Officers Association (MOAA), Wounded Warrior Project, and other veterans organizations in the military coalition (35 members).
5. Utilize the Veterans Choice Program: The Veterans Choice Program allows veterans to receive care from non-VA providers if they face long wait times or live far from a VA facility. Veterans should be aware of this option and use it when necessary to ensure timely and quality care.
6. Provide Feedback: Veterans should provide feedback on their care experiences through VA surveys or directly to their healthcare providers. Constructive feedback can help identify areas for improvement and ensure that veterans’ voices are heard in the ongoing effort to enhance VA services.

Transitioning from grassroots advocacy to strategic reforms, the VA must adopt financial oversight and streamlining to meet budgetary challenges without sacrificing care quality. Patient advocates, social media, organizations, legislators, and the Veterans Choice Program are driving this systemic change, ensuring better care for all.

Our Nation’s Call to Action

The VA needs a strategic overhaul to address its budget shortfall and improve care. A strategic overhaul includes insurance subvention, enabling the VA to receive reimbursements from Medicare and Medicaid. This streamlines administrative processes and consolidates redundant programs, ensuring efficient resource allocation. This strategic overhaul is crucial for meeting budget mandates and delivering high-quality care to veterans.

1. Align Funding with Care Delivery: If you have other forms of health care coverage (like a private insurance plan, Medicare, Medicaid, or TRICARE), you can use VA health care benefits along with these plans. Insurance subvention would allow the VA to receive reimbursements from Medicare and Medicaid for treating veterans enrolled in these programs.
2. Accelerate Streamline Administrative Processes By reducing bureaucratic overhead and improving processes via the VA’s Learning from Lean Enterprise Transformation efforts; the VA can reallocate funds directly to patient care. Implementing lean management principles can help identify and eliminate waste, like a centralized health system operation optimizing care processes or supply chains to ensure that frontline providers are well-equipped.
3. Evaluate, Implement, Expand, or Consolidate Community Care Network (CCN) Programs: For example, during early CCN implementation, community PC wait times increased sharply at VA facilities that did and did not implement CCNs, regardless of rural/urban or PC HPSA status, suggesting community care demand likely overwhelmed VA resources such that CCNs had limited impact. In 2021, the Congressional Budget Office (CBO) study determined that since 2014, the number of veterans using community care has increased. The average wait times in VHA facilities have declined and remained generally below those in the private sector.
4. Enhance Financial and Operational Oversight:  Strengthening financial oversight mechanisms can prevent mismanagement and ensure funds are used effectively. The VA has faced longstanding challenges in managing and overseeing its operations. As of January 9, 2019, VA had 223 open recommendations. GAO considers 30 of these recommendations the highest priority for VA implementation. These recommendations include veterans’ access to timely health care, veterans’ use of community-based health care, quality of care and patient safety, information technology, and national policy reform, among others.

The VA needs smarter processes to reduce budgetary issues and inefficiencies. Insurance subvention is an urgent long-term solution.

Conclusion

Inefficiency, mismanagement, and redundant programs must be fixed before giving the VA’s $15 billion. The VA must streamline services, reduce bureaucracy, and partner with the private sector to provide timely, quality care. Insurance subventions may provide long-term funding without taxation. For better results, policymakers should prioritize veterans’ health over bureaucratic growth. INSURANCE SUBVENTION IS A SERIOUS LONG-TERM SOLUTION THAT REQUIRES ACTION NOW!

Will VA face the challenge and implement these reforms? How long will we let inefficiency degrade veteran care? Better is needed from the VA.

Learn more at https://sheldr.com

~DrQD (Douglas E. Anderson)

Deep Dive Discussion Questions

These questions are designed to foster reflection and discussion among readers, encouraging them to apply the concepts of leadership and accountability to their own experiences.

1. What examples of bureaucratic inefficiency have you encountered in your leadership roles, and how did you address them?
2. How can leaders prioritize accountability in their organizations, particularly in managing public funds and resources?
3. What roles do partnerships with the private sector play in your organization’s strategy, and how can they be leveraged to improve service delivery?
4. Reflect on a time when you advocated for a systemic change in your workplace. What strategies did you employ, and what was the outcome?
5. Considering the proposed insurance subvention strategy, how can aligning funding with care delivery impact organizational culture and employee morale?

Professional Development and Learning Activities

These activities provide practical ways for readers to apply the lessons from the article, enhancing their leadership skills and understanding of systemic reforms.

1. Case Study Analysis: Select a case study of a public organization that successfully reformed its budget management and service delivery. Analyze the steps taken and discuss how similar strategies could be applied to the VA.
2. Leadership Workshop: Organize a workshop focused on accountability and resource management. Include role-playing scenarios where participants must decide how to allocate limited resources while addressing inefficiencies in a simulated organization.
3. Advocacy Action Plan: Develop a personal advocacy action plan in which participants identify an issue in their organization that requires reform. Outline the steps they will take to engage stakeholders, raise awareness, and implement changes based on the lessons from the article.

Disclosure:  AI assisted the author to create initial ideas and an outline. The author completed the article through detailed research, revisions, and editing. Image created by Copilot.

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