COLUMN-To help injured veterans, bring in private sector help

by Reuters
Friday, 23 May 2014 15:58 GMT

(Michael O'Hanlon is a senior fellow at the Brookings Institution. The opinions expressed are his own.)

By Michael O'Hanlon

May 23 (Reuters) - In all the brouhaha about the Veterans Administration - the alleged misconduct and malpractice in Arizona, and the ensuing calls for the head of Secretary Eric Shinseki - it is crucial that the issue not be treated solely as a referendum on Shinseki, and on the Obama administration generally.

The VA system is far too reluctant to ask for help from the private sector in caring for the hundreds of thousands suffering from the signature injuries of 21st century war: post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).

This is ironic, since it has been increasingly successful in getting veterans themselves to seek help with these challenges - which used to be so stigmatized that they often preferred to hide or ignore them.

It is true that the medical and therapeutic services of the Defense Department and the Veterans Administration have made many advances during these wars in Iraq and Afghanistan. The quality of prosthetic technology, for example, and associated rehabilitative programs have been greatly improved.

But the picture with mental healthcare in particular is not nearly so impressive. Here, the VA's bureaucracy has dug in its heels against reform proposals to offer a combination of private and public healthcare.

The VA system still rejects ideas that could dramatically reduce the number of veterans on waiting lists to receive health care and veteran suicide rates that are at a modern-era high. Even as methods of care for PTSD and traumatic brain injury are rapidly improving,

The reason for the VA's poor performance has less to do with Shinseki, who may even have favored some of the reform proposals, and more with VA career professionals. The culture is resistant to change - particularly to any change "not invented here."

A proposal for public-private partnerships to treat PTSD and TBI would give veterans access to vouchers for treatment at any qualifying hospital in the nation - public or private, VA or not. The participating hospitals should include the best teaching and clinical hospitals, because they have the capacity and sophistication to make a serious difference. They're more likely to develop advances to treat the brain injuries that can ravage the quality of life of veterans and their families than the stagnant VA. They can also make a difference in addressing the enormous healthcare backlogs we have today through their sheer size. Otherwise, those backlogs are unlikely to disappear, even as the Afghanistan conflict winds down.

Shinseki has been unable to make meaningful changes. After years of bureaucratic resistance, a 2012 executive memorandum from the White House took steps to allow a greater role for non-military hospitals in addressing this PTSD and TBI epidemic. Joint research efforts into the best treatment methods for these brain injuries were initiated as public-private partnerships. In addition, a pilot program allowing up to 20 non-military hospitals in remote rural areas to treat wounded warriors was authorized.

While welcome, these efforts do not go nearly far enough. The research agenda is reasonable. But adopting only a pilot approach to public-private partnerships, a dozen years into the nation's current wars, is unconscionable. If the idea is a sincere effort to try out new methods to see if they work, where is the data on how well the program is working so far? Military analysts have looked for it in the public domain, without success.

Worse, where is the sense of urgency? By the time this pilot program is assessed, it will likely be too late to reach the majority of suffering veterans before the most acute phase of the current veterans challenge has passed.

The solution is simple. Any veteran qualifying for treatment of PTSD or TBI should immediately have the option of seeking therapy within the VA system or outside -- with the government footing the bill either way. Doing so will spark innovation and healthy competition that will lead to better care for our nation's wounded soldiers, sailors, Marines, airmen and airwomen.

Shinseki is a remarkable military leader with a decades-long record of command and bravery. That said, however, a degree of accountability is appropriate and some degree of partisan debate inevitable. Whether Shinseki survives the scandal or not, we must assess where we now stand in veterans' care and determine what challenges any future Veterans Administration secretary will have to tackle. (Michael O'Hanlon)

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